Yonsei Med J.  2012 Mar;53(2):358-362. 10.3349/ymj.2012.53.2.358.

Are Clinically Insignificant Prostate Cancers Really Insignificant among Korean Men?

• Yeom CD
• Lee SH
• Park KK
• Park SU
• Chung BH

• KMID: 1120203
• DOI: http://doi.org/10.3349/ymj.2012.53.2.358

Abstract

PURPOSE
We aimed to determine whether 12 core-extended biopsies of the prostate could predict insignificant prostate cancer (IPCa) in Koreans reliably enough to recommend active surveillance.
MATERIALS AND METHODS
Two hundred and ninety-seven patients who underwent radical prostatectomy after 12 core-extended prostate biopsies were retrospectively reviewed. 38 cases (12.8%) were shown to be IPCa.
RESULTS
The average age was 65.2 years, serum PSA was 5.49 ng/dL, and the PSA density was 0.11. The Gleason scores (GS) were 6 (3+3) in 31, 5 (3+2) in 4, and 4 (2+2) in 3. After radical prostatectomy, higher GS was given in 16 (42.1%), whereas lower GS was given in 1 case (2.6%), as compared with the GS obtained from biopsy. 11 (28.9%) had GS of 7 (3+4) and 5 (13.2%) had GS of 7 (4+3). 6 in GS 7 (4+3) and 1 in GS 7 (3+4) showed prostate capsule invasion and 1 in GS 7 (4+3) had seminal vesicle invasion. Prostate capsule invasion was observed in 1 with GS 6 (3+3). The rate of inaccuracy of the contemporary Epstein criteria was 42.1%. Only PSA density was a reliable indicator of clinically IPCa (odds ratio=1.384, 95% CI, 1.103 to 2.091).
CONCLUSION
Diagnosis of IPCa from a prostate biopsy underestimated the true nature of prostate cancer in as many as 42.1% of Koreans.

Keyword

Prostate cancer; gleason score; prostate; clinically insignificant

MeSH Terms

Aged
Humans
Male
Middle Aged
Prostate-Specific Antigen/blood
Prostatectomy
Prostatic Neoplasms/blood/*diagnosis/surgery
Retrospective Studies

Figure

• 

  Fig. 1 Incidence of insignificant prostate cancer after prostate biopsy and upgraded pathology after radical prostatectomy. IPCa, insignificant prostate cancer.

Reference

1. Chun FK, Briganti A, Gallina A, Hutterer GC, Shariat SF, Antebie E, et al. Prostate-specific antigen improves the ability of clinical stage and biopsy Gleason sum to predict the pathologic stage at radical prostatectomy in the new millennium. Eur Urol. 2007. 52:1067–1074.

2. Yin M, Bastacky S, Chandran U, Becich MJ, Dhir R. Prevalence of incidental prostate cancer in the general population: a study of healthy organ donors. J Urol. 2008. 179:892–895.

3. Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA. 1994. 271:368–374.

4. Bastian PJ, Mangold LA, Epstein JI, Partin AW. Characteristics of insignificant clinical T1c prostate tumors. A contemporary analysis. Cancer. 2004. 101:2001–2005.

5. Chung JS, Choi HY, Song HR, Byun SS, Seo SI, Song C, et al. Nomogram to predict insignificant prostate cancer at radical prostatectomy in Korean men: a multi-center study. Yonsei Med J. 2011. 52:74–80.

6. Lee SE, Kim DS, Lee WK, Park HZ, Lee CJ, Doo SH, et al. Application of the Epstein criteria for prediction of clinically insignificant prostate cancer in Korean men. BJU Int. 2010. 105:1526–1530.

7. Hekal IA, El-Tabey NA, Nabeeh MA, El-Assmy A, Abd El-Hameed M, Nabeeh A, et al. Validation of Epstein criteria of insignificant prostate cancer in Middle East patients. Int Urol Nephrol. 2010. 42:667–671.

8. Chun FK, Briganti A, Jeldres C, Gallina A, Erbersdobler A, Schlomm T, et al. Tumour volume and high grade tumour volume are the best predictors of pathologic stage and biochemical recurrence after radical prostatectomy. Eur J Cancer. 2007. 43:536–543.

9. Gore JL, Shariat SF, Miles BJ, Kadmon D, Jiang N, Wheeler TM, et al. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol. 2001. 165:1554–1559.

10. Partin AW, Epstein JI, Cho KR, Gittelsohn AM, Walsh PC. Morphometric measurement of tumor volume and per cent of gland involvement as predictors of pathological stage in clinical stage B prostate cancer. J Urol. 1989. 141:341–345.

11. Allan RW, Sanderson H, Epstein JI. Correlation of minute (0.5 MM or less) focus of prostate adenocarcinoma on needle biopsy with radical prostatectomy specimen: role of prostate specific antigen density. J Urol. 2003. 170(2 Pt 1):370–372.

12. Jeldres C, Suardi N, Walz J, Hutterer GC, Ahyai S, Lattouf JB, et al. Validation of the contemporary epstein criteria for insignificant prostate cancer in European men. Eur Urol. 2008. 54:1306–1313.

13. Song C, Ro JY, Lee MS, Hong SJ, Chung BH, Choi HY, et al. Prostate cancer in Korean men exhibits poor differentiation and is adversely related to prognosis after radical prostatectomy. Urology. 2006. 68:820–824.

14. Man A, Pickles T, Chi KN. British Columbia Cancer Agency Prostate Cohort Outcomes Initiative. Asian race and impact on outcomes after radical radiotherapy for localized prostate cancer. J Urol. 2003. 170:901–904.

15. Hoffman MA, DeWolf WC, Morgentaler A. Is low serum free testosterone a marker for high grade prostate cancer? J Urol. 2000. 163:824–827.

16. Kim HS, Jeon SS, Choi JD, Kim W, Han DH, Jeong BC, et al. Detection rates of nonpalpable prostate cancer in Korean men with prostate-specific antigen levels between 2.5 and 4.0 ng/mL. Urology. 2010. 76:919–922.

17. Sokoloff MH, Yang XJ, Fumo M, Mhoon D, Brendler CB. Characterizing prostatic adenocarcinomas in men with a serum prostate specific antigen level of < 4.0 ng/mL. BJU Int. 2004. 93:499–502.

18. Smith RP, Malkowicz SB, Whittington R, VanArsdalen K, Tochner Z, Wein AJ. Identification of clinically significant prostate cancer by prostate-specific antigen screening. Arch Intern Med. 2004. 164:1227–1230.

19. Chun FK, Steuber T, Erbersdobler A, Currlin E, Walz J, Schlomm T, et al. Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol. 2006. 49:820–826.

20. Singh J, Trabulsi EJ, Gomella LG. Is there an optimal management for localized prostate cancer? Clin Interv Aging. 2010. 5:187–197.