Extracapsular Extension Of Prostate Cancer Research Articles

Predictive Value of Magnetic Resonance Imaging Determined Tumor Contact Length for Extracapsular Extension of Prostate Cancer

Tumor contact length is defined as the amount of prostate cancer in contact with the prostatic capsule. We evaluated the ability of magnetic resonance imaging determined tumor contact length to predict microscopic extracapsular extension compared to existing predictors of extracapsular extension. We retrospectively analyzed the records of 111 consecutive patients with magnetic resonance imaging/ultrasound fusion targeted, biopsy proven prostate cancer who underwent radical prostatectomy from January 2010 to July 2013. Median patient age was 64 years and median prostate specific antigen was 8.9 ng/ml. Clinical stage was cT1 in 93 cases (84%) and cT2 in 18 (16%). Postoperative pathological analysis confirmed pT2 in 71 patients (64%) and pT3 in 40 (36%). We evaluated 1) in the radical prostatectomy specimen the correlation of microscopic extracapsular extension with pathological cancer volume, pathological tumor contact length and Gleason score, 2) the correlation between microscopic extracapsular extension and magnetic resonance imaging tumor contact length, and 3) the ability of preoperative variables to predict microscopic extracapsular extension. Logistic regression analysis revealed that pathological tumor contact length correlated better with microscopic extracapsular extension than the predictive power of pathological cancer volume (0.821 vs 0.685). The Spearman correlation between pathological and magnetic resonance imaging tumor contact length was r = 0.839 (p <0.0001). ROC AUC analysis revealed that magnetic resonance imaging tumor contact length outperformed cancer core involvement on targeted biopsy and the Partin tables to predict microscopic extracapsular extension (0.88 vs 0.70 and 0.63, respectively). At a magnetic resonance imaging tumor contact length threshold of 20 mm the accuracy for diagnosing microscopic extracapsular extension was superior to that of conventional magnetic resonance imaging criteria (82% vs 67%, p = 0.015). We developed a predicted probability plot curve of extracapsular extension according to magnetic resonance imaging tumor contact length. Magnetic resonance imaging determined tumor contact length could be a promising quantitative predictor of microscopic extracapsular extension.

Pre-operative tumor localization and evaluation of extra-capsular extension of prostate cancer: how misleading can it be?

To verify the accuracy of transrectal ultrasound-guided prostatic biopsy (TRUS Bx), magnetic resonance imaging (MRI) and their combination in evaluating the laterality of prostate cancer and to determine the accuracy of MRI in assessing extra-capsular extension of prostate cancer. We retrospectively reviewed our past 100 consecutive series of radical prostatectomy performed between February 2010 and April 2012 at our institution. Their TRUS Bx and MRI results were compared with the pathology of the radical prostatectomy specimens. For tumor localization, we calculated the accuracies in unilateral diseases, bilateral diseases, overall accuracies and Cohen Kappa concordance coefficient of TRUS Bx, MRI and their combination. For the assessment of extra-capsular extension, we calculated the sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, likelihood ratio positive and likelihood ratio negative of MRI. Eighty-two percent of our radical prostatectomy specimens had bilateral tumor involvement and 32% had extra-capsular extension. The accuracies of TRUS Bx in unilateral disease, bilateral disease and overall accuracy were 15.2%, 91.4% and 43.6%, respectively. The accuracies of MRI in unilateral disease, bilateral disease and overall accuracy were 11.1%, 66.7% and 38.9%, respectively. When combining the assessment of TRUS Bx and MRI, the accuracies in unilateral disease, bilateral disease and overall accuracy were 16.7%, 75% and 55.6%, respectively. The Cohen Kappa concordance co-efficient of TRUS Bx, MRI, and combination of them were 0.1165, -0.2047 and -0.1084, respectively. The positive predictive value, negative predictive value, sensitivity, specificity, overall accuracy, likelihood ratio positive and likelihood ratio negative of MRI in assessing extra-capsular extension were 33.3%, 69.8%, 5.9%, 94.9%, 67.9%, 1.16 and 0.99, respectively. TRUS Bx, MRI, and their combination had poor concordance and limited accuracies in assessment of the laterality of tumor involvement. The combination of TRUS Bx and MRI offered a better of accuracy when compared to either modality alone. MRI was a specific, but not sensitive tool in assessing the presence of extra-capsular extension.

