Prediction Of Extraprostatic Extension Research Articles

Computer-aided diagnosis in prostate cancer: a retrospective evaluation of the Watson Elementary® system for preoperative tumor characterization in patients treated with robot-assisted radical prostatectomy.

Computer-aided diagnosis (CAD) may improve prostate cancer (PCa) detection and support multiparametric magnetic resonance imaging (mpMRI) readers for better characterization. We evaluated Watson Elementary® (WE®) CAD system results referring to definitive pathological examination in patients treated with robot-assisted radical prostatectomy (RARP) in a tertiary referral center. Patients treated with RARP between 2020 and 2021 were selected. WE® calculates the Malignancy Attention Index (MAI), starting from the information contained in the mpMRI images. Outcome measures were the capability to predict the presence of PCa, to correctly locate the dominant lesion, to delimit the largest diameter of the dominant lesion, and to predict the extraprostatic extension (EPE). Overall, tumor presence was confirmed in 46 (92%) WE® highly suspicious areas, while it was confirmed in 43 (86%) mpMRI PI-RADS ≥ 4 lesions. The WE® showed a positive agreement with mpMRI of 92%. In 98% of cases, visible tumor at WE® showed that the highly suspicious areas were within the same prostate sector of the dominant tumor nodule at pathology. WE® showed a 2.5mm median difference of diameter with pathology, compared with a 3.8mm of mpMRI versus pathology (p = 0.019). In prediction of EPE, WE® and mpMRI showed sensitivity, specificity, positive and negative predictive value of 0.81 vs 0.71, 0.56 vs 0.60, 0.88 vs 0.85 and 0.42 vs 0.40, respectively. The WE® system resulted accurate in the PCa dominant lesion detection, localization and delimitation providing additional information concerning EPE prediction.

State of the art of radiomic analysis in the clinical management of prostate cancer: A systematic review.

We present the current clinical applications of radiomics in the context of prostate cancer (PCa) management. Several online databases for original articles using a combination of the following keywords: "(radiomic or radiomics) AND (prostate cancer or prostate tumour or prostate tumor or prostate neoplasia)" have been searched. The selected papers have been pooled as focus on (i) PCa detection, (ii) assessing the clinical significance of PCa, (iii) biochemical recurrence prediction, (iv) radiation-therapy outcome prediction and treatment efficacy monitoring, (v) metastases detection, (vi) metastases prediction, (vii) prediction of extra-prostatic extension. Seventy-six studies were included for qualitative analyses. Classifiers powered with radiomic features were able to discriminate between healthy tissue and PCa and between low- and high-risk PCa. However, before radiomics can be proposed for clinical use its methods have to be standardized, and these first encouraging results need to be robustly replicated in large and independent cohorts.

Prostate Magnetic Resonance Imaging Analyses, Clinical Parameters, and Preoperative Nomograms in the Prediction of Extraprostatic Extension.

Introduction: Proper planning of laparoscopic radical prostatectomy (RP) in patients with prostate cancer (PCa) is crucial to achieving good oncological results with the possibility of preserving potency and continence. Aim: The aim of this study was to identify the radiological and clinical parameters that can predict the risk of extraprostatic extension (EPE) for a specific site of the prostate. Predictive models and multiparametric magnetic resonance imaging (mpMRI) data from patients qualified for RP were compared. Material and methods: The study included 61 patients who underwent laparoscopic RP. mpMRI preceded transrectal systematic and cognitive fusion biopsy. Martini, Memorial Sloan-Kettering Cancer Center (MSKCC), and Partin Tables nomograms were used to assess the risk of EPE. The area under the curve (AUC) was calculated for the models and compared. Univariate and multivariate logistic regression analyses were used to determine the combination of variables that best predicted EPE risk based on final histopathology. Results: The combination of mpMRI indicating or suspecting EPE (odds ratio (OR) = 7.49 (2.31–24.27), p < 0.001) and PSA ≥ 20 ng/mL (OR = 12.06 (1.1–132.15), p = 0.04) best predicted the risk of EPE for a specific side of the prostate. For the prediction of ipsilateral EPE risk, the AUC for Martini’s nomogram vs. mpMRI was 0.73 (p < 0.001) vs. 0.63 (p = 0.005), respectively (p = 0.131). The assessment of a non-specific site of EPE by MSKCC vs. Partin Tables showed AUC values of 0.71 (p = 0.007) vs. 0.63 (p = 0.074), respectively (p = 0.211). Conclusions: The combined use of mpMRI, the results of the systematic and targeted biopsy, and prostate-specific antigen baseline can effectively predict ipsilateral EPE (pT3 stage).

