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Can we predict real T3 stage prostate cancer in patients with clinical T3 (cT3) disease before radical prostatectomy?

Lee HW, Seo SI, Jeon SS, Lee HM, Choi HY - Yonsei Med. J. (2010)

Bottom Line: We identified the significant predictors for down-staging of cT3 after RP.When the cut-off points of significant parameters which were a PSA < 10 ng/mL, a percent of positive cores < or = 30%, a maximum tumor volume of the positive cores < or = 75% and GS < or = 7 were combined, the sensitivity, specificity, and positive predictive value were 0.25%, 1.00%, and 100%, respectively.The percent of positive cores < or = 30%, serum PSA < 10 ng/mL, the biopsy GS < or = 7, and the maximum tumor volume of the positive cores < or = 75% were the significant predictors of down-staging cT3 disease after RP.

View Article: PubMed Central - PubMed

Affiliation: Department of Integrative Bioscience and Biotechnology, Pohang University of Science and Technology, Pohang, Korea.

ABSTRACT

Purpose: Down-staging of clinical T3 (cT3) prostate cancer after radical prostatectomy (RP) is not uncommon due to the inaccuracy of the currently available staging modalities, although selected down-staged cT3 patients can be a candidate for definitive RP. We identified the significant predictors for down-staging of cT3 after RP.

Materials and methods: We included 67 patients with cT3 stage prostate cancer treated with radical perineal prostatectomy (RPP) between 1998 and 2006 and reviewed their medical records retrospectively. The clinical stage was obtained according to the DRE, the prostate biopsy findings, and the prostate MRI.

Results: Fifty three (79%) patients with cT3 prostate cancer were down-staged to pT2 after RP. The percent of positive cores had the strongest association with down-staging of cT3 [p = 0.01, odds ratio (OR) = 6.3], followed by baseline prostate specific antigen (PSA) (p = 0.03, OR = 5.0), the biopsy Gleason sum (GS) (p = 0.03, OR = 4.7), and the maximum tumor volume of the positive cores (p = 0.05, OR = 4.0). When the cut-off points of significant parameters which were a PSA < 10 ng/mL, a percent of positive cores < or = 30%, a maximum tumor volume of the positive cores < or = 75% and GS < or = 7 were combined, the sensitivity, specificity, and positive predictive value were 0.25%, 1.00%, and 100%, respectively.

Conclusion: The percent of positive cores < or = 30%, serum PSA < 10 ng/mL, the biopsy GS < or = 7, and the maximum tumor volume of the positive cores < or = 75% were the significant predictors of down-staging cT3 disease after RP.

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Related in: MedlinePlus

The ROC curve analysis of each clinical parameter for predicting down-staging of clinical T3 prostate cancer area under curve (AUC). Preoperative PSA, 0.832; Biopsy Gleason sum (GS), 0.706; Percent of positive cores, 0.687; Maximum tumor volume of the positive cores, 0.592. ROC, receiver operating characteristics; PSA, prostate specific antigen.
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Figure 1: The ROC curve analysis of each clinical parameter for predicting down-staging of clinical T3 prostate cancer area under curve (AUC). Preoperative PSA, 0.832; Biopsy Gleason sum (GS), 0.706; Percent of positive cores, 0.687; Maximum tumor volume of the positive cores, 0.592. ROC, receiver operating characteristics; PSA, prostate specific antigen.

Mentions: The ROC curve analysis demonstrated the largest AUC for the preoperative PSA (0.832), and this was followed by the biopsy GS (0.706), the percent of positive cores (0.687), and the maximum tumor volume of the positive cores (0.592) (Fig. 1). Table 3 lists the sensitivity, specificity, and PPV at the cut-off value of each predictor for down-staging cT3 disease. Among the 28 (42%) patients with an initial PSA level ≤ 10 ng/mL, only 57% were down-staged according to the radical prostatectomy specimen. But if the preop PSA level was less than 10 ng/mL, then 95% of the patients would have had a pathological stage ≤ pT2. If the cut off value of the percent of positive cores was determined as 30%, then the sensitivity, specificity, and PPV were 0.36, 1.00, and 100% in contrast to 0.94, 0.14, and 85%, respectively, when the percent of positive cores was determined as 75%. In addition, the sensitivity, specificity, and PPV were 0.66, 0.50, and 83%, respectively, at a 75% maximum tumor volume of the positive core and these values were 0.40, 0.79 and 88%, respectively, at a biopsy GS of 7. Finally, when the cut-off points of significant parameters which were a PSA < 10 ng/mL, a percent of positive cores ≤ 30%, a maximum tumor volume of the positive cores ≤ 75% and GS ≤ 7 were combined, then the sensitivity, specificity, and PPV were determined to be 0.25, 1.00, and 100%, respectively.


