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830Validation of 2001 partin tables in Turkey: A multicenter study
829
83O
LOW CORRELATION BETWEEN BIOPTICAL FINDINGS OF A SINGLE MICROFOCUS (< 1 M M NON GRADABLE) OF PROSTATE ADENOCARCINOMA AND CLINICAL SIGNIFICANT DISEASE ASSESSED AFTER RADICAL PROSTATECTOMY
VALIDATION OF 2001 PARTIN TABLES IN TURKEY: A MULTICENTER
Graziotti P.~, Colombo P.~, Seveso M?, Ginsti G), Piccinelli A. ~ qstituto Clinico Humanitas, Urology, Milan, Italy, 2Istituto Clinico Humanitas, Pathology, Milan, Italy INTRODUCTION & OBJECTIVES: To determine whether a clinical significant adenocarcinoma of the prostate is predictable before surge12¢by finding only one mierofocus of adenocaminoma (defined as a lesion <-1 ram, <5%, non gradable) at needle biopsy, even repeated, and/or through prostate specific antigen (PSA), PSA density and free-to- total PSA ratio (f/t ratio). MATERIAL & METHODS: Retrospectively- 65/1060 consecutive patients underwent a multisite prostatic needle biopsies presented one microfocus of prostatic adenocarcinoma. All patients underwent PSA, PSAD and f/t ratio to evaluate positive predictive value for clinically significant disease. 41/65 patients (63%) submitted to radical retropubic prostatectomy (RRP) were divided into three grunps: Group A 14/41 Pts. RRP after diagnosis of just one non gradable microfocus at first biopsy; Group B 13/41- RRP after two successive diagnoses of non gradable microfocus; Group C 14/41 after diagnosis ofgradable disease at successive biopsy. 10/65 pts. (15%) submitted to repeat biopsy which gave negative results; 5/65 pts. (7.6%) opted for wait-and-see and 9/65 (13.8%) pts chose conformational radiotherapy (RT). RESULTS: Clinically significant disease was found in 25 (60.9%) of the 41 patients submitted to RRP: 8/14 (57.1%) Group A; 7/13 (53.8%) Group B; 10/14 (71.4%) Group C. The three subgroups resulted comparable for age, PSA and PSAD. The only variable among the tln'ee subgroups regarded the F/T ratio which resulted 11.9% in group A, 13.1% in group B and 19.2% in group C (p:0.02). PSA, F/T ratio and PSAD showed no predictive value neither globally nor in the single subgroups and the apparent difference between A-B groups and C group in terms of clinically significant disease was not however statistically significant (p:0.604). 10/65 (15%) patients who had negative results repeated biopsies. 6/10 patients have stable PSA; 4/10 present gradual increase of PSA. 5/65 (7.6%) patients under wait-and-see are alive. 3/5 (60%) are in follow-up with stable PSA. 2/5 (40%) present progressive increase of PSA. 9/65 (13.8%) submitted to RT have disease regression (mean fullow-up: 15 mos. PSA <1 ng/ml). CONCLUSIONS: No selective criteria with consolidated predictive values emerge fi'om the literature and the risk of finding no significant clinical disease is 9-48% approximately. Our data shows that 30-45% of patients did not harbour a clinically significant disease at the following RRP and the assumed predictive value of the repeat biopsies was not confirmed and that no other preoperative predictive values can be helpful.
