PD14-02 PERCENTAGE OF CANCER INVOLVEMENT IN POSITIVE CORES CAN PREDICT UNFAVOURABLE DISEASE IN MEN WITH LOW-RISK PROSTATE CANCER BUT ELIGIBLE FOR THE PROSTATE CANCER INTERNATIONAL: ACTIVE SURVEILLANCE CRITERIA

Abstract

You have accessJournal of UrologyProstate Cancer: Localized II1 Apr 2014PD14-02 PERCENTAGE OF CANCER INVOLVEMENT IN POSITIVE CORES CAN PREDICT UNFAVOURABLE DISEASE IN MEN WITH LOW-RISK PROSTATE CANCER BUT ELIGIBLE FOR THE PROSTATE CANCER INTERNATIONAL: ACTIVE SURVEILLANCE CRITERIA Giorgio Ivan Russo, Sebastiano Cimino, Vincenzo Favilla, Eugenia Fragalà, Tommaso Castelli, Daniele Urzì, Massimo Madonia, and Giuseppe Morgia Giorgio Ivan RussoGiorgio Ivan Russo More articles by this author , Sebastiano CiminoSebastiano Cimino More articles by this author , Vincenzo FavillaVincenzo Favilla More articles by this author , Eugenia FragalàEugenia Fragalà More articles by this author , Tommaso CastelliTommaso Castelli More articles by this author , Daniele UrzìDaniele Urzì More articles by this author , Massimo MadoniaMassimo Madonia More articles by this author , and Giuseppe MorgiaGiuseppe Morgia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1279AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance has reached an important popularity with the intention to avoid or postpone surgery in patients with prostate cancer at low risk. Unfortunately, some doubts persist about the ability of the different criteria to predict an organ-confined prostate cancer. The aim of this study was to identify predictive factors of unfavourable disease and of biochemical failure in patients treated with radical prostatectomy (RP) but eligible for AS according to PRIAS criteria. We aimed to introduce and validate the percentage of cancer involvement in positive cores (CIPC) as potential worse predictive factor. METHODS From January 2002 to December 2007, 750 consecutive subjects underwent RP at a single institution. We identified 147 (19.05%) patients who were eligible for AS based on PRIAS criteria: clinical stage T1c or T2 disease, PSA level of ≤10 ng/ml, Gleason score ≤6, PSA-D of <0.2 ng/ml2 and fewer than three positive biopsy cores. We incorporated a new detailed histological parameter, the percentage of cancer involvement in positive cores (CIPC), calculated by dividing the cumulative cancer length (CCL) to the cumulative length of positive cores (CLPC). CCL was defined as the sum of the length of all cancerous lesions in mm while CLPC as sum of the length of all positive cores in mm. Unfavourable disease was considered as non-organ confined disease (pathological stage >pT2) and/or upgraded disease (Gleason score >6). RESULTS Of the 147 patients, 95 (66.43%) patients had favourable while 48 (33.57%) had unfavourable disease. In multivariate logistic regression, maximum cancer length (OR 12.52, p<0.01) and CIPC (OR 1.70, p<0.01) represented independent predictors of unfavourable PCa. The AUC analysis revealed significantly higher performance after including CIPC to the PRIAS criteria (0.61 vs. 0.94, p<0.01). A cutoff of 0.4 mm of CIPC was set to predict unfavourable disease with 93% specificity, 76% sensibility and 87% accuracy based on the ROC curve analysis. Finally, the 3- and 5-years BFS were significantly lower in subjects with CIPC ≥0.4 mm, 88.4 % and 81.0% vs. 97.8% and 95.7% respectively (p<0.01). CONCLUSIONS We showed that including CIPC to the pathological parameters of prostate biopsy is possible to estimate the presence of organ-confined disease in 93% of cases. Our findings suggest that the inclusion of CIPC to the prostate biopsy features could be helpful to avoid misclassification in patients eligible for AS according to the PRIAS criteria. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e411 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Giorgio Ivan Russo More articles by this author Sebastiano Cimino More articles by this author Vincenzo Favilla More articles by this author Eugenia Fragalà More articles by this author Tommaso Castelli More articles by this author Daniele Urzì More articles by this author Massimo Madonia More articles by this author Giuseppe Morgia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...