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The role of biopsy core number in selecting prostate cancer patients for active surveillance.

Abstract：

BACKGROUND:Studies offer wide variations in inclusion criteria for active surveillance (AS) in prostate cancer (PCa), but the role of the biopsy core number has not been thoroughly assessed. OBJECTIVE:To evaluate the impact of the biopsy core number on the risk of misclassification for AS eligibility. DESIGN, SETTING, AND PARTICIPANTS:This prospective study included 411 men eligible for AS who fulfilled at least one of four of the criteria reported in the literature groupings among a screening cohort of 2917 patients. INTERVENTION:All patients underwent a 21-core biopsy with cores mapped by location and acted as controls of themselves for the analysis of biopsy core number (6-, 12- and 21-core schemes). Radical prostatectomy (RP) was performed in 297 men (72%). MEASUREMENTS:The number of included patients, PCa extent on biopsy, rate of unfavorable disease in RP specimens, and biochemical recurrence-free survival were compared as a function of (1) the different criteria groupings for AS and (2) the biopsy core number (6, 12, or 21). RESULTS AND LIMITATIONS:Of the 1104 patients with PCa, the proportion eligible for AS ranged from 22.5% to 35.4% based on AS criteria. In men who fulfilled AS criteria only in a 12-core strategy, tumor length and percentage of cancer involvement on biopsy were significantly greater than in those who fulfilled AS criteria in a 21-core scheme. The rate of unfavorable disease on RP specimens was also higher in the former group, from 28.6% to 35.9% relative to AS criteria (p=0.014, 0.044, and 0.113 in groups 2, 3, and 4, respectively). CONCLUSIONS:Men eligible for AS based on a 21-core strategy have cancers with a lower extent of disease on biopsies and a lower risk of unfavorable disease on RP specimens regardless of how AS criteria are defined, compared with men eligible in a 12-core scheme.

journal_name

Eur Urol

journal_title

European urology

authors

Ploussard G,Xylinas E,Salomon L,Allory Y,Vordos D,Hoznek A,Abbou CC,de la Taille A

doi

10.1016/j.eururo.2009.07.053

subject

Has Abstract

pub_date

2009-12-01 00:00:00

pages

891-8

issue

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(09)00800-8

journal_volume

pub_type

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The role of biopsy core number in selecting prostate cancer patients for active surveillance.