Can a Gleason 6 or Less Microfocus of Prostate Cancer in One Biopsy and Prostate-Specific Antigen Level <10‚ÄČng/mL Be Defined as the Archetype of Low-Risk Prostate Disease?

Gianluigi Taverna1, Rodolfo Hurle1, Fabio Grizzi1, Mauro Seveso1, Guido Giusti1, Alessio Benetti1, Piergiuseppe Colombo1, Luisa Pasini1, Luigi Castaldo1, Silvia Zandegiacomo De Zorzi1, Roberto Peschechera1, Pierpaolo Graziotti1
  • 1 Istituto Clinico Humanitas (Rozzano)

Objective

Prostate cancer ( PC ) remains a cause of death worldwide. Here we investigate whether a single microfocus of PC at the biopsy ( graded as Gleason 6 or less, ≤5% occupancy ) and the PSA < 10 ng/mL can define the archetype of low – risk prostate disease. 4500 consecutive patients were enrolled. Among them, 134 patients with a single micro – focus of PC were followed up, and the parameters influencing the biochemical relapse (BR) were analysed. Out of 134 patients, 94 had clinically significant disease, specifically in 74.26% of the patients with PSA < 10 ng/mL. Positive surgical margins and the extracapsular invasion were found in 29.1% and 51. 4% patients, respectively. BR was observed in 29.6% of the patients. Cox regression evidenced a correlation between the BR and Gleason grade at the retropubic radical prostatectomy ( RRP ), capsular invasion, and the presence of positive surgical margins. Multivariate regression analysis showed a statistically significant correlation between the presence of surgical margins at the RRP and BR. Considering a single micro-focus of PC at the biopsy and PSA serum level <10 ng/mL, clinically significant disease was found in 74. 26% patients and only positive surgical margins are useful for predicting the BR.

Methods and results

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Discussion

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Argomenti: