The Epstein Criteria Predict for Organ-Confined But Not Insignificant Disease and a High Likelihood of Cure at Radical Prostatectomy

Genomic Scores are Independent of Disease Volume in Men with Favorable Risk Prostate Cancer: Implications for Choosing Men for Active Surveillance

“…We found that OncotypeDx Prostate performed similarly in our cohort as in other reported series, with reclassification rates of 6.3% for NCCN VLR to LR, 7.2% of LR to IR, and 43% LR to VLR in our study compared to published rates of 6-9% 10-11%, and 33-51%, respectively. 20,21 Also as expected, we found that higher tumor volume was associated with a lower LFP. However, the absolute differences were small across all measures of tumor volume and these differences did not correlate with a clinically meaningful difference in predicting reclassification to a higher NCCN risk group.…”

Prostate Cancer: Can Multiparametric MR Imaging Help Identify Patients Who Are Candidates for Active Surveillance?

“…In addition, the patient had to have had undergone a preoperative multiparametric MR imaging examination (with at least three of four of the following available sequences: triplane T2-weighted MR imaging, diffusion-weighted [DW] MR imaging, MR spectroscopy, and dynamic contrast material-enhanced MR imaging) at 3.0 T, followed by promising results have been published by several groups, the accurate characterization of disease extent remains a source of concern when committing a patient to AS. Moreover, the situation is confounded by a considerable rate of misclassification and inconsistency when current risk assessment schemes are utilized (12)(13)(14)(15)(16). A major concern is that results of random 12-core biopsies do not accurately reflect the aggressiveness of the disease.…”

“…They reported ultimate unfavorable histopathologic findings in 3.3%-7.1% of patients who would have been eligible for AS on the basis of Epstein criteria. Lee et al (13) determined the performance of the Epstein criteria for predicting pathologic end points in men with early-stage prostate cancer treated with surgery. They reported that the Epstein criteria were able to help characterize insignificant disease in 34% of patients and concluded that the Epstein criteria can predict a high likelihood of organ-confined disease but not biologically indolent disease.…”

Formalized prediction of clinically significant prostate cancer: is it possible?

“…Lee and colleagues from the Cleveland Clinic validated the Epstein criteria in their cohort of low-risk patients (Gleason score f6) treated with radical prostatectomy and found that the criteria underestimated the presence of Gleason 7 cancer (38% of patients) and extra-prostatic disease (7% of patients). 10 Similarly, validation studies based on international cohorts have shown that the Epstein criteria can underestimate the aggressiveness of disease in as many as a third of men with prostate cancer, as demonstrated by the presence of pathological Gleason scoreo7 or nonorgan-confined disease. 11,12 Moreover, a recent systematic review of the validation literature on the Epstein criteria reported a substantial reduction in the accuracy of the criteria for predicting insignificant cancer or organ-confined disease in more contemporary cohorts of men (i.e., post-2005).…”