Identification of pathologically insignificant prostate cancer is not accurate in unscreened men

Abstract

Background:Identification of men harbouring insignificant prostate cancer (PC) is important in selecting patients for active surveillance. Tools have been developed in PSA-screened populations to identify such men based on clinical and biopsy parameters.Methods:Prospectively collected case series of 848 patients was treated with radical prostatectomy between July 2007 and October 2011 at an English tertiary care centre. Tumour volume was assessed by pathological examination. For each tool, receiver operator characteristics were calculated for predicting insignificant disease by three different criteria and the area under each curve compared. Comparison of accuracy in screened and unscreened populations was performed.Results:Of 848 patients, 415 had Gleason 3+3 disease on biopsy. Of these, 32.0% had extra-prostatic extension and 50.2% were upgraded. One had positive lymph nodes. Two hundred and six (24% of cohort) were D'Amico low risk. Of these, 143 had more than two biopsy cores involved. None of the tools evaluated has adequate discriminative power in predicting insignificant tumour burden. Accuracy is low in PSA-screened and -unscreened populations.Conclusions:In our unscreened population, tools designed to identify insignificant PC are inaccurate. Detection of a wider size range of prostate tumours in the unscreened may contribute to relative inaccuracy.

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

“…A number of studies have shown that in around half of men undergoing radical prostatectomy, the prediction of grade and/or stage is wrong [2][3][4]. The true degree of diagnostic error is difficult to ascertain as those men with a negative TRUS biopsy do not usually undergo a more accurate verification test.…”

Pathological Concordance between Prostate Biopsies and Radical Prostatectomy Using Transperineal Sector Mapping Biopsies: Validation and Comparison with Transrectal Biopsies

“…A 50.2% upgrading was recently found when comparing TRUS biopsy to subsequent radical prostatectomy (RP) Gleason score (GS) [7] and cancers with initial negative TRUS have a 37% underdiagnosis [5,8] . Uncertainty that is inherent in the standard diagnostic pathway has resulted in increasing use of transperineal biopsies.…”

Magnetic Resonance Imaging Targeted Biopsy Improves Selection of Patients Considered for Active Surveillance for Clinically Low Risk Prostate Cancer Based on Systematic Biopsies

“…3 Upgrading rates up to 50% were reported when RP specimens were used as the reference test. 4 Therefore, there is a need for new diagnostic tools that might improve the estimation of tumor grade and extent, and the selection of patients for AS.…”