Positive fraction of systematic biopsies predicts risk of relapse after radical prostatectomy

Presti, Joseph C.; Shinohara, Katsuto; Bacchetti, Peter; Tigrani, Vida S; Bhargava, Vivek

doi:10.1016/s0090-4295(98)00373-2

Cited by 65 publications

(32 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[1][2][3][4] One of the most easily obtainable measurements of biopsy tumor volume is the total percentage of cores positive, which predicted outcome significantly after RP, as reported previously by both our group and others. [1][2][3][4] However, we recently found that the percentage of cores positive from the dominant side of the prostate may be an even stronger predictor of recurrence. 5 To evaluate this hypothesis further, we directly compared the total percentage of cores positive with the percentage of cores positive from the dominant side and found that the percentage of cores from the dominant side provided slightly better risk assessment than did the total percentage of cores positive.…”

Section: Discussionsupporting

confidence: 70%

“…P rostate needle biopsy (PNBx) tumor volume is an important predictor of outcome for men undergoing treatment for prostate carcinoma. [1][2][3][4] This is often and most easily quantified by determining the percentage of biopsy cores with carcinoma. We recently found that among 1094 men who underwent radical prostatectomy (RP), the percentage of positive biopsy cores was the strongest independent predictor of adverse pathologic findings and prostate specific antigen (PSA) recurrence.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The percentage of prostate needle biopsy cores with carcinoma from the more involved side of the biopsy as a predictor of prostate specific antigen recurrence after radical prostatectomy

Freedland

Aronson

Terris

et al. 2003

Cancer

Self Cite

View full text Add to dashboard Cite

BACKGROUNDThe authors previously found that, although the total percentage of prostate needle biopsy cores with carcinoma was a significant predictor of prostate specific antigen (PSA) failure among men undergoing radical prostatectomy (RP), there was a trend toward a lower risk of recurrence in patients with positive bilateral biopsies, suggesting that high‐volume, unilateral disease was a worse predictor of outcome than an equivalent number of positive cores distributed over two lobes. In the current study, the authors sought to compare the total percentage of cores with carcinoma directly with the percentage of cores from the more involved or dominant side of the prostate with carcinoma for their ability to predict outcome among men who underwent RP.METHODSA retrospective survey of 535 patients from the Shared Equal Access Regional Cancer Hospital database who underwent RP at 4 different equal‐access medical centers between 1988 and 2002 was undertaken. The total percentage of cores positive was compared with the percentage of cores positive from the dominant and nondominant sides for their ability to predict biochemical recurrence after RP. The best predictor then was compared with the standard clinical variables PSA, biopsy Gleason score, and clinical stage in terms of ability to predict time to PSA recurrence after RP using multivariate analysis.RESULTSThe adverse pathologic features of positive surgical margins and extracapsular extension were significantly more likely to be ipsilateral to the dominant side on the prostate biopsy. The percentage of cores positive from the dominant side provided slightly better prediction (concordance index [C] = 0.636) for PSA failure than the total percentage of cores positive (C = 0.596) and markedly better than the percentage of cores from the nondominant side (C = 0.509). Cutoff points for percentage of cores positive from the dominant side were identified (< 34%, 34–67%, and > 67%) that provided significant risk stratification for PSA failure (P < 0.001). On multivariate analysis, the percentage of cores positive from the dominant side was the strongest independent predictor of PSA recurrence (P < 0.001). Biopsy Gleason score (P = 0.017) also was a significant, independent predictor of recurrence. There was a trend, which did not reach statistical significance, toward an association between greater PSA values and biochemical failure (P = 0.052). Combining the PSA level, biopsy Gleason score, and percentage of cores positive from the dominant side of the prostate resulted in a model that provided a high degree of prediction for PSA failure (C = 0.671).CONCLUSIONSThe percentage of cores positive from the dominant side of the prostate was a slightly better predictor of PSA recurrence than was the total percentage of cores positive. Using the percentage of cores from the dominant side along with the PSA level and the biopsy Gleason score provided significant risk stratification for PSA failure. Cancer 2003. Published 2003 by the American Cancer Society.

show abstract

Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

The percentage of prostate needle biopsy cores with carcinoma from the more involved side of the biopsy as a predictor of prostate specific antigen recurrence after radical prostatectomy

Freedland

Aronson

Terris

et al. 2003

Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…13,14 Evidence from numerous studies over the past several years indicates that information derived from the results of the diagnostic biopsy contributes significantly to accurate risk assessment among patients with newly diagnosed localized disease. [15][16][17][18] In the CAPRA model, PPB only contributed one point despite analysis of this variable in multiple forms. It may be the case that variability in the community setting in urologists' biopsy techniques and/or pathologists' interpretations of specimens, or some other unexplained factor, reduces the predictive power of this variable relative to that found in academic series.…”

