Prediction of pathological stages before prostatectomy in prostate cancer patients: Analysis of 12 systematic prostate needle biopsy specimens

Objective: To identify the most reliable predictor of the pathological stage among multiple parameters obtained by performing systematic biopsies and to assess the predictive value of any identified parameters in combination with the prostate specific antigen and the Gleason scores. Methods: We examined 5 biopsy parameters from 12 systematic needle biopsy results in 104 consecutive prostate cancer patients who underwent prostatectomy: the number of cores positive for cancer, percentage of positive biopsy cores, total linear cancer length (absolute sum of tumor length at each core), percentage cancer length (total cancer length divided by total length of cores obtained x100), and maximum cancer core length. The predictive values of these parameters were assessed using multivariate logistic analysis and receiver operating characteristic analysis. We evaluated whether the most reliable biopsy parameter in combination with traditional variables show better predictability of the pathological stage than traditional variables alone by receiver operating characteristic analysis. Results: Of 104 patients, 85 (82.9%) had organ confined cancer and 19 (17.1%) showed extraprostatic extension. Of the five parameters examined, maximum cancer length was found to best predict pathological staging. Although insignificant, adding results of maximum cancer length to prostate specific antigen and Gleason scores improved predictability. Of 41 patients with a maximum cancer length of < 0.9 cm, PSA of < 16 ng/mL, and Gleason score of < 7, none showed extraprostatic extension. Conclusions: The maximum cancer length was found to be the most reliable predictor of disease staging. The findings of a maximum cancer length of < 0.9 cm, PSA of < 16 ng/mL, and a Gleason score of < 7 can suggest an organ-confined disease.