Adult urologyUtility of saturation biopsy to predict insignificant cancer at radical prostatectomy
Section snippets
Material and methods
Using the preoperative needle biopsy pathologic findings and serum PSA levels, RP candidates were identified who were likely to harbor insignificant prostate cancer and who, alternatively, could have been considered for expectant management. Consecutive patients undergoing RP were selected for the following features. Clinically, all patients were required to have nonpalpable disease (Stage T1c) with a PSA density of less than 0.15. The serum PSA density was calculated using the prostate weight
Preoperative Clinical and Pathologic Findings
Patients ranged in age from 40 to 71 years (mean 59.6, median 57). The serum PSA level ranged from 0.7 to 8.6 ng/mL (mean 4.6, median 4.7). The serum PSA density level ranged from 0.013 to 0.15 (mean and median 0.08). Of the preoperative needle biopsies, 76 (73.8%) showed only one core involved. The remaining cases had two cores involved. The maximal percentage of core involvement by cancer ranged from 5% to 40% (mean 12.4%), with 53% of cases showing less than 5% involvement.
Pathologic Findings at RP
The prostate
Comment
With increased detection of early prostate cancer using serum PSA testing, concern has been raised that an increasing number of prostate cancers detected by such tests may be clinically insignificant, resulting in potentially unnecessary definitive therapy. Some authorities have even questioned whether serum PSA levels that are moderately elevated (less than 10 ng/mL) do not reflect prostate cancer, but rather correlate more with benign prostatic hyperplasia.5 If so, biopsies detecting cancer
Conclusions
Although none of the tests to predict significant versus insignificant cancer will be 100% accurate, saturation needle biopsy sampling provides a rational, accurate measurement of tumor extent and grade within the prostate to allow better stratification of men who are candidates for watchful waiting. Nevertheless, even with saturation biopsy, a small percentage of men will have more significant, but undersampled, cancer who will have been falsely predicted as having insignificant cancer because
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