954 Utility of preoperative 3 Tesla pelvic phased-array magnetic resonance imaging in prediction of extracapsular extension of prostate cancer and its impact on surgical margin status: Experience at a Canadian tertiary academic health science center

954 Utility of preoperative 3 Tesla pelvic phased-array magnetic resonance imaging in prediction of extracapsular extension of prostate cancer and its impact on surgical margin status: Experience at a Canadian tertiary academic health science center

Diffusion-Weighted MRI as a Predictor of Extracapsular Extension in Prostate Cancer

The objective of our study was to evaluate the value of the apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) as a predictor of extracapsular extension (ECE) in patients with localized prostate cancer. Enrolled in this study were 167 patients who underwent preoperative DWI at 3 T followed by surgery. Univariate and multivariate analyses including clinical variables (serum prostate-specific antigen level, biopsy-based Gleason score, clinical stage, greatest percentage of cancer in all biopsy cores, and presence of perineural invasion) and tumor ADC data were performed for predicting ECE. Receiver operating characteristic curve analysis was also performed to investigate the diagnostic performance of the clinical variables and tumor ADC for predicting ECE. Histopathologic results indicated that 23 (13.8%) patients had ECE. At univariate analysis, tumor ADC, biopsy-based Gleason score, the presence of perineural invasion, and greatest percentage of cancer in all biopsy cores were associated with ECE (p<0.05). Multivariate analysis revealed that the greatest percentage of cancer in all biopsy cores (p=0.001), biopsy-based Gleason score (p=0.015), and tumor ADC (p=0.032) were independent predictors of ECE. For predicting ECE, the area under the curve (AUC) of tumor ADC was 0.771, which is the second best AUC of all the variables evaluated. As an imaging biomarker, tumor ADC may have potential for predicting ECE before surgery in patients with prostate cancer. Further studies investigating this possibility are warranted.

Can 3T multiparametric magnetic resonance imaging accurately detect prostate cancer extracapsular extension?

Accurate staging is essential to determine the correct management of patients diagnosed with prostate cancer. We assess the accuracy of 3T multiparametric magnetic resonance imaging (MRI) with endorectal coil (3TemMRI) in detecting prostate cancer local extension. We retrospectively reviewed charts from January 2008 to July 2012 from all patients undergoing radical prostatectomy. Patients were only included if 3TemMRI and radical prostatectomy were performed at our institution. Based on the presence of extracapsular extension (ECE) at 3TemMRI, prostate cancer was dichotomized into locally advanced or organ-confined disease. The accuracy of 3TemMRI local staging was then evaluated using definitive pathology as a reference. Overall, 177 radical prostatectomies were performed within the timeframe. After applying exclusion criteria, 60 patients were included in the final analysis. The mean patient age was 67 ± 7 (standard deviation) years. Mean prostate-specific antigen value was 12.7 ± 12.7 ng/L. Based on preoperative characteristics, we considered 38 of the 60 patients (63%) patients high risk. 3TemMRI identified an organ-confined tumour in 46 patients and locally advanced disease in 14 patients. When correlated to final pathology, 3TemMRI specificity, sensitivity, negative and positive predictive values, and accuracy in detecting locally advanced prostate cancer were 90%, 35%, 57%, 79% and 62%, respectively. This study shows that the use of preoperative 3TemMRI can be used to identify organ-confined prostate cancer when locally advanced disease is suspected.

