To evaluate the prevalence of adverse pathological features and the percentage of multifocal and/or bilateral disease in a series of patients who underwent radical prostatectomy (RP) for unique, microfocal prostate cancer (miPCA) detected on prostate biopsy in the pre-active surveillance (AS) era.
MATERIAL AND METHODS: In this retrospective, multi-institutional study, we analyzed the clinical records of of 131 consecutive patients who underwent either retropubic or robot-assisted RP for miPCA at two referral centers from January 2000 to December 2011. MiPCA was defined as a neoplastic lesion present in ≤ 10% of core with not applicable or 6 biopsy Gleason score (GS).
RESULTS: We observed 17 (13%) pT3-4 prostate cancers and a single case (0.8%) of pN+ tumor. Moreover, 31 (24.1%) patients showed GS> 6 in RP specimens. Therefore, unfavorable pathological outcomes (pT3-4/N+ and/or GS>6) were present in 40 (30.5%) patients. Median PSA density was 0.11 (interquartile range [IQR] 0.09-0.17) and 0.16 (IQR 0.11-0.24) in patients with favorable and unfavorable pathological characteristics, respectively (p=0.003). ROC curve showed a AUC value of 0.67 (95% IC 0.56-0.77) for PSA density to predict the risk of unfavorable pathological outcomes.
CONCLUSION: Patients with microfocal prostate cancer (MiPCA) candidate for AS protocol should be adequately informed that in about 30% of the cases the cancer might be locally advanced and/or with GS >6. Those unfavorable pathological outcomes could be predicted by PSA density value. Further studies should investigate the role of a more extensive biopsy sampling to reduce the risk of understaging and/or undergrading in patients with initial diagnosis of MiPCA.
Written by:
Guttilla A, Zazzara M, Zattoni F, Novara G, Zanin M, Gardiman M, Ficarra V, Zattoni F. Are you the author?
Department of Surgical, Oncologic and Gastrointestinal Sciences, Urologic Unit, University of Padova, Italy.
Reference: BJU Int. 2014 Apr 21. Epub ahead of print.
doi: 10.1111/bju.12786
PubMed Abstract
PMID: 24750975
UroToday.com Prostate Cancer Section