Prediction of extraprostatic extension on multi-parametric magnetic resonance imaging in patients with anterior prostate cancer

To validate how established markers of extraprostatic extension (EPE) are applied to anterior prostate cancers (APCs), and to investigate other novel markers if available. Among 614 histopathologically confirmed APCs from 2011 to 2016, 221 lesions with PiRADS (verion 2) scores ≥4 on 3-T multi-parametric MRI were analyzed retrospectively. Two radiologists independently assessed capsular morphology qualitatively with 5-point scale (normal, thinning, bulging, loss, extracapsular disease), and capsule contact length (arc), tumor dimension, and their ratio (arc-dimension ratio) quantitatively. Reproducibility in measurement was assessed with κ and intra-class correlation coefficients (ICCs). Logistic regression analysis was done to find meaningful indicators of EPE. Diagnostic performance of markers was compared to one another with generalized linear model and multi-reader multi-case ROC analysis. Reproducibility was moderate to substantial (κ 0.45-0.73) for qualitative, and moderate to almost perfect (ICC 0.50-0.87) for quantitative features of EPE. Capsular morphology (odds ratio [OR] 1.818), capsule contact length (OR 1.115), tumor dimension (OR 1.035), and arc-dimension ratio (OR 1.846) were independently associated with EPE (p≤0.019). Capsular bulging and capsule contact length of 10mm as thresholds of EPE demonstrated sensitivity/specificity of 0.58/0.85 and 0.77/0.68, respectively. Capsule contact length yielded greatest AUC (0.784), followed by capsular morphology (0.778), arc-dimension ratio (0.749), and tumor dimension (0.741). Diagnostic performance of capsular morphology, capsule contact length, and arc-dimension ratio was comparable in predicting EPE. Existing markers of EPE applicable regardless of locations of tumors apply similarly to APCs. Arc-dimension ratio may be a novel marker of EPE of APCs. • Existing imaging markers of extraprostatic extension (EPE) which have been applied regardless of locations of tumors are reflected similarly to anterior prostate cancers (APCs). • Measuring tumor dimension without capsular assessment may result in insufficient pre-operative prediction of EPE of APCs. • Arc-dimension ratio (capsule contact length divided by tumor dimension) exhibited highest OR and comparable performance to existing features in predicting EPE of APCs.

