Korean J Urol.  2006 May;47(5):475-481. 10.4111/kju.2006.47.5.475.

Clinical Significance of a Single-Core Positive Prostate Cancers Detected on Extended Prostate Needle Biopsy

• Kim YJ
• Lee SC
• Chang IH
• Gil MC
• Hong SK
• Byun SS
• Lee SE

• KMID: 2294130
• DOI: http://doi.org/10.4111/kju.2006.47.5.475

Abstract

PURPOSE
The widespread use of serum prostate specific antigen and extended needle biopsy of the prostate as screening procedures for prostate cancer has not only led to an increase of detecting prostate cancer as a whole, but also to an increase of detecting small low grade tumors. Still, the clinical significance of small, low grade, single-core positivity on prostate biopsy hasn't yet been determined. So, we tried to investigate the clinicopathological features of prostate cancers that showed only single- core positivity on extended prostate needle biopsy.
MATERIALS AND METHODS
144 patients were managed with radical prostatectomy during 2003-2005 at our institution. Insignificant prostate cancer on biopsy specimens was defined as a single-core positive biopsy containing a focus of 3mm or less of moderately differentiated prostate cancer (Gleason score< or=6) and clinical insignificant cancer in the radical specimens was defined as a low volume (<0.5cc) of moderately differentiated organ- confined prostate cancer. We analyzed the clinicopathological features and the clinical significance in regards to the number of positive cores and the biopsy significance.
RESULTS
Of 144 patients, 46 (31.9%) patients were diagnosed on the basis on single-core positive prostate cancer. Of these 114 patients, 32 (69.6%) patients had insignificance prostate cancer on biopsy. Although the single core positive group had more favorable pathologic features than the multiple core positive group, only 5 (10.9%) were found to have clinically insignificant cancer at radical prostatectomy. Also, in the biopsy insignificant group, only 5 patients (15.6%) were found to have clinically insignificant cancer. However, there were no features that could accurately predict insignificant prostate cancer preoperatively.
CONCLUSIONS
Although the clinicopathological features of the prostate cancers that were detected in only a single-core on prostate needle biopsy were observed to be suggestive of less advanced disease, most of such single-core positive cancers may be clinically significant disease.

Keyword

Prostate cancer; Biopsy; Prostatectomy

MeSH Terms

Biopsy
Biopsy, Needle*
Humans
Mass Screening
Needles*
Prostate*
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms*
Prostate-Specific Antigen

Reference

1.Brawer MK. Prostate-specific antigen: current status. CA Cancer J Clin. 1999. 49:264–81.

2.Cooperberg MR., Broering JM., Litwin MS., Lubeck DP., Mehta SS., Henning JM, et al. The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disease registry. J Urol. 2004. 171:1393–401.

3.Holmberg L., Bill-Axelson A., Helgesen F., Salo JO., Folmerz P., Haggman M, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med. 2002. 347:781–9.

4.Wei JT., Dunn RL., Sandler HM., McLaughlin PW., Montie JE., Litwin MS, et al. Comprehensive comparison of health-related quality of life after contemporary therapies for localized prostate cancer. J Clin Oncol. 2002. 20:557–66.

5.Khan MA., Partin AW., Carter HB. Expectant management of localized prostate cancer. Urology. 2003. 62:793–9.

6.Klotz L. Active surveillance with selective delayed intervention using PSA doubling time for good risk prostate cancer. Eur Urol. 2005. 47:16–21.

7.Parker C. Active surveillance: towards a new paradigm in the management of early prostate cancer. Lancet Oncol. 2004. 5:101–6.

8.Anast JW., Andriole GL., Bismar TA., Yan Y., Humphrey PA. Relating biopsy and clinical variables to radical prostatectomy findings: can insignificant and advanced prostate cancer be predicted in a screening population? Urology. 2004. 64:544–50.

9.Lee AK., Doytchinova T., Chen MH., Renshaw AA., Weinstein M., Richie JP, et al. Can the core length involved with prostate cancer identify clinically insignificant disease in low risk patients diagnosed on die basis of a single positive core? Urol Oncol. 2003. 21:123–7.

