Epstein criteria for insignificant prostate cancer

OBJECTIVE To review the accuracy of the Epstein Criteria for insignificant prostate cancer and to explore the effect of the modified Gleason classification system on this system. METHODS We searched PubMed, EMBASE and the Cochrane Database using search terms 'Epstein Criteria', 'Prostate Cancer', 'Validation' and 'Insignificant Cancer' between 1994 to 2010 for validation articles. These were divided into pre-2005 and post-2005 and concordances for organ-confined status, Gleason score <= 6 and insignificant cancer were analysed. RESULTS A pre-2005 study showed concordance for insignificant prostate cancer, Gleason score <= 6 and organ-confined status at 84%, 90.3% and 91.6%, respectively. Five post-2005 validation studies were concordant for insignificant cancer, Gleason score <= 6 and organ-confined status at 37-76%, 54.3-75.9% and 80.0-96.9%, respectively. CONCLUSIONS The Epstein Criteria has a suboptimal accuracy for predicting for insignificant prostate cancer. The modification to Gleason scoring may be responsible for a reduced accuracy over time. However, significant heterogeneity in the validation studies means better quality validation studies are required.