Insignificant Prostate Cancer in Radical Prostatectomy Specimen: Time Trends and Preoperative Prediction

Augustin, Herbert; Hammerer, Peter; Graefen, Markus; Erbersdobler, Andreas; Blonski, Jakob; Palisaar, Jüri; Daghofer, Fedor; Huland, Hartwig

doi:10.1016/s0302-2838(03)00139-8

Cited by 78 publications

(55 citation statements)

References 20 publications

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“…11,[15][16][17][18][19][20][21][22][23][24][25][26] Three of those articles were unique: One referred to the number of positive biopsy sites rather than cores, 42 another examined the relation between the number of positive cores on each side (right or left) and the incidence of extraprostatic spread on that side, 48 and the final article took into account both biopsy cancer volume and presenting PSA density in the presentation of results. 46 Those 3 articles were not considered further, because they did not provide data that were comparable with data from the other 29 articles.…”

Section: Methodsmentioning

confidence: 99%

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The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Harnden

Naylor

Shelley

et al. 2008

Cancer

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Clinically localized prostate cancer is associated with a wide variation in biologic behavior, and men with the less aggressive form of the disease may never develop symptoms. There has been a rise in prostate cancer incidence in countries in which the blood test for prostatic-specific antigen (PSA) is common, and concerns have been expressed that this may be because of the increased detection of indolent disease, subjecting these men to unnecessary treatment and associated side effects. For the current review, the authors conducted a systematic evaluation of the literature regarding the outcomes of men who were diagnosed on the basis of a small volume of cancer in prostatic biopsies. The results indicated that, despite differences in study design and reporting, a significant proportion of patients with microfocal cancer, regardless of how it was defined, had adverse pathologic findings and a significant risk of PSA recurrence after undergoing radical prostatectomy. Biochemical and clinical recurrences also were observed after radiotherapy or watchful waiting. The authors concluded that patients with microfocal carcinoma on biopsy should be advised that their disease is not necessarily ''insignificant'' and should be counseled accordingly. Cancer 2008; 112:971-81.

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Section: Methodsmentioning

confidence: 99%

“…The overall Prior transurethral resection 39,46 Slides unavailable for review 28,39,42 Incomplete data on Clinical stage 37,46 Preoperative PSA value 37,46 Biopsy cancer volume 15,32,41,46 No. of biopsies taken 29,35 Clinical follow-up 11 risk was estimated at 17.6% (Fig.…”

Section: Findings In the Radical Prostatectomy Specimenmentioning

confidence: 99%

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Harnden

Naylor

Shelley

et al. 2008

Cancer

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“…Goto et al 5 described that a single core of 2 mm or less and a PSA density of 0.1 ng/ ml/g predicted unimportant subsequent disease with a 75% positive predictive value and 53% sensitivity. Although Augustin et al 10 reported a P value of 0.025 for PSAD on logistic regression in their sample of 1254 men, the combination of a PSADo0.15 ng/ml/g and 5% biopsy cancer extent yielded a positive predictive value for insignificant disease at the time of RP to be only 27.2%. Instead, many investigators have reported preoperative PSA velocity (PSAV) as an important predictor of outcome following surgery.…”

Section: Psa Level and Kineticsmentioning

confidence: 87%

“…Beginning with Epstein et al's 1 first description in 1994, there have been over a dozen studies of the subject. [2][3][4][5][6][7][8][9][10][11][12][13] The construct was originally intended to describe cancers that 'pose no threat to the patient and might be followed up without immediate treatment'. 1 Although much data have been analyzed, it has almost exclusively been in radical prostatectomy (RP) specimens.…”

Section: Introductionmentioning

confidence: 99%

‘Insignificant’ prostate cancer on biopsy: pathologic results from subsequent radical prostatectomy

Johnstone

Rossi

Jani

et al. 2007

Prostate Cancer Prostatic Dis

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“…2 Small-volume prostate cancers (0.5 ml or less) without elements of Gleason grade pattern 4 or 5 are not thought to be clinically significant. [2][3][4][5][6][7][8][9][10] However, tumor volume and other parameters, especially Gleason score, are closely related. Since many prostate cancer deaths occur more than 10 years after the initial diagnosis, 11 the biological behavior of small-volume prostate cancer, which some consider to be clinically insignificant, may become important in patients with a relatively long postdiagnosis life expectancy.…”

mentioning

confidence: 99%

Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens

et al. 2005

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Some investigators consider small-volume prostate cancer (0.5 ml or less) without Gleason pattern 4/5 elements as clinically insignificant. The objective of this study was to characterize the anatomic distribution and pathologic features of small tumors (aggregate volume of 0.5 ml or less) in whole-mount prostatectomy specimens. Between 1999 and 2003, 371 consecutive patients underwent radical prostatectomy at the Indiana University Hospitals for localized prostate cancer. Patients who received hormonal or radiation therapy prior to the surgery were excluded from the study. A total of 62 specimens with total tumor volume of 0.5 ml or less were identified and included in this study. All specimens were embedded and whole-mounted. Tumor volume was measured using the grid method. The mean age at the time of surgery was 59 years (median, 61 years; range, 37-72 years). The mean preoperative prostate-specific antigen (PSA) was 6.5 ng/ml (range: 0.3-18 ng/ml). The mean prostate weight was 53 g (range: 16-132 g). The mean tumor volume was 0.29 ml (median, 0.35 ml; range, 0.02-0.48 ml). Tumor multifocality and bilaterality were present in 69 and 37% of cases, respectively. Three (5%) had positive surgical margins. The largest tumor was located in the peripheral zone, transitional zone, and central zone in 79, 16, and 5% of cases, respectively. The largest tumor was located in the anterior prostate in 10 cases (16%) and in the posterior prostate in 52 cases (84%). The distribution of Gleason scores was 5 (12 cases, 19 %), 6 (40 cases, 65 %), and 7 (10 cases, 16 %). One case had a primary Gleason pattern 4. None had extraprostatic extension, seminal vesicle invasion, or lymph node metastasis. Small-volume prostate cancers are often multifocal and bilateral, with predilection for the peripheral zone. Of these small-volume cases, 16% had Gleason pattern 4 and might, therefore, be clinically significant.

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Insignificant Prostate Cancer in Radical Prostatectomy Specimen: Time Trends and Preoperative Prediction

Cited by 78 publications

References 20 publications

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

‘Insignificant’ prostate cancer on biopsy: pathologic results from subsequent radical prostatectomy

Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens

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