Prostate cancer (PC) represents the second most frequent cancer in the male population worldwide. It is mandatory to have a very accurate staging to choice the best possible treatment.
To test the possibility of improving the performance of Partin's tables in predicting the pathological staging of PC by introducing bioptic parameters through an innovative statistic tool (Fagan's two-step nomogram).
We prospectivelly collected data of all 1048 consecutive patients undergoing saturation 24-core transrectal prostate biopsy. Then, in eligible 94 patients, we compared the prediction of presence/absence of extracapsular extension of neoplasm (EPE+/-), with pathological assessment of invasion through (pseudo)capsule in the prostatectomy specimens. Starting from the probability of EPE- (pre-test probability, calculated with formula "100%-risk of EPE+"), we used Fagan's nomogram to examine the diagnostic sensitivity (DSe) and specificity (DSp) of negative "lateral" bioptic cores.
We specifically analyzed the status of "lateral" cores in each side (94 patients × 2 sides = 188 sides). "Lateral" cores were negative in 42.5% of sides (80/188) with a DSe and DSp of 91.7 and 45.4%, respectively. In these sides, the mean probability of EPE+ according to Partin's tables was 21.6%. With Fagan's nomogram, the post-test probability of EPE+ when all "lateral" cores were negative was 14.1%, with a substantial gain of 7.5%.
The spatial distribution of bioptic positive cores allowed us to demonstrate the role Fagan's nomogram in increasing the accuracy of already existing, predictive tools for PC.
This pioneering study may justify the use of the above nomogram in testing "local" predictive parameters in combination with pre-existing nomograms.
Aging clinical and experimental research. 2018 May 02 [Epub ahead of print]
Fabrizio Dal Moro, Tommaso Prayer-Galetti, Lorenzo Angelini, Fabio Vianello, Marina Gardiman, Massimo Rugge, Filiberto Zattoni
Department of Surgery, Oncology and Gastroenterology - Urology, University of Padova, Via Giustiniani 2, 35128, Padova, Italy., Department of Surgery, Oncology and Gastroenterology - Urology, University of Padova, Via Giustiniani 2, 35128, Padova, Italy. ., Department of Pathology, Azienda Ospedaliera di Padova/University of Padova, Padova, Italy.