Individual Core Length, but Not Total Number of Cores or Total Core Length, Is Associated with Gleason Score Upgrading at Radical Prostatectomy in Patients Eligible for Active Surveillance
Kathy R Kawaguchi, Michael P Herman, Kyung Park, Abhishek Srivastava, Ashutosh K Tewari, Juan Miguel Mosquera, Brian D Robinson. Weill Cornell Medical College, New York
Background: Active surveillance (AS) of prostate cancer is becoming an increasingly attractive option for men with potentially indolent disease who wish to avoid the risk of treatment side effects. While several studies have looked at the effect of biopsy number and quality on the detection of cancer and on Gleason score (GS) upgrading at radical prostatectomy, few have evaluated these parameters specifically in patients who are candidates for active surveillance. Moreover, none have examined the length of each needle core as a potential marker of biopsy quality in selecting patients for AS.
Design: This study included 79 patients who underwent radical prostatectomy (RP) at our institution but were candidates for active surveillance based upon Epstein criteria (≤2 cores involved, ≤50% involvement of any core, GS≤6, and PSA density <0.1 ng/ml). 55 of these men had GS 6 and organ confined (pT2) disease at RP (“control group”), while 24 had GS 7 and PT2 disease at RP (“upgraded group”). Number of cores taken, number of cores/core fragments received in pathology, and length of each core/core fragment was recorded for each case.
Results: Control and upgraded groups had an average of 19.4 (range: 6-43) and 17.2 (range: 4-49) cores taken per case, respectively (p=0.08). Core/core fragments received in pathology averaged 23.0 (range: 27-56) for the control and 21.3 (range: 5-70) for the upgraded groups (p=0.07). Mean (±SD) total length of tissue examined was 27.4 (±13) mm and 23.1 (±16) mm in the control and upgraded groups, respectively (p=0.2). However, average core length was 1.19 (±0.55) mm in the control group versus 1.09 (±0.58) mm in the upgraded group (p<0.0005). Other variables, including age, BMI, clinical stage, number cores positive, % core involvement, and pre-op PSA, did not differ between the two groups.
Conclusions: Although the number of cores taken, rate of core fragmentation, and total length of tissue examined did not differ between the control and upgraded groups, the length of individual cores did differ significantly between the two groups. These findings reaffirm the need for high quality biopsy technique in selecting patients for active surveillance, as suboptimal biopsy cores may be undersampling more central and anterior regions of the prostate and thus missing detection of higher GS cancer.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 174, Wednesday Afternoon