STUDY Eskicorapci S?, Karabulut E. z, Tfirkeri L. 3, Baltacl S.4, Cal C. s, Toktas G. 6, Akpmar It.:, Ozer G. s, Sozen S.9, Tokuc R. ~°, Lekili M. ~, Soylu A. 12, Albayrak S. ~3, Sahin H ) ' , Alpar R. 2, 0zen H. z tHacettepe University -Fac. of Medicine, Urology, Ankara, Turkey, 2Hacettepe University Hospital, Biostatistics, Ankara, Turkey, 3Marmara University - Fac. of Medicine, Urology, lstanbul, Turkey, 4Ankara University - Fac. of Medicine, Urology, Ankara, Turkey, 5Ege University - Fac. of Medicine, Urology, Izmir, Turkey, 6SSK. Istanbul Egitim Hospital, Urology, Istanbul, Turkey, 7Florans Nightingale Hospital, Urology, Istanbul, Turkey, SYaksek Ihtisas Hospital, Urology, Ankara, Tin'key, 9Gazi University Hospital, Urology, Aukara, Turkey, mGoztepe SSK Egitim Hospital, Urology, Istanbul, Turkey, ~Manisa Celal Bayar University Hospital, Urology, Manisa, Turkey, ~2Inona University Hospital, Urology, Malatya, Turkey, t3Dr.l. Kirdar Kartal Egitim Ve Arastinna Hospital, Urology, Ist~mbul, Turkey, ~4Dicle University Hospital, Urology, Diyarbaklr, Turkey INTRODUCTION & OBJECTIVES: Although Partin tables were developed in United States to predict the stage of prostate cancer preoperatively, they are used by many clinics throughout the world assuming that these figures apply to their population as well. However the predictive value of current Partin tables, which was updated in 2001, has not been validated in most of the countries as well as in Turkey. Therefore, we evaluated the validity of 2001 Partin tables, for the ability to predict the pathological stage in Turkish patients. MATERIAL & METHODS: The clinical and patbol0gieal findings of 1043 patients who have bad radical prostatectomy were assessed. Serum PSA values, clinical stage, biopsy Gleason score and the pathological features of the radical prostatectomy specimens were collected from each clinic and evaluated. The predictive value of Partin nomogram and pathological findings of prostatectomy specimens were compared and analyzed according to Receiver Operating Characteristics (ROC) analysis. RESULTS: Median age of the patients was 60(45-74). In the presented study, percentage of patients with clinical stage Tlc was 43%. Patients with Gleason score of 2-4 in biopsy constituted 23,4% of the study group. In the present study, the ratio of the patients with serum PSA higher than 10 ng/ml was 39,6%. Organ confined disease, seminal vesicle involvement, lymph node metastases ratios were 64,7%, 10,3%, 1,8% respectively. Area Under Curve (AUC) values for organ confined disease, seminal vesicle involvement and lymph node involvement were calculated as 0.665, 0.733 and 0.759 respectively. CONCLUSIONS: It appears that Partin tables have a reasonable predictive value for the final pathological features like organ confined disease, seminal vesicle and lymph node invol,~-ement in Turkish patients. This multicentre study showed that current Partin tables could also be used in Turkish patients with comparable accuracy.
831
832
DOES CLINICALLY INSIGNIFICANT PROSTATIC CARCINOMA REALLY EXIST? HISTOLOGICAL FEATURES OF RADICAL PROSTATECTOMY SPECIMENS IN PATIENTS WITH SINGLE POSITIVE CORE AND GLEASON SCORE < 6 ON NEEDLE BIOPSY
S A T U R A T I O N R E B I O P S Y T O S T A G E P R O S T A T E C A N C E R IN C A S E O F M I C R O F O C A L C A N C E R AT I N I T I A L B I O P S Y
Simone M., Pomara G., Milesi C., Felipetto R., Casale P., Leonetti C., Tognetti A., Francesca I=. S. Chiara Hospital, Urology Unit, Surgery, Pisa, Italy INTRODUCTION & OBJECTIVES: Pre-treatment parameters of clinically insignificant prostate cancer are defined, on needle biopsy, as single positive core with cancer length less than 3 ram, Gleason score (GS) not more than 6 and or PSA-density < 0.15 (1). Some debate exists about the indication to definitive treatment. Aim of this study was to evaluate the pathologic outcome of patients in this setting, after radical prostatectomy. MATERIAL & METHODS: Between October 1999 and September 2004, 45 men were diagnosed with prostate cancer on ultrasound-guided transrectal prostatic biopsy, having one single positive over 6/12 cores, less than 3 mm in length and GS _<6. Median age was 68 years (range 53-82). Mean PSA was 10.35 (range 2.5-28.6) ng/ml. Among these, 43 patients were suitable for radical retro pubic prostatectomy (RRP), having median age 67 years (range 53-76), median PSA 8 ng/ml (range 2.5~8.7); the remaining 2 were excluded because of age (more than 79 years) and Performance Status. RESULTS: 2002 TNM staging system was applied to specimens. Lymph node involvement was demonstrated in one patient (pT2c). The Table shows the relationship between preoperative PSA mad pathological stage: pStage T2a T2b T2c T3a T4 Total
#patients 13 4 18 4 4 43
. . . .
PSA < 4 1 . . . . . . . . 1
. . . .
