Gleason 6 prostate cancer in one or two biopsy cores can harbor more aggressive disease

Mark H. Katz, Sergey Shikanov, Maxine Sun, Firas Abdollah, Lars Budaeus, Edward M. Gong, Scott E. Eggener, Gary D. Steinberg, Gregory P. Zagaja, Arieh L. Shalhav, Pierre I. Karakiewicz, Kevin C. Zorn

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background and Purpose: Patients with Gleason (GL) 6 prostate cancer in one or two biopsy cores can be upgraded and/or upstaged at the time of surgery, which may adversely impact long-term outcome. A novel model for prediction of adverse pathologic outcomes was developed using preoperative characteristics. Patients and Methods: Between 2003 and 2007, 1159 patients underwent robot-assisted radical prostatectomy (RARP) at our institution. GL 6 prostate cancer in one or two biopsy cores was identified in 416 (36%) patients. Logistic regression analyses were used to assess the rate of GL ≥7 and/or extraprostatic extension at RARP. Covariates consisted of age, body mass index (BMI), number of positive cores, greatest percent of cancer in a core (GPC), clinical stage, and preoperative prostate-specific antigen (PSA) level. After backward variable selection, the developed model was internally validated using the area under the curve and subjected to methods of calibration. Results: Respectively, 278 (67%) and 138 (33%) patients had one or two positive biopsy cores. At RARP, 90 (22%) patients were upgraded to GL ≥7 and 37 (9%) had extraprostatic extension. The novel model relied on age, BMI, preoperative PSA level, and GPC for prediction of adverse pathologic outcomes and was 69% accurate. Calibration plot revealed a virtually perfect relationship between predicted and observed probabilities. Conclusions: In patients with GL 6 prostate cancer in one or two biopsy cores, 25% have more ominous pathology at RARP. The model provides an individual assessment of adverse outcomes at surgery. Consequently, it may be considered when counseling patients regarding their management options.

Original languageEnglish (US)
Pages (from-to)699-703
Number of pages5
JournalJournal of Endourology
Volume25
Issue number4
DOIs
StatePublished - Apr 1 2011

ASJC Scopus subject areas

  • Urology

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