Performance characteristics of prostate-specific antigen density and biopsy core details to predict oncological outcome in patients with intermediate to high-risk prostate cancer underwent robot-assisted radical prostatectomy

BMC Urology

Research Article

Yoshimasa Nakazato¹  Yasushi Kaji²  Masahiro Yashi³  Tsunehito Kambara³  Issei Suzuki³  Akinori Nukui³  Hironori Betsunoh³  Kohei Takei³  Hideyuki Abe³  Yuumi Tokura³  Takao Kamai³  Hideo Yuki³  Kazumasa Sakamoto³  Yoshitatsu Fukabori³ 

[1] Department of Pathology, Dokkyo Medical University, Tochigi, Japan;Department of Radiology, Dokkyo Medical University, Tochigi, Japan;Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, 321-0293, Mibu, Shimotsuga, Tochigi, Japan;

关键词: Predictive factor;    Performance characteristics;    Prostate-specific antigen density;    Biopsy core details;    Robot-assisted radical prostatectomy;   

DOI  :  10.1186/s12894-017-0238-y

 received in 2017-03-08, accepted in 2017-06-19,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMany urologic surgeons refer to biopsy core details for decision making in cases of localized prostate cancer (PCa) to determine whether an extended resection and/or lymph node dissection should be performed. Furthermore, recent reports emphasize the predictive value of prostate-specific antigen density (PSAD) for further risk stratification, not only for low-risk PCa, but also for intermediate- and high-risk PCa. This study focused on these parameters and compared respective predictive impact on oncologic outcomes in Japanese PCa patients.MethodsTwo-hundred and fifty patients with intermediate- and high-risk PCa according to the National Comprehensive Cancer Network (NCCN) classification, that underwent robot-assisted radical prostatectomy at a single institution, and with observation periods of longer than 6 months were enrolled. None of the patients received hormonal treatments including antiandrogens, luteinizing hormone-releasing hormone analogues, or 5-alpha reductase inhibitors preoperatively. PSAD and biopsy core details, including the percentage of positive cores and the maximum percentage of cancer extent in each positive core, were analyzed in association with unfavorable pathologic results of prostatectomy specimens, and further with biochemical recurrence. The cut-off values of potential predictive factors were set through receiver-operating characteristic curve analyses.ResultsIn the entire cohort, a higher PSAD, the percentage of positive cores, and maximum percentage of cancer extent in each positive core were independently associated with advanced tumor stage ≥ pT3 and an increased index tumor volume > 0.718 ml. NCCN classification showed an association with a tumor stage ≥ pT3 and a Gleason score ≥8, and the attribution of biochemical recurrence was also sustained. In each NCCN risk group, these preoperative factors showed various associations with unfavorable pathological results. In the intermediate-risk group, the percentage of positive cores showed an independent predictive value for biochemical recurrence. In the high-risk group, PSAD showed an independent predictive value.ConclusionsPSAD and biopsy core details have different performance characteristics for the prediction of oncologic outcomes in each NCCN risk group. Despite the need for further confirmation of the results with a larger cohort and longer observation, these factors are important as preoperative predictors in addition to the NCCN classification for a urologic surgeon to choose a surgical strategy.

【 授权许可】

CC BY   
© The Author(s). 2017