Pathologic features from prostate needle biopsy and prognosis after I-125 brachytherapy

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Early-stage prostate cancer treatment often involves I-125 brachytherapy.
• Predicting treatment outcomes is crucial for patient management.
• The role of detailed pathological features in predicting outcomes requires further evaluation.

Purpose of the Study:

• To assess the prognostic value of detailed pathological features on biopsy for predicting outcomes in early-stage prostate cancer patients treated with I-125 brachytherapy.
• To correlate biochemical tumor control rates with pretreatment PSA, Gleason score, tumor volume on biopsy, and perineural invasion.

Main Methods:

• Retrospective review of biopsy slides from 103 patients with T1/T2 prostate cancer and Gleason scores of 4-7 treated with transperineal I-125 implantation.
• Multivariate Cox proportional-hazard analysis was used to identify predictors of biochemical failure (PSA < 1.0 ng/ml).

Main Results:

• Pretreatment PSA > 10 ng/ml was the strongest predictor of biochemical failure (P = 0.013).
• The length of biopsy specimen replaced by tumor showed borderline significance (P = 0.15).
• Gleason score, percent of biopsy tissue replaced by tumor, and perineural invasion were not significant predictors of prognosis.

Conclusions:

• Pretreatment PSA is the most significant predictor of biochemical failure in this patient cohort.
• Detailed pathological assessment of needle biopsies provides limited additional prognostic information beyond pretreatment PSA.
• Significant overlap exists in pathological features among patients with varying biochemical control outcomes.