PD47-11 THE ROLE OF MRI-TARGETED BIOPSY IN PREDICTION OF ADVERSE PATHOLOGICAL AND ONCOLOGICAL OUTCOME AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2018PD47-11 THE ROLE OF MRI-TARGETED BIOPSY IN PREDICTION OF ADVERSE PATHOLOGICAL AND ONCOLOGICAL OUTCOME AFTER RADICAL PROSTATECTOMY Yoh Matsuoka, Hiroshi Tanaka, Tomo Kimura, Yuma Waseda, Sho Uehara, Yosuke Yasuda, Toshiki Kijima, Soichiro Yoshida, Minato Yokoyama, Junichiro Ishioka, Kazutaka Saito, Kazunori Kihara, and Yasuhisa Fujii Yoh MatsuokaYoh Matsuoka More articles by this author , Hiroshi TanakaHiroshi Tanaka More articles by this author , Tomo KimuraTomo Kimura More articles by this author , Yuma WasedaYuma Waseda More articles by this author , Sho UeharaSho Uehara More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Toshiki KijimaToshiki Kijima More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2171AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric MRI and MRI-targeted biopsy (MTB) facilitate prostate cancer (PC) detection. We have reported that the Prostate Imaging Reporting and Data System (PI-RADS) version 2 promotes overstaging (AJR 2017) and that risk-group migration occurs when MTB data is applied in systematic biopsy (SB)-based risk models (AUA 2016). We aimed to clarify roles of MTB in the prediction of extraprostatic extension (EPE) and biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS Subjects were 174 clinically localized PC patients who had undergone multiparametric MRI, 12-core SB, and RP without prior treatment. MTB was performed for index lesions with PI-RADS scores ≥3. BCR was defined as PSA >0.2 ng/ml. Preoperative factors were examined for associations with EPE and BCR by logistic and Cox regression analyses, respectively. The performance of models was evaluated. RESULTS SB showed no PC in 19 men (11%) and PC of grade groups (GG) 1/2/3/≥4 in 42/65/24/24 men (24/37/14/14%). MTB (median core number, 4) was performed in 153 men (88%) and showed no PC in 11 men (6%) and PC of GG 1/2/3/≥4 in 25/63/28/26 men (14/36/16/15%). EPE was identified in 35 men (20%). After a median follow-up of 43 months, 28 men (16%) had BCR. In multivariate analyses, T-stage ≥3 on MRI (p <0.001) and MTB-GG ≥4 (p = 0.004) were independent predictors of EPE. Among 92 men at T-stage ≥3 on MRI, EPE was found in 67% (10/15) of men with MTB-GG ≥4 and 30% (23/77) of men without MTB-GG ≥4 (p = 0.007). Regarding BCR, PSA ≥10 ng/ml (hazard ratio [HR] 4.1, p = 0.001), SB-GG ≥3 (HR 2.8, p = 0.02), MTB-GG ≥3 (HR 11.6, p <0.001), and maximal cancer length (MCL) ≥6 mm in MTB (HR 6.4, p <0.001) were independent predictors. A scoring model was developed in which the score was calculated as 1 (if PSA ≥10 ng/ml) + 1 (if SB-GG ≥3) + 2 (if MTB-GG ≥3) + 2 (if MCL ≥6 mm in MTB) or 0 (otherwise). Postoperative courses were stratified with three-year BCR-free rates of 100/78/34% for men with scores 0-2/3-4/5-6 (n = 113/35/26) (p <0.001). The concordance index was 0.82 for this model and 0.58 and 0.63 for the NCCN risk model using SB alone and both SB and MTB, respectively. CONCLUSIONS MTB has predictive values for pathological and oncological outcomes after RP. PC grades on MTB may complement MRI staging, and grades and size on MTB could be useful in risk stratification for BCR. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e902 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Yoh Matsuoka More articles by this author Hiroshi Tanaka More articles by this author Tomo Kimura More articles by this author Yuma Waseda More articles by this author Sho Uehara More articles by this author Yosuke Yasuda More articles by this author Toshiki Kijima More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Kazutaka Saito More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Editorial Comment

No AccessJournal of UrologyAdult Urology1 Aug 2016Editorial Comment Bertram Yuh Bertram YuhBertram Yuh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2994AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 196(2), pp. 512–513 References 1 : Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effect on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis. World J Urol2015; . Epub ahead of print. Google Scholar 2 : The impact of magnetic resonance imaging on prediction of extraprostatic extension and prostatectomy outcome in patients with low-, intermediate- and high-risk prostate cancer: try to find a standard. J Endourol2015; 29: 1396. Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 196Issue 2August 2016Page: 512-513 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bertram Yuh More articles by this author Expand All Advertisement PDF downloadLoading ...

The value of prostate-specific antigen density in the prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer

Objective To evaluate the role of PSA density with prostate volume determined by MR images in the prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer. Method A total of 71 patients with clinically organ-confined prostate cancer who underwent radical prostatectomy from January 2009 to December 2013 were included in the study.MRI PSAD, preoperative total serum PSA (tPSA), free PSA/total PSA(fPSA/tPSA), biopsy Gleason score, prostate volume, age, body mass index in patients with extraprostatic extension were compared with those in patients with organ-confined disease.The receiver operating characteristic (ROC)curve was used to analyze the performance of each of the above parameters to predict the extraprostatic extension.Multivariate logistic regression analysis was used to select the independent influencing factors for extraprostatic extension. Results Pathologic examination revealed 32 patients were positive for extraprostatic extension and 39 patients had organ-confined disease.MRI PSAD(P<0.001), tPSA(P<0.001) and biopsy Gleason score levels(P=0.006) were higher in patients with extraprostatic extension than that in patients with organ-confined disease, and prostate volume was lower(P=0.009). MRI PSAD showed the largest area under ROC curve(AUC) among those parameter(AUC=0.852, P<0.001), and tPSA was the second(AUC=0.764). Multivariate logistic regression analyses showed that MRI PSAD was an independent predictor of extraprostatic extension. Conclusions MRI PSAD was better than tPSA in predicting pathological stage of extraprostatic extension.The value of PSAD should not be ignored in the prediction of pathological stage. Key words: Prostatic neoplasms; Prostate specific antigen; Prostate specific antigen density; Pathological stage; Extraprostatic extension.

