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Prostate biopsy volume indices do not predict for significant Gleason upgrading
Christopher R King1, Deep A Patel, Martha K Terris
1Division of Urologic Oncology, Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305, USA. christopher@reyes.stanford.edu
American Journal of Clinical Oncology
|April 2, 2005
Summary
Tumor volume from prostate biopsies predicts outcomes after surgery but does not predict changes in Gleason grade. This finding highlights the importance of tumor volume in prostate cancer prognosis.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Discordance between prostate biopsy and radical prostatectomy Gleason grades is common.
- Accurate grading is crucial for treatment decisions and predicting outcomes.
Purpose of the Study:
- To investigate if surrogate tumor volume indices from prostate biopsies can better predict the actual Gleason grade in the prostatectomy specimen.
- To determine if tumor volume indices predict for biochemical failure (BF) and nonorgan-confined disease after radical prostatectomy.
Main Methods:
- Retrospective review of 124 patients undergoing radical prostatectomy.
- Biopsies assessed for Gleason grade, number of positive cores, and linear tumor length.
- Prostatectomy specimens assessed for Gleason grade, organ-confined disease, seminal vesicle invasion, and margins.
- Biochemical failure defined as postoperative prostate-specific antigen >0.05 ng/mL.
Main Results:
- Cumulative tumor length in biopsies independently predicted for biochemical failure (P = 0.050) and nonorgan-confined disease (P = 0.034).
- Patients with cumulative tumor length >10 mm had higher rates of nonorgan-confined disease (49%) and biochemical failure (37%) compared to those with <=10 mm (29% and 19%, respectively).
- No biopsy surrogate volume indices predicted for clinically significant upgrading or downgrading of Gleason grade.
Conclusions:
- Tumor volume indices from prostate needle biopsies are independent predictors of organ-confined disease and biochemical failure after prostatectomy.
- These volume indices do not predict for clinically significant changes in Gleason grade between biopsy and prostatectomy.
- The association between tumor volume surrogates and surgical outcomes appears to be related to tumor volume effects, not grade prediction accuracy.