PSA 4-10 8 1 12 2 3 26
PSA> 10 4 3 6 2 1 16
Raver?/_ VS, Khouaja K. ~, Dominique S / , Toublanc M. a, Boccon-Gibod L. 3, Boccon-Gibod L.I ~Bichat H6pital, Urology, Paris, France, 2Bichat H6pital, Anatomopathology, Paris, France, 3Hopital Trousseau, Anatomopathology, Paris, France I N T R O D U C T I O N & O B J E C T I V E S : The discovery of a micro focal cancer ( l single positive biopsy out of 6/10 with less than 3 m m of cancer Gleason _<6) on a TRUS biopsy of the prostate is a challenging situation as it correlates at final pathology of radical prostatectomy (RP) specimen with 30% of insignificant cancer (tumour volume <_0.5 cc) and with 30% of P3 stages. We investigated the ability of saturation rebiopsy to detect significant prostate cancer in patients with biopsy micro focal cancer. M A T E R I A L & M E T H O D S : 15 patients were prospectively enrolled in the study. All of them had, at previous biopsy, a micro focal cancer. Rebiopsy was performed within 3 months following the previous set and involved 24 to 34 cores (depending on prostate volume). Saturation rebiopsy was performed transrectally under ultrasound guidance and anaesthesia. Rebiopsy features were noted. RESULTS:
N 15
Mean age (y.o) 62.9 (54-72)
Values PSA (ng/M1) 6.8 ( 0 . 5 - 14)
Positive biopsy 60 %
Mean pathological GS was 6 (range 3-7). Biopsy assessment overestimated the tumour grade in one patient (2.3%), underestimated in 12 (28%), and agreed in 30 patients (69.7%). Nine out 0f43 patients (21%) demonstrated locally advanced prostate cancer (three of which having PSA < 10 ng/ml); 3 of them had received sextant biopsies.
In 6 patients the saturation biopsy was negative (40%); among the 9 positive cases, 6 (66%) had again a micro focal cancer at saturation rebiopsy. Patients with negative rebiopsy (6) or micro focal rebiopsy cancer (6) were offered smazeillance with delayed treatment whereas the 3 remaining patients with more significant cancer at rebiopsy were offered radical therapy. 1 of them has been operated and pathology of the specimen documented the presence of "significant cancer" and pathological analysis of the prostate concluded on multimodal and significant cancer. The other 2 patients are not operated yet.
CONCLUSIONS: These results suggest a careful management in cases of single positive biopsy due to the potential for significant clinical disease. We therefore advocate aggressive definitive treatment for these patients. (1) Noguchi M, Stamey TA, McNeal JE, Yemoto CM, J Urol, 166: 104, 2001
C O N C L U S I O N S : Saturation rebiopsy might help to differentiate non significant tumours from those justifying radical treatment in the case of micro focal cancer at initial biopsy. These results have to be confirmed.
European Urology Supplements 4 (2005) No. 3, pp. 210
83O
LOW CORRELATION BETWEEN BIOPTICAL FINDINGS OF A SINGLE MICROFOCUS (< 1 M M NON GRADABLE) OF PROSTATE ADENOCARCINOMA AND CLINICAL SIGNIFICANT DISEASE ASSESSED AFTER RADICAL PROSTATECTOMY
VALIDATION OF 2001 PARTIN TABLES IN TURKEY: A MULTICENTER
Graziotti P.~, Colombo P.~, Seveso M?, Ginsti G), Piccinelli A. ~ qstituto Clinico Humanitas, Urology, Milan, Italy, 2Istituto Clinico Humanitas, Pathology, Milan, Italy INTRODUCTION & OBJECTIVES: To determine whether a clinical significant adenocarcinoma of the prostate is predictable before surge12¢by finding only one mierofocus of adenocaminoma (defined as a lesion <-1 ram, <5%, non gradable) at needle biopsy, even repeated, and/or through prostate specific antigen (PSA), PSA density and free-to- total PSA ratio (f/t ratio). MATERIAL & METHODS: Retrospectively- 65/1060 consecutive patients underwent a multisite prostatic needle biopsies presented one microfocus of prostatic adenocarcinoma. All patients underwent PSA, PSAD and f/t ratio to evaluate positive predictive value for clinically significant disease. 41/65 patients (63%) submitted to radical retropubic prostatectomy (RRP) were divided into three grunps: Group A 14/41 Pts. RRP after diagnosis of just one non gradable microfocus at first biopsy; Group B 13/41- RRP after two successive diagnoses of non gradable microfocus; Group C 14/41 after diagnosis ofgradable disease at successive biopsy. 10/65 pts. (15%) submitted to repeat biopsy which gave negative results; 5/65 pts. (7.6%) opted for wait-and-see and 9/65 (13.8%) pts chose conformational radiotherapy (RT). RESULTS: Clinically significant disease was found in 25 (60.9%) of the 41 patients submitted to RRP: 8/14 (57.1%) Group A; 7/13 (53.8%) Group B; 10/14 (71.4%) Group C. The three subgroups resulted comparable for age, PSA and PSAD. The only variable among the tln'ee subgroups regarded the F/T ratio which resulted 11.9% in group A, 13.1% in group B and 19.2% in group C (p:0.02). PSA, F/T ratio and PSAD showed no predictive value neither globally nor in the single subgroups and the apparent difference between A-B groups and C group in terms of clinically significant disease was not however statistically significant (p:0.604). 10/65 (15%) patients who had negative results repeated biopsies. 6/10 patients have stable PSA; 4/10 present gradual increase of PSA. 5/65 (7.6%) patients under wait-and-see are alive. 3/5 (60%) are in follow-up with stable PSA. 2/5 (40%) present progressive increase of PSA. 9/65 (13.8%) submitted to RT have disease regression (mean fullow-up: 15 mos. PSA <1 ng/ml). CONCLUSIONS: No selective criteria with consolidated predictive values emerge fi'om the literature and the risk of finding no significant clinical disease is 9-48% approximately. Our data shows that 30-45% of patients did not harbour a clinically significant disease at the following RRP and the assumed predictive value of the repeat biopsies was not confirmed and that no other preoperative predictive values can be helpful.
