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PATHOLOGY
Characteristics
of insignificant clinical T1c prostate tumors. A contemporary analysis
Bastian PJ, Mangold LA, Epstein JI, Partin AW
The James Buchanan Brady Urological Institute, The Johns Hopkins University
School of Medicine, Baltimore, Maryland, USA
Cancer. 2004; 101: 2001-5.
- Background:
The authors examined the cases of men who had undergone radical prostatectomy
for low-volume clinical T1c prostate carcinoma that was judged to be
“insignificant” on the basis of previously established preoperative
clinicopathologic parameters. Pathologic findings subsequently were
analyzed for correlations with extent of disease in an attempt to validate
the contemporary usefulness of existing parameters for predicting the
“significance” of prostate tumors.
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Methods: A
series of 237 men who had undergone radical prostatectomy for T1c disease
between December 2000 and August 2003 was evaluated. Insignificant prostate
carcinoma as assessed on biopsy was defined according to the 1994 Epstein
criteria, which were as follows: prostate-specific antigen density <
0.15 ng/mL, Gleason score < or = 6, fewer than 3 cores containing
prostate carcinoma, and < or = 50% involvement of any core with prostate
carcinoma. Postsurgical pathologic findings were analyzed for potential
correlations with the Epstein criteria.
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Results:
According to the Epstein needle biopsy criteria, organ-confined prostate
carcinoma was detected in 91.6% of all patients, whereas the remaining
8.4% of patients were found to have non-organ-confined disease. Comparison
of pathologic findings and Epstein biopsy criteria revealed that alteration
of the original criteria did not improve the detection of non-organ-confined
prostate carcinoma.
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Conclusions:
The findings made in the current study suggest that the majority of
patients with T1c prostate carcinoma have insignificant disease. Furthermore,
it was found that the Epstein criteria for identifying insignificant
prostate carcinoma remained a useful tool in the making of treatment-related
decisions.
- Editorial
Comment
Considering the aggressive screening and more extensive biopsy sampling
resulting in higher frequency of stage T1c, criteria predicting “minute”
(minimal, insignificant) tumor in radical prostatectomy are of utmost
importance.
The Epstein criteria for identifying insignificant prostate carcinoma
remain a useful tool in the making of treatment related decisions. In
this study prostate-specific antigen density < 0.15ng/mL was included
in the criteria. In another study Epstein et al. (1) found a positive
predictive value of 94.4% using a free/total PSA of 0.15 or greater
and favorable needle biopsy findings (less than 3 cores involved, none
of the cores with greater than 50% tumor involvement and Gleason score
less than 7).
The involvement of the cores in percentage is controversial. Other authors
consider that the extension of the tumor is a better way of evaluation.
Noguchi et al. (2) consider that the combination of 1 positive core
with cancer length less than 3 mm. that contains no Gleason grade 4
or 5 is probably the best predictor of prostate cancer less than 0.5
cc in men with nonpalpable tumors (stage T1c). These authors also found
that PSA or PSA density in combination with needle biopsy findings did
not enhance prediction of tumor significance.
References
1. Epstein JI, Chan DW, Sokoll LJ, Walsh PC, Cox JL, Rittenhouse H, et
al.: Nonpalpable stage T1c prostate cancer: prediction of insignificant
disease using free/total prostate specific antigen levels and needle biopsy
findings. J Urol. 1998; 160: 2407-11.
2. Noguchi M, Stamey TA, McNeal JE, Yemoto CM: Relationship between systematic
biopsies and histological features of 222 radical prostatectomy specimens:
lack of prediction of tumor significance for men with nonpalpable prostate
cancer. J Urol. 2001; 166: 104-109.
Dr.
Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil
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