Yonsei Med J.  2010 Sep;51(5):700-707. 10.3349/ymj.2010.51.5.700.

Can We Predict Real T3 Stage Prostate Cancer in Patients with Clinical T3 (cT3) Disease before Radical Prostatectomy?

• Lee HW
• Seo SI
• Jeon SS
• Lee HM
• Choi HY

• KMID: 1071421
• DOI: http://doi.org/10.3349/ymj.2010.51.5.700

Abstract

PURPOSE
Down-staging of clinical T3 (cT3) prostate cancer after radical prostatectomy (RP) is not uncommon due to the inaccuracy of the currently available staging modalities, although selected down-staged cT3 patients can be a candidate for definitive RP. We identified the significant predictors for down-staging of cT3 after RP.
MATERIALS AND METHODS
We included 67 patients with cT3 stage prostate cancer treated with radical perineal prostatectomy (RPP) between 1998 and 2006 and reviewed their medical records retrospectively. The clinical stage was obtained according to the DRE, the prostate biopsy findings, and the prostate MRI.
RESULTS
Fifty three (79%) patients with cT3 prostate cancer were down-staged to pT2 after RP. The percent of positive cores had the strongest association with down-staging of cT3 [p = 0.01, odds ratio (OR) = 6.3], followed by baseline prostate specific antigen (PSA) (p = 0.03, OR = 5.0), the biopsy Gleason sum (GS) (p = 0.03, OR = 4.7), and the maximum tumor volume of the positive cores (p = 0.05, OR = 4.0). When the cut-off points of significant parameters which were a PSA < 10 ng/mL, a percent of positive cores < or = 30%, a maximum tumor volume of the positive cores < or = 75% and GS < or = 7 were combined, the sensitivity, specificity, and positive predictive value were 0.25%, 1.00%, and 100%, respectively.
CONCLUSION
The percent of positive cores < or = 30%, serum PSA < 10 ng/mL, the biopsy GS < or = 7, and the maximum tumor volume of the positive cores < or = 75% were the significant predictors of down-staging cT3 disease after RP.

Keyword

Prostate cancer; staging; cT3; MRI

MeSH Terms

Aged
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Staging
Predictive Value of Tests
Prostate-Specific Antigen/blood
*Prostatectomy
Prostatic Neoplasms/blood/diagnosis/*pathology/*surgery

Figure

• 

  Fig. 1 The ROC curve analysis of each clinical parameter for predicting down-staging of clinical T3 prostate cancer area under curve (AUC). Preoperative PSA, 0.832; Biopsy Gleason sum (GS), 0.706; Percent of positive cores, 0.687; Maximum tumor volume of the positive cores, 0.592. ROC, receiver operating characteristics; PSA, prostate specific antigen.

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