10.Ravery V., Szabo J., Toublanc M., Boccon-Gibod LA., Billebaud T., Hermieu JF, et al. A single positive prostate biopsy in six does not predict a low-volume prostate tumour. Br J Urol. 1996. 77:724–8.

11.Amico AV., Wu Y., Chen MH., Nash M., Renshaw AA., Richie JP. Pathologic findings and prostate specific antigen outcome after radical prostatectomy for patients diagnosed on the basis of a single microscopic focus of prostate carcinoma with a gleason score. Cancer. 2000. 89:1810–7.

12.Allan RW., Sanderson H., Epstein JI. Correlation of minute (0.5 MM or less) focus of prostate adenocarcinoma on needle biopsy with radical prostatectomy specimen: role of prostate specific antigen density. J Urol. 2003. 170:370–2.

13.Boccon-Gibod LM., Dumonceau 0., Toublanc M., Ravery V., Boccon-Gibod LA. Microfocal prostate cancer: a comparison of biopsy and radical prostatectomy specimen features. Eur Urol. 2005. 48:895–9.

14.Epstein JI., Walsh PC., Carmichael M., Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage Tic) prostate cancer. JAMA. 1994. 271:368–74.

15.Gardner TA., Lemer ML., Schlegel PN., Waldbaum RS., Vaughan ED Jr., Steckel J. Microfocal prostate cancer: biopsy cancer volume does not predict actual tumour volume. Br J Urol. 1998. 81:839–43.

16.Terris MK., McNeal JE., Stamey TA. Detection of clinically significant prostate cancer by transrectal ultrasound-guided systematic biopsies. J Urol. 1992. 148:829–32.

17.Gore JL., Shariat SF., Miles BJ., Kadmon D., Jiang N., Wheeler TM, et al. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol. 2001. 165:1554–9.

18.Gann PH., Hennekens CH., Stampfer MJ. A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. JAMA. 1995. 273:289–94.

19.Hoedemaeker RF., Rietbergen JB., Kranse R., Schroder FH., van der Kwast TH. Histopathological prostate cancer characteristics at radical prostatectomy after population based screening. J Urol. 2000. 164:411–5.

20.Lee SE. Diagnosis of prostate cancer. Korean J Urol. 2004. 45:197–208.

21.Wang X., Brannigan RE., Rademaker AW., Me Vary KT., Oyasu R. One core positive prostate biopsy is a poor predictor of cancer volume in the radical prostatectomy specimen. J Urol. 1997. 158:1431–5.

22.Hoedemaeker RF., Van der Kwast TH., Schroder FH. The clinical significance of a small focus of well-differentiated carcinoma at prostate biopsy. BJU Int. 2003. 92(Suppl 2):92–6.

23.Stamey TA., Freiha FS., McNeal JE., Redwine EA., Whittemore AS., Schmid HP. Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer. 1993. 71((3 Suppl):):933–8.

24.Stamey TA., McNeal JE., Yemoto CM., Sigal BM., Johnstone IM. Biological determinants of cancer progression in men with prostate cancer. JAMA. 1999. 281:1395–400.

25.Nelson CP., Rubin MA., Strawderman M., Montie JE., Sanda MG. Preoperative parameters for predicting early prostate cancer recurrence after radical prostatectomy. Urology. 2002. 59:740–5.

26.D' Amico AV., Whittington R., Malkowicz SB., Schultz D., Fondurulia J., Chen MH, et al. Clinical utility of the percentage of positive prostate biopsies in defining biochemical outcome after radical prostatectomy for patients with clinically localized prostate cancer. J Clin Oncol. 2000. 18:1164–72.

27.Grossklaus DJ., Coffey CS., Shappell SB., Jack GS., Chang SS., Cookson MS. Percent of cancer in the biopsy set predicts pathological findings after prostatectomy. J Urol. 2002. 167:2032–5.

28.Miyake H., Ono Y., Park SJ., Hara I., Eto H. Pathological findings of radical prostatectomy specimens in Japanese men diagnosed on single core positive prostate biopsy in eight with a Gleason score less than 4. Int J Urol. 2003. 10:383–6.