The Impact of Magnetic Resonance Imaging on Prediction of Extraprostatic Extension and Prostatectomy Outcome in Patients with Low-, Intermediate- and High-Risk Prostate Cancer: Try to Find a Standard.

To investigate the value of multiparametric magnetic resonance imaging (mpMRI) and to predict extracapsular extension (ECE), seminal vesicle (SV) infiltration, and a negative surgical margin (SM) status at radical prostatectomy (RP) for different prostate cancer (PC) risk groups. In the study, 805 men underwent 3 tesla mpMRI without endorectal coil before MRI/transrectal ultrasonography-fusion guided prostate biopsy. MRIs were analyzed using the prostate imaging reporting and data system. The cohort was classified into risk groups according to National Comprehensive Cancer Network (NCCN) criteria. Of 132 men who subsequently underwent RP, pathologic stage and SM status at RP were used as reference. Retrospectively, we investigated a European Society of Urogenital Radiology (ESUR) score for ECE and SV-infiltration. Statistical analyses included regression analyses, receiver operating characteristics (ROC), and Youden Index to assess an ESUR-score cutoff. Area under the curve in ROC curve analyses was 0.82 for ESUR-ECE score to detect pT(3a)-disease and 0.77 for ESUR-SV score for pT(3b). Using a cutoff of 4 for ECE and of 2 for SV, the positive predictive value of the ECE-score for harboring pT(3) was 50.0%, 90.0%, and 88.8% for the low-, intermediate- and high-risk cohort. Retrospectively, the use of the ESUR-ECE score preoperatively would have changed the initial surgical plan, according to NCCN criteria, in 31.1% of patients. In the high-risk subgroup, 9/35 (25.7%) patients were correctly assessed as not harboring pT(3) by imaging (ECE score <4), and would have allowed secure robot-assisted radical prostatectomy and nerve-sparing surgery (NSS). When T3 suspicion on preoperative MRI would be taken into account, intraoperative frozen-sections (IFS) might avoid positive SM in 12/18 high-risk patients and an oncologic secure NSS in 8/20 intermediate-risk patients. Prediction of pT(3) disease is crucial to plan NSS and to achieve negative SM in RP. Standardized ECE scoring on mpMRI is an independent predictor of pT(3) and may help to plan RP with oncologic security, even in high-risk patients. In addition, it allows more accurate selection of a subgroup of patients for systematic and MRI-guided IFS.

Prediction of Extraprostatic Extension in Patients with Clinically Organ-Confined Prostate Cancer

Introduction: Preoperative parameters for predicting extraprostatic extension (ECE) in clinically organ-confined prostate cancer patients are not well defined. Our aim was to evaluate the roles of the biopsy Gleason score, prostate-specific antigen (PSA)-based parameters, volume, and clinical T classification in prediction of ECE. Materials and Methods: A total of 188 patients with clinically organ-confined prostate cancer who underwent radical prostatectomy from January 1998 to December 2007 were included in the study. Age, prostate volume, preoperative total serum PSA (tPSA), free PSA, PSA density (PSAD), biopsy Gleason score, and clinical T classification were analyzed by univariate and multivariate analyses to predict ECE. Results: Pathologic examination revealed 130 patients had organ-confined disease and 58 patients were positive for ECE. Multivariate logistic regression analyses showed that tPSA was an independent predictor of ECE. Gleason score ≥8 had a trend for predicting ECE. Receiver operating characteristic (ROC) curves suggested that tPSA and PSAD had a similar diagnosis performance in the whole cohort. For patients with Gleason score of 7, PSAD was found to be statistically better than tPSA for predicting ECE. Conclusions: tPSA remains one of the most important factors for predicting ECE in prostate cancer patients. PSAD may be more helpful than tPSA for predicting ECE in the patients with Gleason score of 7.

Prediction of Extraprostatic Extension in Intermediate Risk Prostate Cancer: The Evolving Role of Endorectal MRI

Prediction of Extraprostatic Extension in Intermediate Risk Prostate Cancer: The Evolving Role of Endorectal MRI

Novel predictive tools for Irish radical prostatectomy pathological outcomes: development and validation

We developed and validated prostate cancer predictive models for Irish patients, allowing individualised predictions of radical prostatectomy pathological outcomes. Retrospective review of the Irish Prostate Cancer Research Consortium database from 2003 to 2008 was performed. Two predictive models were formulated: a replica of the Partin tables (n = 169) and a look-up table based on PSA and biopsy Gleason Score (n = 253). Clinico-pathological parameters were compared to the Partin data set. Internal validation was performed. In total, 70% of patients were at clinical stage T1c. 5.8% had a PSA less than 4.1 ng/ml, whereas 25% of the Partin patients had a PSA in this range. Maximal predictive accuracy was seen for seminal vesicle invasion (area under the curve = 72%). Prediction of extra-prostatic extension and lymph node involvement was only equivalent to that of a chance phenomenon. Our current results do not support the introduction of the formulated predictive models into routine clinical practice.