Can we predict real T3 stage prostate cancer in patients with clinical T3 (cT3) disease before radical prostatectomy?

Lee HW, Seo SI, Jeon SS, Lee HM, Choi HY - Yonsei Med. J. (2010)

The ROC curve analysis of each clinical parameter for predicting down-staging of clinical T3 prostate cancer area under curve (AUC). Preoperative PSA, 0.832; Biopsy Gleason sum (GS), 0.706; Percent of positive cores, 0.687; Maximum tumor volume of the positive cores, 0.592. ROC, receiver operating characteristics; PSA, prostate specific antigen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908868&req=5

Figure 1: The ROC curve analysis of each clinical parameter for predicting down-staging of clinical T3 prostate cancer area under curve (AUC). Preoperative PSA, 0.832; Biopsy Gleason sum (GS), 0.706; Percent of positive cores, 0.687; Maximum tumor volume of the positive cores, 0.592. ROC, receiver operating characteristics; PSA, prostate specific antigen.
Mentions: The ROC curve analysis demonstrated the largest AUC for the preoperative PSA (0.832), and this was followed by the biopsy GS (0.706), the percent of positive cores (0.687), and the maximum tumor volume of the positive cores (0.592) (Fig. 1). Table 3 lists the sensitivity, specificity, and PPV at the cut-off value of each predictor for down-staging cT3 disease. Among the 28 (42%) patients with an initial PSA level ≤ 10 ng/mL, only 57% were down-staged according to the radical prostatectomy specimen. But if the preop PSA level was less than 10 ng/mL, then 95% of the patients would have had a pathological stage ≤ pT2. If the cut off value of the percent of positive cores was determined as 30%, then the sensitivity, specificity, and PPV were 0.36, 1.00, and 100% in contrast to 0.94, 0.14, and 85%, respectively, when the percent of positive cores was determined as 75%. In addition, the sensitivity, specificity, and PPV were 0.66, 0.50, and 83%, respectively, at a 75% maximum tumor volume of the positive core and these values were 0.40, 0.79 and 88%, respectively, at a biopsy GS of 7. Finally, when the cut-off points of significant parameters which were a PSA < 10 ng/mL, a percent of positive cores ≤ 30%, a maximum tumor volume of the positive cores ≤ 75% and GS ≤ 7 were combined, then the sensitivity, specificity, and PPV were determined to be 0.25, 1.00, and 100%, respectively.

Bottom Line: We identified the significant predictors for down-staging of cT3 after RP.When the cut-off points of significant parameters which were a PSA < 10 ng/mL, a percent of positive cores < or = 30%, a maximum tumor volume of the positive cores < or = 75% and GS < or = 7 were combined, the sensitivity, specificity, and positive predictive value were 0.25%, 1.00%, and 100%, respectively.The percent of positive cores < or = 30%, serum PSA < 10 ng/mL, the biopsy GS < or = 7, and the maximum tumor volume of the positive cores < or = 75% were the significant predictors of down-staging cT3 disease after RP.

View Article: PubMed Central - PubMed

Affiliation: Department of Integrative Bioscience and Biotechnology, Pohang University of Science and Technology, Pohang, Korea.

ABSTRACT

Purpose: Down-staging of clinical T3 (cT3) prostate cancer after radical prostatectomy (RP) is not uncommon due to the inaccuracy of the currently available staging modalities, although selected down-staged cT3 patients can be a candidate for definitive RP. We identified the significant predictors for down-staging of cT3 after RP.

Materials and methods: We included 67 patients with cT3 stage prostate cancer treated with radical perineal prostatectomy (RPP) between 1998 and 2006 and reviewed their medical records retrospectively. The clinical stage was obtained according to the DRE, the prostate biopsy findings, and the prostate MRI.

Results: Fifty three (79%) patients with cT3 prostate cancer were down-staged to pT2 after RP. The percent of positive cores had the strongest association with down-staging of cT3 [p = 0.01, odds ratio (OR) = 6.3], followed by baseline prostate specific antigen (PSA) (p = 0.03, OR = 5.0), the biopsy Gleason sum (GS) (p = 0.03, OR = 4.7), and the maximum tumor volume of the positive cores (p = 0.05, OR = 4.0). When the cut-off points of significant parameters which were a PSA < 10 ng/mL, a percent of positive cores < or = 30%, a maximum tumor volume of the positive cores < or = 75% and GS < or = 7 were combined, the sensitivity, specificity, and positive predictive value were 0.25%, 1.00%, and 100%, respectively.

Conclusion: The percent of positive cores < or = 30%, serum PSA < 10 ng/mL, the biopsy GS < or = 7, and the maximum tumor volume of the positive cores < or = 75% were the significant predictors of down-staging cT3 disease after RP.

Show MeSH
Related in: MedlinePlus