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| |  Minimal Tumour on Prostate Biopsy Not Predictive of Tumour Volume: Presented at CURy By Chris Berrie BARCELONA, SPAIN -- February 3, 2008 -- A single positive core at biopsy for patients undergoing radical prostatectomy (RP) is not predictive of significantly greater tumour volume or oncologically dormant tumour when compared with multiple positive cores, according to a retrospective review presented here at the World Congress on Controversies in Urology (CURy). "At multidisciplinary team meetings, it can often be stated that where there is only one core positive for disease in a biopsy, that patient must have minimal tumour, and so they are more suitable for active surveillance rather than radical prostatectomy," said Khurshid Ghani, MD, Principal Investigator and Senior Resident, Department of Urology, The Princess Alexandra Hospital, Harlow, Essex, England. However, as Dr. Ghani indicated in a presentation on February 1, this has not been specifically demonstrated. On the basis of their more aggressive approach to the use of RP also for single positive-core biopsies, Dr. Ghani and colleagues therefore evaluated whether a single cancer-positive core at biopsy is indeed predictive of low tumour volume or extracapsular extension at subsequent RP. Over 3 years, 105 patients (mean age, 64.6 years) with mean prostate-specific antigen (PSA) levels of 8.8 ng/mL underwent prostate biopsy followed by RP, with a median of 14 cores taken. Patients were divided according to numbers of positive cores: group 1 had one positive core for cancer (n = 34); group 2 had more than one positive core (n = 71). Group 1 patients were also divided for tumour pathology: 1a, microfocal (<1 mm focus; n = 17); 1b, small volume (<3 mm focus; n = 9); and 1c, >3 mm focus (n = 8). Across and within these groups there were no significant differences seen for mean age and PSA levels, and median number of cores taken. Following RP, there were no significant differences in mean tumour volumes between groups 1 and 2 (13.9% vs 21.1%, respectively) and patients classified with positive surgical margins (26% vs 28%, respectively). However, the latter was not considered further as there were discrepancies in margin reporting over time, Dr. Ghani said. Across subgroups 1a, 1b, and 1c, as there were no significant differences in tumour volumes (15.0% vs 8.7% vs 16.7%, respectively), those with microfocal disease still had significant volume, Dr. Ghani noted. Although the extracapsular extension was significantly lower for group 1 versus group 2 (17.7% vs 40.9%; P =.025), Dr. Ghani stressed that it was still almost 18%, representing T3 disease in the one-core group. While noting their use of 14 cores, and that one third of their patients had anterior tumours, Dr. Ghani stressed, "If you are going to tell your one-core patient to have active surveillance -- hold on a minute, rebiopsy that patient to be absolutely sure, and target the anterior area."
[Presentation title: Minimal Tumor on Prostate Biopsy - the Tip of the Iceberg? Poster 30]
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