Is a Single Focus of Low-Grade Prostate Cancer Diagnosed on Saturation Biopsy Predictive of Clinically Insignificant Cancer?

Abstract

Objectives: To evaluate the incidence of indolent prostate cancer (PCa; <0.5 ml cancer and Gleason score, GS, ≤6) in men with microfocal PCa diagnosed on saturation biopsy (SPBx) submitted to radical retropubic prostatectomy. Methods: From January 2005 to December 2008, 413 patients (median age 61.5 years) underwent SPBx (median 30 cores). A single neoplastic microfocus (5% or less of cancer in a single core) was found in 55 men and all patients underwent retropubic prostatectomy. Median PSA was equal to 8.2 ng/ml, digital rectal examination was negative and GS was 6 in 40 cases and not evaluable in 15 cases. Results: Prostatectomy specimens showed a significant cancer in 48/55 (87.3%) patients with a median GS of 6.2 (range 5–8), presence of extraprostatic extension and positive surgical margins in 15 (27.3%) and 8 (14.5%) cases, respectively. Six patients had an indolent PCa, and in 1 case no tumor was found. Conclusions: Patients with a single microfocal PCa diagnosed on SPBx corresponded to an insignificant cancer in surgical specimens only in 12.7% of cases, but they should be informed that they may harbor more aggressive disease with a risk of non-organ-confined cancer that in our series was 27.3%.

Transperineal Template-guided Mapping Biopsy as a Staging Procedure to Select Patients Best Suited for Active Surveillance

“…Several studies have demonstrated that even extended "saturation" biopsies performed transrectally do not reliably identify aggressive cancers. 12,13 However, as we demonstrated in an earlier report, 14 TTMB seems to outperform saturation biopsies performed transrectally and is particularly effective at identifying cancers in the anterior prostate, the area most frequently missed by the transrectal approach.…”

670 Can a Microfocal Prostate Cancer Be Regarded as Low Risk Prostate Cancer?

“…PSA screening for prostate cancer has become widespread, and the occurrence of low-risk prostate cancer has been dramatically increasing [5]. Using definite therapy such as RP, clinically localized prostate cancer might be curatively treated, especially in low-risk prostate cancer patients.…”

“…However, according to the Epstein criteria [4], the preoperative diagnosis of low-risk prostate cancer is a difficult decision to make since prostate cancer is a multifocal, heterogeneous disease. Some studies have reported that even low-risk patients may demonstrate disease upgrading or upstaging [5].…”

Is PCA3 Score Useful in Preoperative Staging of a Single Microfocus of Prostate Cancer Diagnosed at Saturation Biopsy

“…The correlation between biopsy findings and overall tumor burden is rather poor and even a single focus on low-grade PCa in a biopsy specimen does not predict the pathologic stage of the disease. We have previously observed a statistically significant correlation between the definitive pathologic stage and quantitative histology when performing SPBx [6], but the prediction failed in the presence of a microfocus of cancer where the incidence of OC PCa, extraprostatic extent and surgical margin positivity ranged between 50 and 92%, 6 and 27.3% and 7 and 14.5%, respectively [11,14,22]. SPBx has been proposed as a staging tool for revaluating patients with microfocal PCa [13].…”

“…Boccon-Gibod et al [23] reported that in 34 patients submitted to repeat SPBx the presence of multifocal PCa and un-upgrading of GS was true in 70 and 20% of the cases, respectively. Moreover, in 55 patients with microfocal disease who underwent RRP after SPBx we detected a significant cancer in 85% of the cases, with presence of non-OC PCa in 27.3% of them [22]. Thus, the sensitivity of SPBx (i.e.…”