Section: Discussionmentioning

confidence: 99%

The University of California, San Francisco Cancer of the Prostate Risk Assessment Score: A Straightforward and Reliable Preoperative Predictor of Disease Recurrence After Radical Prostatectomy

et al. 2005

View full text Add to dashboard Cite

Purpose-Multivariate prognostic instruments aim to predict risk of recurrence among patients with localized prostate cancer. We sought to devise a novel risk assessment tool which would be a strong predictor of outcome across various levels of risk, and which could be easily applied and intuitively understood.Materials and Methods-We studied 1,439 men who had undergone radical prostatectomy and were followed in the CaPSURE database (a longitudinal, community-based disease registry of prostate cancer patients) diagnosed between 1992 and 2001 were included. Disease recurrence was defined as prostate specific antigen (PSA) ≥0.2 ng/ml on 2 consecutive occasions following prostatectomy, or a second cancer treatment more than six months after surgery. The UCSF-CAPRA score was developed using pre-operative PSA, Gleason score, clinical T-stage, biopsy results, and age. The index was developed and validated using Cox proportional hazards and life table analyses.Results-210 patients (15%) recurred, 145 by PSA criteria and 65 by second treatment. Based on the results of the Cox analysis, points were assigned based on PSA (0-4 points), Gleason score (0-3), T stage (0-1), age (0-1), and biopsy data (0-1). The CAPRA score range is 0 to 10, with roughly double the risk of recurrence for each 2-point increase in score. Recurrence-free survival at 5 years ranged from 85% for a CAPRA score of 0-1 (95% CI 73-92%) to 8% for a score of 7-10 (95% CI 0-28%). The concordance index for the CAPRA score was 0.66. Conclusions-The UCSF-CAPRA score is a straightforward yet powerful preoperative risk assessment tool. It must be externally validated in future studies.

show abstract

“…Recent efforts have focused on incorporating prostate needle biopsy measurements as an adjunct to improve pretreatment risk stratification (35)(36)(37)(38). However, it is controversial which is the best predictor method (16)(17)(18).…”

Section: Tumor Extent On Needle Prostatic Biopsiesmentioning

confidence: 99%

Controversial predictors of biochemical recurrence after radical prostatectomy: a study from a Latin American (Brazilian) Institution

et al. 2013

View full text Add to dashboard Cite

Purpose: To analyze controversial clinicopathologic predictors of biochemical recurrence after surgery: age, race, tumor extent on surgical specimen, tumor extent on needle biopsy, Gleason score 3 + 4 vs 4 + 3, and amount of extent of extraprostatic extension and positive surgical margins. Materials and Methods:The needle biopsies and the correspondent surgical specimens were analyzed from 400 patients. Time to recurrence was analyzed with the Kaplan--Meier curves and risk of shorter time to recurrence using Cox univariate and multivariate analysis. Results: Except for age, race, maximum percentage of cancer per core, and number of cores with cancer, all other variables studied were significantly predictive of time to biochemical recurrence using the Kaplan-Meier curves. In univariate analysis, except for focal extraprostatic extension, age, race, focal positive surgical margins, and maximum extent and percentage of cancer per core, all other variables were significantly predictive of shorter time to recurrence. On multivariate analysis, diffuse positive surgical margins and preoperative PSA were independent predictors. Conclusions: Young patients and non-whites were not significantly associated with time to biochemical recurrence. The time consuming tumor extent evaluation in surgical specimens seems not to add additional information to other well established predictive findings. The higher predictive value of Gleason score 4 + 3 = 7 vs 3 + 4 = 7 discloses the importance of grade 4 as the predominant pattern. Extent and not simply presence or absent of extraprostatic extension should be informed. Most tumor extent evaluations on needle biopsies are predictive of time to biochemical recurrence, however, maximum

show abstract

Positive fraction of systematic biopsies predicts risk of relapse after radical prostatectomy

Cited by 65 publications

References 17 publications

The percentage of prostate needle biopsy cores with carcinoma from the more involved side of the biopsy as a predictor of prostate specific antigen recurrence after radical prostatectomy

The percentage of prostate needle biopsy cores with carcinoma from the more involved side of the biopsy as a predictor of prostate specific antigen recurrence after radical prostatectomy

The University of California, San Francisco Cancer of the Prostate Risk Assessment Score: A Straightforward and Reliable Preoperative Predictor of Disease Recurrence After Radical Prostatectomy

Controversial predictors of biochemical recurrence after radical prostatectomy: a study from a Latin American (Brazilian) Institution

Contact Info

Product

Resources

About