Spatial distribution of positive cores improves the selection of patients with low‐risk prostate cancer as candidates for active surveillance. (7th June 2013)

• Record Type: Journal Article
• Authors: Abdollah, Firas; Suardi, Nazareno; Capitanio, Umberto; Gallina, Andrea; Sun, Maxine; Villa, Luca; Scattoni, Vincenzo; Bianchi, Marco; Tutolo, Manuela; Fossati, Nicola; Karakiewicz, Pierre; Rigatti, Patrizio; Montorsi, Francesco; Briganti, Alberto
• Is Part Of: BJU international. Volume 112:Number 4(2013:Aug.)
• Page Start: E234
• Page End: E242
• Publication Date: 2013-06-07
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12152
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12152-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12152-list-0001" list-type="bullet"> <list-item> <p>To test the hypothesis that spatial distribution of positive cores at biopsy is a predictor of unfavourable prostate cancer characteristics at radical prostatectomy (RP) in active surveillance (AS) candidates.</p> </list-item> </list> </p> </sec> <sec id="bju12152-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12152-list-0002" list-type="bullet"> <list-item> <p>We examined the data of 524 patients treated with RP, between 2000 and 2012. All fulfilled at least one of four commonly used AS criteria.</p> </list-item> <list-item> <p>Regression models tested the relationship between positive cores spatial distribution, defined as the number of positive zones at biopsy (PBxZ) and tumour laterality at biopsy and two endpoints: (i) unfavourable prostate cancer at RP (Gleason score ≥4 + 3, and/or pT3 disease), and (ii) clinically significant prostate cancer (tumour volume ≥2.5 mL).</p> </list-item> </list> </p> </sec> <sec id="bju12152-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12152-list-0003" list-type="bullet"> <list-item> <p>Unfavourable prostate cancer and clinically significant prostate cancer rates were 8 and 25%, respectively. Patients with more than one PBxZ had a 3.2‐fold higher risk of harbouring unfavourable prostate cancer, and a 2.3‐fold higher risk of harbouring clinically significant prostate cancer compared with their counterparts with one PBxZ (both <italic>P</italic> = 0.01).</p> </list-item> <list-item> <p>Patients with bilateral tumour at biopsy had a 3.3‐fold higher risk of harbouring unfavourable prostate cancer and a 1.7‐fold higher risk of harbouring clinically significant prostate cancer compared with their counterparts with unilateral tumour at biopsy (both <italic>P</italic> ≤ 0.04).</p> </list-item> <list-item> <p>Some of these results did not reach a statistically significant level, when the analyses were restricted to patients that fulfilled the most stringent AS criteria.</p> </list-item> </list> </p> </sec> <sec id="bju12152-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12152-list-0004" list-type="bullet"> <list-item> <p>Positive cores spatial distribution at biopsy should be considered, when advising patients about AS.</p> </list-item> <list-item> <p>The addition of this predictor to AS inclusion criteria can help identifying patients at a higher risk of progression, and reduce the rate of inappropriate surveillance of aggressive tumours. However, the most stringent AS criteria (namely John‐Hopkins criteria and Prostate Cancer Research International: Active Surveillance criteria) might not benefit from the addition of this predictor. This point warrants further investigation in future studies.</p> </list-item> </list> </p> </sec> </abstract>