VALIDATING THE PARTIN TABLES USING THE NCI SEER DATABASE

INTRODUCTION AND OBJECTIVE: The Partin Tables are a widely used nomogram predicting the pathologic stage of prostate cancer (CaP) given common preoperative clinical characteristics. The model is based on patients undergoing radical prostatectomy (RP) at the Johns Hopkins Medical Institutions, a tertiary care center. We sought to validate the Partin tables using a large national cohort to see whether the model could be applied to all patients undergoing RP for CaP in the United States. METHODS: The published 2007 Partin Tables were used to estimate the risk of positive lymph nodes (LN+), seminal vesicle invasion (SV+), and extraprostatic extension (EPE+) in men with prostate cancer from the NCI-SEER Database using clinical stage, preoperative PSA, and Gleason score. The discriminative and predictive ability of the tables were explored by constructing receiver operating characteristic (ROC) and calibration curves. An overall Brier score was calculated for each endpoint. The utility of the nomogram was determined based on clinically relevant endpoints. RESULTS: We identified 11,185 men who underwent RP for CaP in the years 2004-2005. The Partin tables discriminated between patient groups at risk for lymph node involvement and seminal vesicle involvement well, with an AUC of 0.77 and 0.74, and Brier score 0.026 and 0.042, respectively. Extraprostatic extension discrimination and prediction was more limited (AUC 0.62, Brier score 0.171). CONCLUSIONS: The Partin tables showed excellent discrimination for seminal vesicle and lymph node involvement. Prediction of lymph node involvement was reasonable even within lower risk groups. Prediction of extraprostatic extension and seminal vesicle involvement was somewhat more limited.

Prediction of Extraprostatic Extension in Men With Biopsy Gleason Score of 8 or Greater

Recent data have shown that high grade prostate cancer is a potentially surgically curable disease in properly selected patients. We assessed the ability of preoperative variables to predict extraprostatic extension in men with biopsy Gleason score 8 or greater. We identified 159 patients who underwent prostatectomy without neoadjuvant therapy for biopsy proven Gleason score 8 or greater T1c-T2N0M0 cancer between 1996 and 2006. Univariate and multivariate analyses were performed to predict extraprostatic extension using side specific data, including clinical features and biopsy findings. Organ confined cancer was pathologically confirmed in 84 of 159 patients (52.8%). Side specific analysis was practicable on 124 sides (124 men) and side specific extraprostatic extension was found on 48 of the 124 sides (38.7%). Gleason grade 5 element, maximum tumor length, percent of positive cores, positive basal cores and side specific palpable disease were significantly associated with side specific extraprostatic extension. On multivariate analysis maximum tumor length and a positive basal core were independent predictors of side specific extraprostatic extension (p <0.001 and 0.033, respectively). When maximum tumor length was less than 7 mm and the basal core was negative for cancer, the incidence of side specific extraprostatic extension was low (2 of 35 cases or 5.7%). In contrast, the risk of side specific extraprostatic extension was 56.8% (25 of 44 cases) when maximum tumor length was 7 mm or greater and the basal core was positive for cancer. Applying our criteria for prostatectomy could significantly decrease the risk of inadequate cancer control and increase the probability of maintaining potency in patients with prostate cancer with biopsy Gleason score 8 or greater.

