DERGİSİ TIPDERGİSİ - DNT ORTADOĞU YAYINCILIK :: Anasayfa

Is Percentage Of Cancer Positive Cores In Prostate Biopsy Useful For Predicting The
Changes In Gleason Scores After Radical Prostatectomy?
Introduction
Radical prostatectomy (RP), remains to be the treatment
of choice for the patients with clinically localized prostate
cancer and a life-expectancy of at least 10 years, due to
its continously refined surgical outcomes and decreasing
morbidity and mortality rates. Local recurrence-free survival
rates of 83% and 75% were reported after RP for
10 and 15 years, respectively (1). Prognostic factors after
RP include baseline PSA level, clinical stage, biopsy
Gleason score, postoperative Gleason score and pathological
stage (2-4). It has been demonstrated in various studies
that prostatectomy Gleason score is the most important
prognostic factor for biochemical recurrence after RP
(5, 6). Higher prostatectomy gleason score is associated
with higher postoperative biochemical recurrence and low
cancer-specific survival rates(7). On the other hand, it was
reported that although the biopsy Gleason score remained
unchanged after RP in 31-63% of the patients, it increased
in 35 to 44% of them (8-10). These findings suggest that
a pre-operative low-risk patient for biochemical failure
and cancer-specific survival according to biopsy Gleason
score may be in fact, a high-risk patient with respect to
the RP gleason score. Considering the points mentioned
above, preoperative prediction of the patients who are at
the risk of Gleason score increase after RP may contribute
the overall outcome of the definitive therapy.
The association between the Gleason score increase after
RP and percentage of positive biopsy cores was evaluated
in this study.
Material and Methods
One hundred and ninety-five patients who underwent RP
for clinically localized prostate cancer between January
1997 and may 2008 were included in the study. Clinical
and pathological records of the patients were evaluated retrospectively.
Patients with a history of previous radiation
or hormonal therapy (n=7), with 4ng/ml . PPC was obtained by dividing
the number of cancer positive cores to the total number of
biopsy cores. The total and free PSA levels were measured
with monoclonal tandem assays using various kits in time.
Histological grading of biopsy and RP specimens were
made according to the Gleason grading system (11).
50 ORTADOGU MEDICAL JOURNAL 4 (2): 49- 52 2012
Gleason score increase and decrease were defined as
“higher” and “lower than biopsy” RP scores, respectively.
Clinical and pathological staging were performed according
to the 2002 TNM classification.
Patients were followed every 3 months first year, every 6
months for the next 5 years and annually afterwards, with
DRE, PSA and/or bone scan. Two consecutive PSA levels
≥0.2ng/ml were defined as biochemical failure.
Data were analyzed using SPSS software v11.5. Cathegorical
data were presented as the number and percentage of
the patients whereas continous variables were expressed as
mean±standard deviation. The differences between independent
groups regarding continous variables were evaluated
by Kruskal-Wallis test. For categorical comparisons
Chi-square test was used. P values lower than 0.05 were
considered as statistically significant.
Results
The mean age and mean baseline PSA values of the patients
were 62.9±5.9 years and 11.4±9.6ng/ml, respectively. Preoperative
clinical and pathological data of the patients are
Table 1: Preoperative clinical and pathological data
Mean Age (Years) 62.9±5.9
Mean Baseline PSA (ng/ml) 11.4±9.6
Baseline PSA
n %
15 ng/ml
31 18.9
Mean Prostate Volume (ml) 46.9±23.7
Mean biopsy Gleason score 5.3±1.6
Biopsy Gleason score
n %
2-4
44 26.8
5-7
109 66.5
8-10
11 6.7
Clinical stage
n %
T1a
3 1.8
T1b
15 9.1
T1c
71 43.3
T2a
37 22.6
T2b
29 17.7
T2c
9 5.5
Mean Number of biopsy cores 9.3±1.3
Mean Number of positive biopsy cores 3.5±2.3
Mean percentage of positive biopsy cores 0.38±0.25
Percentage of positive biopsy cores n %
≤0.20
47 32.2
0.21-0.40
46 31.5
0.41-0.60
25 17.1
≥0.61
28 19.2