The presence of positive surgical margins in patients with organ-confined prostate cancer results in biochemical recurrence at a similar rate to that in patients with extracapsular extension and PSA≤10 ng/ml

PurposesWe investigated whether patients with organ-confined prostate cancer (PCa) and positive surgical margins (SMs) had a similar biochemical recurrence (BCR) risk compared with patients with pT3a and preoperative prostate-specific antigen (PSA) levels≤10ng/ml. Furthermore, we examined the effects of incorporating SM status, Gleason score (Gls), and preoperative PSA level into the discrimination accuracy of the current tumor node metastasis-staging system. Materials and methodsWe analyzed 863 PCa patients treated with radical prostatectomy from 1999 to 2008. Only individuals with pT2N0 or pT3N0, without neoadjuvant or adjuvant therapy, were included. We performed chi-square automatic interaction detection analysis to generate a classification model for predicting BCR by analyzing interactions between age at surgery, SM status, Gls, PSA, and tumor stage, tumor volume and relative tumor volume. Cox regression analyses tested the relationship between SM status and BCR rate after stratification according to T-stage and the novel classification. The predictive and discrimination accuracy of the current T-stage and of the classification model was quantified with time-dependent receiver operating characteristics and integrated discrimination improvement. The topographical association between extracapsular extension of PCa and positive SM was analyzed in patients with pT3aR1 using a computational reconstruction diagram of the prostate. ResultsThe chi-square automatic interaction detection analysis found interactions among pT Stage, SM status, PSA and Gls and generated a classification model for BCR prediction: pT2R0, pT2R1, pT3a PSA≤10ng/ml, pT3a PSA>10ng/ml and pT3b. Men with pT2R1 had a shorter time to BCR compared with men with pT3a-PSA≤10ng/ml (P<0.0001). Gls≥7a was correlated with a poorer BCR rate than Gls≤7a in men with pT2R1 or pT3a PSA≤10ng/ml (P = 0.012). The rank order (highest to lowest) for the risk of developing BCR was pT3b>pT2R1/pT3a-PSA>10ng/ml>pT2R1/pT3a PSA≤10ng/ml>pT2R0 (P<0.0001). Discrimination accuracy gains were observed when PCa was stratified according to the novel classification (P<0.0001). A topographical association between extracapsular extension and positive SM was found in patients with pT3aR1 (P = 0.01). ConclusionPatients with pT2R1 develop a similar BCR risk to that of patients with pT3a PSA≤10ng/ml. Gls≥7b is associated with a high BCR risk in these patient groups. Including SM status, PSA, and Gls in pT stage appears to improve prognostic stratification in patients with PCa.

Ability of preoperative 3.0‐Tesla magnetic resonance imaging to predict the absence of side‐specific extracapsular extension of prostate cancer

Recent studies have shown an improvement in prostate cancer diagnosis with the use of 3.0-Tesla magnetic resonance imaging. We retrospectively assessed the ability of this imaging technique to predict side-specific extracapsular extension of prostate cancer. From October 2007 to August 2011, prostatectomy was carried out in 396 patients after preoperative 3.0-Tesla magnetic resonance imaging. Among these, 132 (primary sample) and 134 patients (validation sample) underwent 12-core prostate biopsy at the National Cancer Center Hospital of Tokyo, Japan, and at other institutions, respectively. In the primary dataset, univariate and multivariate analyses were carried out to predict side-specific extracapsular extension using variables determined preoperatively, including 3.0-Tesla magnetic resonance imaging findings (T2-weighted and diffusion-weighted imaging). A prediction model was then constructed and applied to the validation study sample. Multivariate analysis identified four significant independent predictors (P < 0.05), including a biopsy Gleason score of ≥8, positive 3.0-Tesla diffusion-weighted magnetic resonance imaging findings, ≥2 positive biopsy cores on each side and a maximum percentage of positive cores ≥31% on each side. The negative predictive value was 93.9% in the combination model with these four predictors, meanwhile the positive predictive value was 33.8%. Good reproducibility of these four significant predictors and the combination model was observed in the validation study sample. The side-specific extracapsular extension prediction by the biopsy Gleason score and factors associated with tumor location, including a positive 3.0-Tesla diffusion-weighted magnetic resonance imaging finding, have a high negative predictive value, but a low positive predictive value.

