Pre-Operative Predictors of Adverse Prostatectomy Outcome. Correlation of 389 12-Core Needle Biopsy Results with Subsequent Prostatectomy Data
ON Kryvenko, M Diaz-Insua, M Ramineni, M Menon, NS Gupta. Henry Ford Hospital, Detroit, MI
Background: The aim of our study is to determine if pre-operative PSA (PSA) and pathologic variables on 12 core transrectal needle biopsy of prostate (NBX) are useful in predicting adverse outcomes on subsequent radical prostatectomy (RP).
Design: 389 NBX with their corresponding RP specimens collected between 2004 and 2008 at our institution were analyzed. RP outcomes such as extraprostatic extension (EPE), seminal vesicle invasion (SVI), positive surgical margin (PSM) and positive lymph nodes (PLN) were studied with respect to PSA and the following features on NBX: location of positive cores (apex, mid, base), number of positive cores (NPC), percentage of each core involved (%PC), perineural invasion (PNI), highest Gleason score on biopsy (HGS) and distribution of positive cores (DPC). Continuous variables were categorized by quartiles or by the median when their association with a categorical variable was thought. Statistical methods used were Chi-square statistics for contingency tables, Mantel-Haenszel Chi-square, Fisher Exact test and Pearson correlation coefficient.
Results: (1) The majority of the variable in which a gradient could be coded show a statistically significant trend (p<0.0001) in predicting EPE and SVI. (2) For PSM, this trend was significant for NPC, %PC, and PNI. (3) In the case of contiguity of involvement, the smallest likelihood for adverse outcome is for isolated positive cores, while the largest is for contiguous core regions. (4) Preoperative PSA >10 ng/dl significantly increases SVI and PLN (p<0.0001). (5) Absence of positive cores in the base or the mid region determines a negative lymph node status, positive cores in the apex do not increase the likelihood of PLN (not statistically significant). (6) RP tumor volume is directly proportional to the NPC, maximal core percentage, and average core percentage. (7) There is no particular region where location of positive cores increases the likelihood of EPE or PSM. The contiguity of positive cores has no bearing in whether EPE appears isolated in a given region or in more than one region.
Conclusions: The NPC, HGS, contiguity of the positive cores, highest percentage of tumor in a core, and PNI are strong predicting factor for EPE, SVI, PSM and PLN. Preoperative PSA >10 ng/dl independently and significantly increases pT3 stage. The likelihood of EPE and PSM in a particular location cannot be predicted on analyzed preoperative data.
Category: Genitourinary (including renal tumors)
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 114, Tuesday Afternoon