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

Abstract

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.

Are prostate needle biopsies predictive of the laterality of significant cancer and positive surgical margins?

“…The median (range) number of biopsies taken for each patient was 10.3 (6-24) and the median cores positive for cancer was 2.84 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Unilateral and bilateral nerve-sparing was performed in 70 (14%) and 287 (59%) patients, respectively.…”

“…Several groups have correlated preoperative clinical and biopsy characteristics with the incidence of ECE and biochemical recurrence [7][8][9][10][11]. Taneja et al [7] reported that the positive predictive value of individual cores for locating ECE was not adequate to guide decisions for nerve-sparing for open RP.…”

Prognostic Factors for Failure after Prostatectomy

“…(98). In a concurrent study of the same patients (100), that wasn't a factor, rather the core density, defined as the per cent of total cores positive from each side. With that, having >67% of the cores from the predominant side was the biggest predictor of failure.…”

Three Dimensional Conformal Radiotherapy and Androgen Deprivation Therapy in Patients with Clinically Localized Prostate Cancer; Hacettepe University Experience

“…15 The relation between PPC and biochemical relapse free survival (BFS) was explored after ADT 16 , RP [16][17][18] , after WPRT 4,19,20 and brachyterapy. [21][22][23][24] Although the prognostic significance of PPC couldn't be demonstrated in some studies 22 , Yushen et al reported the prognostic value of PPC in intermediate and high risk patients with regard to CSS, BFS and DMFS.…”