Valor pronóstico en la prostatectomía radical del número de cilindros positivos y porcentaje de cáncer por cilindro de la biopsia prostática

Abstract

IntroductionClinical stage, PSA value and Gleason score in biopsy are well known independent prognostic factors in prostate cancer. Since the widespread use of PSA, we assist to a changing trend in clinical presentation of patients with prostate cancer toward low stage, low PSA and well-differentiated tumors. This has motivated the search of new prognostic factors to predict those patients at risk of poor outcome. We analyze the histological quantification of tumor in biopsy as a prognostic factor in patients that underwent radical retropubic prostatectomy (RRP). Materials And MethodsOf a series of 112 RRP performed by the same surgeon, we selected 81 in which tumor quantification at biopsy was assessed. results: comparing the group with up to 2 positive cores against the group with 4 or more, the risk of positive surgical margins in rrp multiplies by 2.4 (15.4% vs. 37.5%), and the risk of biochemical progression almost duplicates (34% vs. 60%). when percentage of tumor per core is analyzed, the presence of 40% or more per core compared to less than 20%, multiplies the risk of positive margins by 5 (44.1% vs. 8.7%), and the risk of biochemical relapse by 3 (48% vs. 15%). Resultscomparing the group with up to 2 positive cores against the group with 4 or more, the risk of positive surgical margins in rrp multiplies by 2.4 (15.4% vs. 37.5%), and the risk of biochemical progression almost duplicates (34% vs. 60%). when percentage of tumor per core is analyzed, the presence of 40% or more per core compared to less than 20%, multiplies the risk of positive margins by 5 (44.1% vs. 8.7%), and the risk of biochemical relapse by 3 (48% vs. 15%). ConclusionsThe total number of positive cores, the percentage of the total of positive cores and the amount of cancer in each core, all demonstrated to be significant predictive prognostic factors that should be analyzed in every patient undergoing prostate biopsy, to predict the risk of poor outcome and therefore help planning the most adequate treatment strategy.