Assessment of the optimal number of positive biopsy cores to discriminate between cancer‐specific mortality in high‐risk versus very high‐risk prostate cancer patients. Issue 14 (26th July 2021) - Wenzel, Mike
Abstract: Background: Number of positive prostate biopsy cores represents a key determinant between high versus very high‐risk prostate cancer (PCa). We performed a critical appraisal of the association between the number of positive prostate biopsy cores and CSM in high versus very high‐risk PCa. Methods: Within Surveillance, Epidemiology, and End Results database (2010–2016), 13, 836 high versus 20, 359 very high‐risk PCa patients were identified. Discrimination according to 11 different positive prostate biopsy core cut‐offs (≥2–≥12) were tested in Kaplan–Meier, cumulative incidence, and multivariable Cox and competing risks regression models. Results: Among 11 tested positive prostate biopsy core cut‐offs, more than or equal to 8 (high‐risk vs. very high‐risk: n = 18, 986 vs. n = 15, 209, median prostate‐specific antigen [PSA]: 10.6 vs. 16.8 ng/ml, <.001) yielded optimal discrimination and was closely followed by the established more than or equal to 5 cut‐off (high‐risk vs. very high‐risk: n = 13, 836 vs. n = 20, 359, median PSA: 16.5 vs. 11.1 ng/ml, p < .001). Stratification according to more than or equal to 8 positive prostate biopsy cores resulted in CSM rates of 4.1 versus 14.2% (delta: 10.1%, multivariable hazard ratio: 2.2, p < .001) and stratification according to more than or equal to 5 positive prostate biopsy cores with CSM rates of 3.7 versus 11.9% (delta: 8.2%, multivariable hazard ratio: 2.0, p < .001) in respectively high versus very high‐risk PCa. Conclusions: The more than or equal to 8 positive prostate biopsy cores cutoff yielded optimal results. It was very closely followed by more than or equal to 5 positive prostate biopsy cores. In consequence, virtually the same endorsement may be made for either cutoff. However, more than or equal to 5 positive prostate biopsy cores cutoff, based on its existing wide implementation, might represent the optimal choice.