Assessment of Pathological Prostate Cancer Characteristics in Men with Favorable Biopsy Features on Predominantly Sextant Biopsy

Felix K H Chun, Nazareno Suardi, Umberto Capitanio, Claudio Jeldres, Sascha Ahyai, Markus Graefen, Alexander Haese, Thomas Steuber, Andreas Erbersdobler, Francesco Montorsi, Hartwig Huland, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review


Background: The rate of insignificant prostate cancer (IPCa) is increasing. Objectives: To examine three end points in patients with a single, positive core and no high-grade prostate cancer (PCa) at biopsy, namely (1) rate of clinical IPCa at radical prostatectomy (RP), defined as organ-confined PCa with a Gleason score of 6 or lower and tumor volume <0.5 cc; (2) rate of pathologically unfavorable PCa at RP (Gleason 7-10 or non-organ-confined disease); and (3) ability to predict either insignificant or unfavorable PCa at RP. Design, Setting, and Participants: Retrospective analysis of 209 men with one positive biopsy core showing Gleason 6 or lower. Measurements: : Detailed clinical and RP data were used in multivariable logistic regression models. Their bias-corrected accuracy estimates were quantified using the area under the curve (AUC) method. Results and Limitations: At RP, IPCa was present in 28 patients (13.4%) and pathologically unfavorable PCa, defined as Gleason 7 or higher or non-organ-confined PCa, was reported in 70 (33.5%) of 209 men; when Gleason 8 or higher or non-organ-confined PCa was considered, the proportion fell to 11%. Our multivariable models predicting different categories of pathologically unfavorable PCa at RP had an accuracy rate between 56% and 68% for predicting IPCa at RP versus 65.1% to 66.1% and 61.7% for the IPCa nomograms of Kattan et al and Nakanishi et al, respectively. Our data are not applicable to screening because they originate from a referral population. Conclusions: Despite highly favorable biopsy features, between 11% and 33% of men had unfavorable PCa at RP and only a minority (13.4%) had pathologically confirmed IPCa. Neither clinically insignificant nor pathologically unfavorable features could be predicted with sufficient accuracy for clinical decision making.

Original languageEnglish
Pages (from-to)617-628
Number of pages12
JournalEuropean Urology
Issue number3
Publication statusPublished - Mar 2009


  • Minimal disease
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology


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