OncologyPreoperative Prediction of Unifocal, Unilateral, Margin-Negative, and Small Volume Prostate Cancer
Section snippets
Patients
We performed a retrospective review of pathology specimens from patients with available biopsy materials who underwent radical retropubic prostatectomy for clinically localized prostate cancer between 2000 and 2003. Surgery was performed at two centers: University of Colorado Health Science Center, and Methodist Hospital, Houston. The study was approved by the institutional review boards of participating institutions. Review of patient charts disclosed patient age, serum PSA, and whether
Clinical and Pathologic Findings
Table 1 summarizes our analysis from 393 patients who underwent radical retropubic prostatectomy for clinically localized prostate cancer. Interinstitutional comparison of clinical, biopsy, and prostatectomy findings revealed significant differences in certain measures. The distribution of patients was 346 from Baylor and 47 from Colorado. (Numbers in the Colorado group were limited by the practice being 80% outside consultation cases, with biopsy slides and reports unavailable for these
Comment
Our study shows, for the first time, that tumor laterality and focality in extended or sextant prostatic needle biopsies strongly predict findings in contemporary prostatectomy specimens. Unilaterality of biopsy cancer was the most robust variable, predictive of four outcome findings: unilateral cancer, unifocal cancer, margin status, and small volume cancer. Unilaterality predicted all four findings more strongly than did Gleason score. Notably, sampling 9 or more cores heightened the odds
Conclusions
Unilateral cancer and unifocal cancer are two variables in prostate biopsies that strongly, independently predict unilateral, unifocal, margin-negative, and small volume cancer. These findings are prerequisites for focal cryosurgery, radiotherapy, and high-intensity focused ultrasound, and might allow unilateral lapraroscopic surgery. The predictive value of these variables is amplified by extended sampling.
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