Prediction of prostate cancer extracapsular extension with high spatial resolution dynamic contrast-enhanced 3-T MRI

To assess the value of dynamic contrast-enhanced (DCE) combined with T2-weighted (T2W) endorectal coil (ERC) magnetic resonance imaging (MRI) at 3T for determining extracapsular extension (ECE) of prostate cancer. In this IRB-approved study, ERC 3-T MRI of the prostate was performed in 108 patients before radical prostatectomy. T2W fast spin-echo and DCE 3D gradient echo images were acquired. The interpretations of readers with varied experience were analysed. MRI-based staging results were compared with radical prostatectomy histology. Descriptive statistics were generated for prediction of ECE and staging accuracies were determined by the area under the receiver-operating characteristic curve. The overall sensitivity, specificity, positive predictive value and negative predictive value for ECE were 75%, 92%, 79% and 91%, respectively. Diagnostic accuracy for staging was 86%, 80% and 91% for all readers, experienced and less experienced readers, respectively. ERC 3-T MRI of the prostate combining DCE and T2W imaging is an accurate pretherapeutic staging tool for assessment of ECE in clinical practice across varying levels of reader experience. • Endorectal coil (ERC) magnetic resonance imaging is widely used for imaging prostatic disease. • ERC 3-T MRI is reasonably accurate for local prostate cancer staging. • High diagnostic accuracy is achievable across different levels of reader experience. • MRI facilitates therapeutic decisions in patients with prostate cancer.

Clinical and Pathological Parameters Predicting Extracapsular Disease in Patients Undergoing a Radical Prostatectomy for Clinically Localized Prostate Cancer

To determine the epidemiological, clinical and pathological factors that can potentially predict extracapsular extension of prostate cancer in patients undergoing radical prostatectomy for clinically localized disease. We retrospectively analyzed the medical records of patients who undergone radical prostatectomy from January 2001 until November 2010. Patients age, prostate volume, PSA, PSA density, percent of cancer in prostate biopsy material, presence of cancer in biopsy cores of the right lobe or the left lobe or both lobes, Gleason summary, 1st Gleason pattern and 2nd Gleason pattern were analyzed for their predictive ability. From 187 studied patients, 44 of them (23.5%) had extracapsular disease. Multivariate analyses revealed that smaller prostate volumes and the presence of malignancy in both lobes after prostate biopsy were significant predictors for non-organ confined disease in the total population and in patients with Gleason score ≥ 7. Presence of malignancy in both lobes was the only significant predictive factor in patients with PSA ≤ 10 and in those with Gleason score ≤ 6. Prostate volume and positive cores for malignancy from both lobes after prostate biopsy are preoperative data that can be used for prediction of extracapsular disease. This information can be valuable in cases a nerve sparing radical prostatectomy is planned.

Effect of MRI in the evaluation of extra-capsular extension of prostate cancer

Objective To investigate the effect of MRI in the evaluation of extra-capsular extension (ECE)of prostate cancer.Methods Preoperative MR imaging findings were correlated with histologic findings in 29 patients underwent radical prostatectomy regarding the ECE,the diagnostic accuracy was evaluated retrospectively.Results Histopathological results showed capsular penetration in 9 of 29 patients (31.0%).The sensitivity,specificity,positive predictive value,and negative predictive value of MR imaging were 3/9,90%(18/20),3/5 and 75%(18/24),respectively.The overall accuracy was 72.4% (21/29).Conclusion MR imaging has relatively low sensitivity and high specificity for diagnosis of ECE of prostate cancer,the accuracy is somewhat limited.

Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension?