STUDY Eskicorapci S?, Karabulut E. z, Tfirkeri L. 3, Baltacl S.4, Cal C. s, Toktas G. 6, Akpmar It.:, Ozer G. s, Sozen S.9, Tokuc R. ~°, Lekili M. ~, Soylu A. 12, Albayrak S. ~3, Sahin H ) ' , Alpar R. 2, 0zen H. z tHacettepe University -Fac. of Medicine, Urology, Ankara, Turkey, 2Hacettepe University Hospital, Biostatistics, Ankara, Turkey, 3Marmara University - Fac. of Medicine, Urology, lstanbul, Turkey, 4Ankara University - Fac. of Medicine, Urology, Ankara, Turkey, 5Ege University - Fac. of Medicine, Urology, Izmir, Turkey, 6SSK. Istanbul Egitim Hospital, Urology, Istanbul, Turkey, 7Florans Nightingale Hospital, Urology, Istanbul, Turkey, SYaksek Ihtisas Hospital, Urology, Ankara, Tin'key, 9Gazi University Hospital, Urology, Aukara, Turkey, mGoztepe SSK Egitim Hospital, Urology, Istanbul, Turkey, ~Manisa Celal Bayar University Hospital, Urology, Manisa, Turkey, ~2Inona University Hospital, Urology, Malatya, Turkey, t3Dr.l. Kirdar Kartal Egitim Ve Arastinna Hospital, Urology, Ist~mbul, Turkey, ~4Dicle University Hospital, Urology, Diyarbaklr, Turkey INTRODUCTION & OBJECTIVES: Although Partin tables were developed in United States to predict the stage of prostate cancer preoperatively, they are used by many clinics throughout the world assuming that these figures apply to their population as well. However the predictive value of current Partin tables, which was updated in 2001, has not been validated in most of the countries as well as in Turkey. Therefore, we evaluated the validity of 2001 Partin tables, for the ability to predict the pathological stage in Turkish patients. MATERIAL & METHODS: The clinical and patbol0gieal findings of 1043 patients who have bad radical prostatectomy were assessed. Serum PSA values, clinical stage, biopsy Gleason score and the pathological features of the radical prostatectomy specimens were collected from each clinic and evaluated. The predictive value of Partin nomogram and pathological findings of prostatectomy specimens were compared and analyzed according to Receiver Operating Characteristics (ROC) analysis. RESULTS: Median age of the patients was 60(45-74). In the presented study, percentage of patients with clinical stage Tlc was 43%. Patients with Gleason score of 2-4 in biopsy constituted 23,4% of the study group. In the present study, the ratio of the patients with serum PSA higher than 10 ng/ml was 39,6%. Organ confined disease, seminal vesicle involvement, lymph node metastases ratios were 64,7%, 10,3%, 1,8% respectively. Area Under Curve (AUC) values for organ confined disease, seminal vesicle involvement and lymph node involvement were calculated as 0.665, 0.733 and 0.759 respectively. CONCLUSIONS: It appears that Partin tables have a reasonable predictive value for the final pathological features like organ confined disease, seminal vesicle and lymph node invol,~-ement in Turkish patients. This multicentre study showed that current Partin tables could also be used in Turkish patients with comparable accuracy.
