OBJECTIVE: To identify parameters that predict insignificant prostate cancer in 67 radical prostatectomies after biopsy reclassification to worse disease on active surveillance. METHODS: Parameters evaluated at diagnosis and at biopsy reclassification included serum prostate-specific antigen, prostate-specific antigen density, number of positive cores, maximum percent involvement of cancer per core, and any interval negative biopsies. Gleason upgrading at biopsy reclassification was also assessed to predict insignificant cancer. RESULTS: Mean time between diagnosis and radical prostatectomies was 30.3 months with a median of 3 biopsies (range 2-9). Nineteen of 67 (28.4%) had clinically insignificant cancer at radical prostatectomy. In the entire group, there were no variables significantly associated with insignificant cancer at radical prostatectomy. In a subgroup analysis of 37 patients without Gleason pattern 4/5 at biopsy reclassification, 16/37 (43.2%) showed insignificant cancer at radical prostatectomy. In this subgroup, prostate-specific antigen at diagnosis was significantly lower in men with insignificant cancer (3.7 ng/mL) vs significant cancer (5.4 ng/mL) (P = .0005). With prostate-specific antigen <4 ng/mL at diagnosis or at biopsy reclassification, 12/13 (92.3%) men showed insignificant cancer, whereas only 4/24 (16.7%) men with prostate-specific antigen >4 ng/mL both at diagnosis and at biopsy reclassification showed insignificant cancer. CONCLUSION: Most men with biopsy reclassification while on active surveillance have significant disease at radical prostatectomy, justifying their treatment. Low prostate-specific antigen at diagnosis or at biopsy reclassification can predict a high probability of insignificant cancer in the absence of Gleason pattern 4/5 on biopsy. These men may be candidates for continuing active surveillance.
OBJECTIVE: To identify parameters that predict insignificant prostate cancer in 67 radical prostatectomies after biopsy reclassification to worse disease on active surveillance. METHODS: Parameters evaluated at diagnosis and at biopsy reclassification included serum prostate-specific antigen, prostate-specific antigen density, number of positive cores, maximum percent involvement of cancer per core, and any interval negative biopsies. Gleason upgrading at biopsy reclassification was also assessed to predict insignificant cancer. RESULTS: Mean time between diagnosis and radical prostatectomies was 30.3 months with a median of 3 biopsies (range 2-9). Nineteen of 67 (28.4%) had clinically insignificant cancer at radical prostatectomy. In the entire group, there were no variables significantly associated with insignificant cancer at radical prostatectomy. In a subgroup analysis of 37 patients without Gleason pattern 4/5 at biopsy reclassification, 16/37 (43.2%) showed insignificant cancer at radical prostatectomy. In this subgroup, prostate-specific antigen at diagnosis was significantly lower in men with insignificant cancer (3.7 ng/mL) vs significant cancer (5.4 ng/mL) (P = .0005). With prostate-specific antigen <4 ng/mL at diagnosis or at biopsy reclassification, 12/13 (92.3%) men showed insignificant cancer, whereas only 4/24 (16.7%) men with prostate-specific antigen >4 ng/mL both at diagnosis and at biopsy reclassification showed insignificant cancer. CONCLUSION: Most men with biopsy reclassification while on active surveillance have significant disease at radical prostatectomy, justifying their treatment. Low prostate-specific antigen at diagnosis or at biopsy reclassification can predict a high probability of insignificant cancer in the absence of Gleason pattern 4/5 on biopsy. These men may be candidates for continuing active surveillance.
Authors: Timothy J Wilt; Michael K Brawer; Michael J Barry; Karen M Jones; Young Kwon; Jeffrey R Gingrich; William J Aronson; Imad Nsouli; Padmini Iyer; Ruben Cartagena; Glenn Snider; Claus Roehrborn; Steven Fox Journal: Contemp Clin Trials Date: 2008-08-23 Impact factor: 2.226
Authors: Hannah K Weir; Michael J Thun; Benjamin F Hankey; Lynn A G Ries; Holly L Howe; Phyllis A Wingo; Ahmedin Jemal; Elizabeth Ward; Robert N Anderson; Brenda K Edwards Journal: J Natl Cancer Inst Date: 2003-09-03 Impact factor: 13.506
Authors: Martin H Umbehr; Elizabeth A Platz; Sarah B Peskoe; Nrupen A Bhavsar; Jonathan I Epstein; Patricia Landis; Alan W Partin; H Ballentine Carter Journal: BJU Int Date: 2013-06-07 Impact factor: 5.588
Authors: Behfar Ehdaie; Bing Ying Poon; Daniel D Sjoberg; Pedro Recabal; Vincent Laudone; Karim Touijer; James Eastham; Peter T Scardino Journal: BJU Int Date: 2015-10-26 Impact factor: 5.588
Authors: Isabel Heidegger; Viktor Skradski; Eberhard Steiner; Helmut Klocker; Renate Pichler; Andreas Pircher; Wolfgang Horninger; Jasmin Bektic Journal: PLoS One Date: 2015-02-06 Impact factor: 3.240
Authors: Bruce J Trock; Helen Fedor; Bora Gurel; Robert B Jenkins; B S Knudsen; Samson W Fine; Jonathan W Said; H Ballentine Carter; Tamara L Lotan; Angelo M De Marzo Journal: Mod Pathol Date: 2016-04-15 Impact factor: 7.842