We performed a complete pathologic analysis examining extracapsular extension (ECE) and microscopic spread of malignant cells beyond the prostate capsule to determine whether and when clinical target volume (CTV) expansion should be performed. A detailed pathologic analysis was performed for 371 prostatectomy specimens. All slides from each case were reviewed by a single pathologist (N.S.G.). The ECE status and ECE distance, defined as the maximal linear radial distance of malignant cells beyond the capsule, were recorded. A total of 121 patients (33%) were found to have ECE (68 unilateral, 53 bilateral). Median ECE distance=2.4 mm [range: 0.05-7.0 mm]. The 90th-percentile distance = 5.0 mm. Of the 121 cases with ECE, 55% had ECE distance>or=2 mm, 19%>or=4 mm, and 6%>or=6 mm. ECE occurred primarily posterolaterally along the neurovascular bundle in all cases. Pretreatment prostrate-specific antigen (PSA), biopsy Gleason, pathologic Gleason, clinical stage, bilateral involvement, positive margins, percentage of gland involved, and maximal tumor dimension were associated with presence of ECE. Both PSA and Gleason score were associated with ECE distance. In all 371 patients, for those with either pretreatment PSA>or=10 or biopsy Gleason score>or=7, 21% had ECE>or=2 mm and 5%>or=4 mm beyond the capsule. For patients with both of these risk factors, 49% had ECE>or=2 mm and 21%>or=4 mm. For prostate cancer with ECE, the median linear distance of ECE was 2.4 mm and occurred primarily posterolaterally. Although only 5% of patients demonstrate ECE>4 to 5 mm beyond the capsule, this risk may exceed 20% in patients with PSA>or=10 ng/ml and biopsy Gleason score>or=7. As imaging techniques improve for prostate capsule delineation and as radiotherapy delivery techniques increase in accuracy, a posterolateral CTV expansion should be considered for patients at high risk.

Prediction of extracapsular extension of prostate cancer based on systematic core biopsies

To evaluate the clinical utility of transrectal ultrasound-guided systematic sextant or octant biopsies for the prediction of extracapsular extension (ECE) at radical prostatectomy. We performed a retrospective analysis of 84 patients who underwent preoperative staging and transrectal ultrasound-guided systematic sextant (n=60) or octant (n=24) biopsy. The presence of ECE was correlated with the number of positive biopsies on each side of the prostate by chi(2) analysis. Sensitivity, specificity and positive and negative predictive values were calculated for both positive (two or three positive biopsies per side) and negative (none or one positive biopsy per side) test results. The number of positive cores was thereafter combined with two other parameters: prostate-specific antigen (PSA) level and Gleason score. ECE was evidenced at radical prostatectomy in 24% of patients (20/84). chi(2) analysis demonstrated a significant correlation between the number of positive biopsies and the presence of ECE. Analysis of the 168 prostate sides and dominant sides revealed that systematic needle biopsies had positive predictive values of 46.7% and 37%, respectively and negative predictive values of 89% and 94%, respectively. Use of a combination of parameters (biopsy Gleason score > or =7 vs <7; PSA >10 vs < or = 10 ng/ml; and >1 positive core vs none or one positive cores) identified patients at high or low risk of ECE. At the extremes, none of the 10 patients in the low-risk group had ECE at radical prostatectomy, compared to 77% of those in the high-risk group. The probability of ECE at radical prostatectomy can be accurately predicted based on the number of positive sextant and octant biopsies, either alone or in combination with other parameters.

Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension

Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension

Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension

We performed a detailed pathologic review of prostatectomy specimens and correlated clinical features [prostate specific antigen (PSA), gleason score (GS), and clinical stage (CS)] with the linear distance of extracapsular extension (ECE) of each prostate cancer case. The degree of influence by these features may have salient implications in the definition of the CTV when significant risk for ECE is suspected.

Prostate cancer: detection of extracapsular extension by genitourinary and general body radiologists at MR imaging.