Prediction of extraprostatic extension by prostate specific antigen velocity, endorectal MRI, and biopsy Gleason score in clinically localized prostate cancer

To investigate the clinical value of prostate specific antigen velocity (PSAV) in predicting the extraprostatic extension of clinically localized prostate cancer. One hundred and three patients who underwent radical prostatectomy for clinically localized prostate cancer were included in the analysis. The correlation between preoperative parameters, including PSA-based parameters, clinical stage, and histological biopsy findings, and the pathological findings were analyzed. Logistic regression analysis was performed to identify a significant set of independent predictors for the local extent of the disease. Sixty-four (60.2%) patients had organ confined prostate cancer and 39 (39.8%) patients had extraprostatic cancer. The biopsy Gleason score, PSA, PSA density, PSA density of the transition zone, and PSAV were significantly higher in the patients with extraprostatic cancer than in those with organ confined cancer. Multivariate logistic regression analysis indicated that the biopsy Gleason score, endorectal magnetic resonance imaging findings, and PSAV were significant predictors of extraprostatic cancer (P < 0.01). Probability curves for extraprostatic cancer were generated using these three preoperative parameters. The combination of PSAV, endorectal magnetic resonance imaging findings, and biopsy Gleason score can provide additional information for selecting appropriate candidates for radical prostatectomy.

A novel algorithm for preoperative prediction of extraprostatic extension near the neurovascular bundles

A novel algorithm for preoperative prediction of extraprostatic extension near the neurovascular bundles

Transition zone biopsy and prediction of extraprostatic extension at radical prostatectomy.

There is limited data in the literature that suggests that transition zone (TZ) biopsy might be useful for the prediction of extraprostatic extension (EPE) in clinically localized prostate cancer. We studied the role of TZ biopsy in the prediction of EPE. Transition zone biopsies were performed in addition to systematic peripheral zone (PZ) biopsies between November 1995 and December 1999. During this period, 59 patients underwent radical prostatectomy for clinically localized disease. Final pathological results were compared with preoperative clinical and biopsy findings. Of the 59 patients who underwent radical prostatectomy, 46 had cancer only in the PZ cores and 13 had cancer both in the PZ and the TZ cores at the biopsy. Final histopathological results revealed EPE in 19 (32%) patients and positive surgical margins in 22 (37%). In univariate analysis of age, prostate-specific antigen (PSA), mean percentage of positive PZ cores, mean biopsy Gleason score and positive TZ biopsy, there was a significant difference for serum PSA levels (P = 0.021), presence of positive TZ cores (P = 0.018) and percentage of positive PZ cores in patients with and without EPE (P < 0.001). In multivariate analysis, the single independent predictor of EPE was the percentage of positive PZ biopsy cores (P = 0.0227). There was agreement between the side of positive TZ biopsy and EPE in seven of eight patients. Taking two TZ cores in addition to peripheral sextant biopsy did not result in better prediction of EPE. The relationship between TZ involvement and the presence of EPE can be investigated further in radical prostatectomy specimens.

Prediction of Extraprostatic Extension of Prostate Cancer Based on Needle Biopsy Findings: Perineural Invasion Lacks Significance on Multivariate Analysis

Extraprostatic extension (EPE) and seminal vesicle invasion (SVI) are adverse prognostic factors in prostate cancer, and their prediction before prostatectomy would be useful. Perineural invasion in needle biopsy has been advocated as a marker of extraprostatic extension, but its independent value a

Prediction of Extraprostatic Extension of Prostate Cancer Based on Needle Biopsy Findings

Prediction of Extraprostatic Extension of Prostate Cancer Based on Needle Biopsy Findings

Optimized microvessel density analysis improves prediction of cancer stage from prostate needle biopsies

Objectives. Clinical staging of prostate cancer is inaccurate, often with significant upstaging on final pathologic review. We previously demonstrated the ability to predict extraprostatic extension of cancer by use of the Gleason score and serum prostate-specific antigen (PSA) measurements. Herein we present an interim analysis of data from an ongoing multi-institutional study to determine the predictive power of an enhancement of microvessel density analysis in combination with Gleason score and serum PSA to predict extraprostatic extension. Methods. We evaluated a total of 186 randomly selected needle biopsy samples and matched totally embedded radical prostatectomy samples with preoperative PSA concentrations and patient demographics. Gleason score and optimized microvessel density (OMVD) were determined from the needle biopsy samples; pathologic stage was verified by independent review of the radical prostatectomy samples. An automated digital image analysis system measured microvessel morphology and calculated the OMVD in the biopsy samples (Biostage; Bard Diagnostic Sciences, Seattle, Wash). Results. Prediction of extraprostatic extension was increased significantly when OMVD analysis was added to Gleason score and serum PSA concentration ( P = 0.003). Conclusions. Optimized microvessel density analysis significantly increases the ability to predict extraprostatic extension of cancer preoperatively when combined with Gleason score and serum PSA concentration. This method appears to be a useful tool that can assist with treatment decisions in selected patients.