831
832
DOES CLINICALLY INSIGNIFICANT PROSTATIC CARCINOMA REALLY EXIST? HISTOLOGICAL FEATURES OF RADICAL PROSTATECTOMY SPECIMENS IN PATIENTS WITH SINGLE POSITIVE CORE AND GLEASON SCORE < 6 ON NEEDLE BIOPSY
S A T U R A T I O N R E B I O P S Y T O S T A G E P R O S T A T E C A N C E R IN C A S E O F M I C R O F O C A L C A N C E R AT I N I T I A L B I O P S Y
Simone M., Pomara G., Milesi C., Felipetto R., Casale P., Leonetti C., Tognetti A., Francesca I=. S. Chiara Hospital, Urology Unit, Surgery, Pisa, Italy INTRODUCTION & OBJECTIVES: Pre-treatment parameters of clinically insignificant prostate cancer are defined, on needle biopsy, as single positive core with cancer length less than 3 ram, Gleason score (GS) not more than 6 and or PSA-density < 0.15 (1). Some debate exists about the indication to definitive treatment. Aim of this study was to evaluate the pathologic outcome of patients in this setting, after radical prostatectomy. MATERIAL & METHODS: Between October 1999 and September 2004, 45 men were diagnosed with prostate cancer on ultrasound-guided transrectal prostatic biopsy, having one single positive over 6/12 cores, less than 3 mm in length and GS _<6. Median age was 68 years (range 53-82). Mean PSA was 10.35 (range 2.5-28.6) ng/ml. Among these, 43 patients were suitable for radical retro pubic prostatectomy (RRP), having median age 67 years (range 53-76), median PSA 8 ng/ml (range 2.5~8.7); the remaining 2 were excluded because of age (more than 79 years) and Performance Status. RESULTS: 2002 TNM staging system was applied to specimens. Lymph node involvement was demonstrated in one patient (pT2c). The Table shows the relationship between preoperative PSA mad pathological stage: pStage T2a T2b T2c T3a T4 Total
#patients 13 4 18 4 4 43
. . . .
PSA < 4 1 . . . . . . . . 1
. . . .
PSA 4-10 8 1 12 2 3 26
PSA> 10 4 3 6 2 1 16
Raver?/_ VS, Khouaja K. ~, Dominique S / , Toublanc M. a, Boccon-Gibod L. 3, Boccon-Gibod L.I ~Bichat H6pital, Urology, Paris, France, 2Bichat H6pital, Anatomopathology, Paris, France, 3Hopital Trousseau, Anatomopathology, Paris, France I N T R O D U C T I O N & O B J E C T I V E S : The discovery of a micro focal cancer ( l single positive biopsy out of 6/10 with less than 3 m m of cancer Gleason _<6) on a TRUS biopsy of the prostate is a challenging situation as it correlates at final pathology of radical prostatectomy (RP) specimen with 30% of insignificant cancer (tumour volume <_0.5 cc) and with 30% of P3 stages. We investigated the ability of saturation rebiopsy to detect significant prostate cancer in patients with biopsy micro focal cancer. M A T E R I A L & M E T H O D S : 15 patients were prospectively enrolled in the study. All of them had, at previous biopsy, a micro focal cancer. Rebiopsy was performed within 3 months following the previous set and involved 24 to 34 cores (depending on prostate volume). Saturation rebiopsy was performed transrectally under ultrasound guidance and anaesthesia. Rebiopsy features were noted. RESULTS:
N 15
Mean age (y.o) 62.9 (54-72)
Values PSA (ng/M1) 6.8 ( 0 . 5 - 14)
Positive biopsy 60 %
Mean pathological GS was 6 (range 3-7). Biopsy assessment overestimated the tumour grade in one patient (2.3%), underestimated in 12 (28%), and agreed in 30 patients (69.7%). Nine out 0f43 patients (21%) demonstrated locally advanced prostate cancer (three of which having PSA < 10 ng/ml); 3 of them had received sextant biopsies.
In 6 patients the saturation biopsy was negative (40%); among the 9 positive cases, 6 (66%) had again a micro focal cancer at saturation rebiopsy. Patients with negative rebiopsy (6) or micro focal rebiopsy cancer (6) were offered smazeillance with delayed treatment whereas the 3 remaining patients with more significant cancer at rebiopsy were offered radical therapy. 1 of them has been operated and pathology of the specimen documented the presence of "significant cancer" and pathological analysis of the prostate concluded on multimodal and significant cancer. The other 2 patients are not operated yet.
CONCLUSIONS: These results suggest a careful management in cases of single positive biopsy due to the potential for significant clinical disease. We therefore advocate aggressive definitive treatment for these patients. (1) Noguchi M, Stamey TA, McNeal JE, Yemoto CM, J Urol, 166: 104, 2001
C O N C L U S I O N S : Saturation rebiopsy might help to differentiate non significant tumours from those justifying radical treatment in the case of micro focal cancer at initial biopsy. These results have to be confirmed.
European Urology Supplements 4 (2005) No. 3, pp. 210