Prostate Core Biopsy: Good Predictor of Adverse Pathology?

Gerald Chodak, MD


July 16, 2018

Hello. I am Dr Gerald Chodak from Medscape. Today's topic is biopsy characteristics that might help determine whether a man is a good candidate for active surveillance. Audenet and colleagues[1] looked at over 3000 men with a Gleason score of 3+3 and a prostate-specific antigen (PSA) score no higher than 10 ng/mL who had undergone a radical prostatectomy. They specifically asked whether the total length of cancer (mm), presence of at least 50% cancer in any one biopsy, or three or more cores showing cancer would identify men with adverse pathology following their surgery.

Adverse pathology included Grade Group 3, meaning they had the presence of seminal vesicle invasion or lymph node invasion, or Gleason score of 4+3. They found that 5.1% of men had the adverse pathology observed on the radical prostatectomy. Total length of cancer, the presence of any one biopsy showing greater than 50% cancer, or the presence of more than two positive cores could not help predict whether patients would have the adverse pathology after radical prostatectomy.

On the basis of this observation, they do not believe that you can use these findings to exclude men from undergoing active surveillance. But I think there is another important [issue to question], based on these findings. We know that characteristics used to tell a man that he should come off active surveillance often may include the finding of more millimeters of cancer, presence of > 50% cancer in a core, or an increase in the number of cores positive. So these data might suggest that those changes may not portend a bad outcome and, perhaps, should not be the determinant for whether a man should remain on active surveillance.

It is fair to say that many of the men who start active surveillance end up stopping it, perhaps prematurely. Here we have some data that say that those pathologic findings may not be associated with a bad finding from radical prostatectomy and may not require aggressive therapy. I look forward to your comments. Thank you.


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