To determine whether predictive value of endorectal magnetic resonance (MR) imaging findings in detection of prostate cancer extracapsular extension (ECE) is significantly affected by the reader's subspecialty experience. In this cohort study, 344 consecutive patients with biopsy-proved prostate cancer underwent endorectal MR imaging followed by surgery. Likelihood of ECE described in MR imaging reports was compared with clinical predictor variables. ECE was determined from the final pathologic report on specimens resected at surgery. Readers of MR images were classified into genitourinary MR imaging radiologists (n = 4) and general body MR imaging radiologists (n = 6). For data analysis, Wilcoxon rank sum and chi(2) tests, as well as receiver operating characteristic (ROC) curves and univariate and multivariate logistic regression analyses, were used. A difference with P <.05 was considered significant. Univariate analysis results demonstrated that all predictors except clinical stage were significantly associated with detection of ECE in both groups of readers (P <.05). In the genitourinary MR imaging radiologist group of patients, area under the ROC curve for endorectal MR imaging findings (0.833) was larger than areas under the curves for all other predictors (0.566-0.701). In the general body MR imaging radiologist group of patients, area under the ROC curve for endorectal MR imaging findings (0.646) was not larger than areas under the curves for all other predictors (0.582-0.793). Results of multivariate analysis of two models, one with all predictors and another with all predictors except endorectal MR imaging findings, demonstrated a significant increase in area under the ROC curve with endorectal MR images interpreted by genitourinary MR imaging radiologists (P =.019 and.31, respectively). Endorectal MR imaging findings are significant predictors for detection of ECE when MR images are interpreted by genitourinary radiologists experienced with MR imaging of the prostate.

648: The Length of the Prostate Core Biopsy Involved as a Predictor of Extra-Capsular Extension in Prostate Cancer

You have accessJournal of UrologyDiscussed Poster, Sunday, May 9, 2004, 1:00 - 5:00 pm1 Apr 2004648: The Length of the Prostate Core Biopsy Involved as a Predictor of Extra-Capsular Extension in Prostate Cancer Aurel A. Messas, Vincent V. Hopirtean, Jérard J. Ghossein, Sébastien S. Dominique, Olivier O. Dumonceau, Vincent V. Ravery, and Laurent Boccon Gibbod Aurel A. MessasAurel A. Messas More articles by this author , Vincent V. HopirteanVincent V. Hopirtean More articles by this author , Jérard J. GhosseinJérard J. Ghossein More articles by this author , Sébastien S. DominiqueSébastien S. Dominique More articles by this author , Olivier O. DumonceauOlivier O. Dumonceau More articles by this author , Vincent V. RaveryVincent V. Ravery More articles by this author , and Laurent Boccon GibbodLaurent Boccon Gibbod More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37910-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "648: The Length of the Prostate Core Biopsy Involved as a Predictor of Extra-Capsular Extension in Prostate Cancer." The Journal of Urology, 171(4S), p. 648 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 648 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Aurel A. Messas More articles by this author Vincent V. Hopirtean More articles by this author Jérard J. Ghossein More articles by this author Sébastien S. Dominique More articles by this author Olivier O. Dumonceau More articles by this author Vincent V. Ravery More articles by this author Laurent Boccon Gibbod More articles by this author Expand All Advertisement Loading ...

557 The length of the prostate core biopsy involved as a predictor of extra-capsular extension in prostate cancer

557 The length of the prostate core biopsy involved as a predictor of extra-capsular extension in prostate cancer

Detailed assessment of the radial distance of extracapsular extension (ECE) from 712 radical prostatectomy specimens: implications for treatment planning margins for brachytherapy and conformal radiotherapy

Purpose/Objective: Brachytherapy and conformal radiation for prostate cancer need to provide adequate therapeutic coverage to the prostate and to all areas of ECE to avoid geographic miss. We analyzed preoperative parameters from patients undergoing radical prostatectomy for definitive treatment of prostate cancer. The aim is to determine whether preoperative data could be used to predict the presence of extracapsular extension of prostate cancer and to determine the radial distance.

Sextant Prostate Biopsies Predict Side and Sextant Site of Extracapsular Extension of Prostate Cancer

