Is it possible to predict low-volume and insignificant prostate cancer by core needle biopsies?
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Is it possible to predict low-volume and insignificant prostate cancer by core needle biopsies? / Berg, Kasper Drimer; Toft, Birgitte Grønkaer; Røder, Martin Andreas; Brasso, Klaus; Vainer, Ben; Iversen, Peter.
In: APMIS : acta pathologica, microbiologica, et immunologica Scandinavica, Vol. 121, No. 4, 04.2013, p. 257-65.Research output: Contribution to journal › Journal article › Research › peer-review
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T1 - Is it possible to predict low-volume and insignificant prostate cancer by core needle biopsies?
AU - Berg, Kasper Drimer
AU - Toft, Birgitte Grønkaer
AU - Røder, Martin Andreas
AU - Brasso, Klaus
AU - Vainer, Ben
AU - Iversen, Peter
N1 - © 2012 The Authors APMIS © 2012 APMIS.
PY - 2013/4
Y1 - 2013/4
N2 - In an attempt to minimize overtreatment of localized prostate cancer (PCa) active surveillance (AS) and minor invasive procedures have received increased attention. We investigated the accuracy of pre-operative findings in defining insignificant disease and distinguishing between unilateral/unifocal and bilateral/multifocal PCa. One-hundred and sixty patients undergoing radical prostatectomy were included. Histology reports from the biopsies and matching prostatectomies were compared. Three definitions of insignificant cancer were used: InsigE: tumour volume ≤0.5 mL; InsigW: tumour volume ≤1.3 mL; InsigM: tumour ≤5% of total prostate volume and prostate-specific antigen (PSA) ≤10 ng/mL. In all definitions, Gleason score (GS) was ≤6 and the tumour was organ confined. Biopsies alone performed poorly as a predictor of unifocal and unilateral cancer in the prostatectomy specimens with positive predictive values of 17.8% and 18.9% respectively. Inclusion of other clinical and biochemical parameters did not significantly increase the predictive value. However, the combination of GS ≤ 6, PSA ≤ 10 ng/mL and unifocal or unilateral cancer in biopsy cores resulted in a positive predictive value of 61.1%, 38.9% and 12.0%, respectively, for identifying InsigM, InsigW and InsigE in the prostate specimen. Conclusively, routine prostate biopsies cannot predict unifocal and unilateral PCa, and must be regarded insufficient to select patients for focal therapy. Although candidates for AS may be identified using standard biopsies, a considerable fraction of patients will be understaged. There is a need for more precise diagnostic tools to assess intraprostatic tumour growth.
AB - In an attempt to minimize overtreatment of localized prostate cancer (PCa) active surveillance (AS) and minor invasive procedures have received increased attention. We investigated the accuracy of pre-operative findings in defining insignificant disease and distinguishing between unilateral/unifocal and bilateral/multifocal PCa. One-hundred and sixty patients undergoing radical prostatectomy were included. Histology reports from the biopsies and matching prostatectomies were compared. Three definitions of insignificant cancer were used: InsigE: tumour volume ≤0.5 mL; InsigW: tumour volume ≤1.3 mL; InsigM: tumour ≤5% of total prostate volume and prostate-specific antigen (PSA) ≤10 ng/mL. In all definitions, Gleason score (GS) was ≤6 and the tumour was organ confined. Biopsies alone performed poorly as a predictor of unifocal and unilateral cancer in the prostatectomy specimens with positive predictive values of 17.8% and 18.9% respectively. Inclusion of other clinical and biochemical parameters did not significantly increase the predictive value. However, the combination of GS ≤ 6, PSA ≤ 10 ng/mL and unifocal or unilateral cancer in biopsy cores resulted in a positive predictive value of 61.1%, 38.9% and 12.0%, respectively, for identifying InsigM, InsigW and InsigE in the prostate specimen. Conclusively, routine prostate biopsies cannot predict unifocal and unilateral PCa, and must be regarded insufficient to select patients for focal therapy. Although candidates for AS may be identified using standard biopsies, a considerable fraction of patients will be understaged. There is a need for more precise diagnostic tools to assess intraprostatic tumour growth.
KW - Aged
KW - Biopsy, Large-Core Needle
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasm Grading
KW - Prostate
KW - Prostate-Specific Antigen
KW - Prostatic Neoplasms
KW - Tumor Burden
U2 - 10.1111/j.1600-0463.2012.02965.x
DO - 10.1111/j.1600-0463.2012.02965.x
M3 - Journal article
C2 - 23030402
VL - 121
SP - 257
EP - 265
JO - A P M I S. Acta Pathologica, Microbiologica et Immunologica Scandinavica
JF - A P M I S. Acta Pathologica, Microbiologica et Immunologica Scandinavica
SN - 0903-4641
IS - 4
ER -
ID: 117547343