We examined the ability of sextant prostate biopsies in combination with other preoperative data to predict side and sextant site of prostate cancer extracapsular extension in a large cohort of patients. We examined 223 contemporary cases of prostate cancer managed by radical prostatectomy. Using logistic regression analysis, we determined whether patient age, Gleason score, clinical stage, prostate specific antigen, number of positive sextants, biopsy location or percent of biopsy cores positive for cancer in a sextant site, side and overall gland was predictive of location of pathological extracapsular extension into periprostatic tissue. Of 41 of the 223 (18%) patients with nonorgan confined disease extracapsular extension was localized to 45 sextant sites in 36 (apex 8, mid 22, base 15) while only side of extension was known in 5. In a multivariate analysis the best predictors of the risk of extracapsular extension on a side were average percent biopsy cores positive for cancer overall 15 or greater (odds ratio 8.4, p <0.0001) and average from 3 ipsilateral biopsies 15 or greater (odds ratio 7.4, p <0.0001). When used in combination these 2 factors yielded a model with a positive predictive value of 37% and a negative predictive value of 95%. Sextant specific percent biopsy cores positive for cancer was predictive of risk of extracapsular extension in a sextant (odds ratio 2.5, p = 0.020). Our data demonstrate that average overall and per side percent biopsy cores positive for cancer is a significant predictor of risk of extracapsular extension on a side. Sextant specific percent biopsy cores positive for cancer is predictive of sextant site of extension. The high negative predictive value of the side specific model identifies patients who are good candidates for nerve sparing surgery.

COMPARISON OF DIGITAL RECTAL EXAMINATION AND BIOPSY RESULTS WITH THE RADICAL PROSTATECTOMY SPECIMEN

Digital rectal examination is integral to staging prostate cancer. Ultrasound guided biopsy establishes the diagnosis, and it may provide useful information regarding disease grade and extent. Treatment decisions are largely based on information gained from digital rectal examination and biopsy but this information is only useful if it correlates with the radical prostatectomy specimen and prognosis. We correlated digital rectal examination and transrectal ultrasound guided biopsy results with a detailed analysis of the radical prostatectomy specimen. The accuracy of an abnormal digital rectal examination for predicting the location and extent of cancer was assessed in 89 patients thought to have clinical stage T2 disease. We evaluated 155 patients with clinical stages T1c and T2 disease to correlate the location of positive biopsies with the tumor site in the prostate. Radical prostatectomy specimens were completely sectioned at 2 mm. intervals, and tumor extent and location were recorded. In 85 patients a unilateral lesion was suspicious on digital rectal examination, that is stage cT2. The final pathological review revealed cancer on the suspicious side in 82 cases (96%) with tumor confined to the same lobe in only 23 (27%), bilateral disease in 59 (69%) and tumor confined to the contralateral lobe in 3 (4%). In 4 patients with a palpable bilateral abnormality a bilateral lesion was confirmed on final pathological evaluation. Digital rectal examination demonstrated a 36 and 31% incidence of extracapsular tumor extension and positive surgical margins, respectively, on the clinically benign side. In 100 patients only unilateral biopsy was positive. The final pathological evaluation revealed cancer in the biopsy positive side in 95 cases (95%) with tumor confined to the ipsilateral lobe in only 26 (26%), bilateral disease in 69 (69%) and tumor confined to the contralateral lobe in 5 (5%). In 46 of the 55 patients (84%) with bilateral positive biopsies tumor involved both sides but the pathologist did not identify cancer in both lobes in 9 (16%). While 100 patients had a unilateral negative biopsy, analysis of the prostatectomy specimen revealed carcinoma in the benign lobe in 74 (74%). Moreover, extracapsular tumor extension and a positive surgical margin were observed on the biopsy negative side in 31% of the patients. The degree to which digital rectal examination and biopsy results confirmed the final pathological evaluation was assessed using the kappa statistic, which revealed only slight agreement with each factor. The correlation of digital rectal examination and biopsy results with the location of extracapsular extension and positive margins was evaluated by the Spearman coefficient of correlation, which indicated poor agreement. When patients with unilateral versus bilateral positive biopsy were compared with respect to prognostic parameters, the difference was statistically significant for initial serum prostate specific antigen, the percentage of surface involved by tumor, biopsy and final Gleason scores, and the incidence of extracapsular extension of tumor. Digital rectal examination and the interpretation of prostate biopsy are not accurate clinical tools for defining the location and extent of prostatic carcinoma. Bilateral positive biopsy may be useful as an adjunct to the current clinical staging system.