Are Clinically Insignificant Prostate Cancers Really Insignificant among Korean Men?.
10.3349/ymj.2012.53.2.358
- Author:
Chan Dong YEOM
1
;
Seung Hwan LEE
;
Kyung Kgi PARK
;
Sang Un PARK
;
Byung Ha CHUNG
Author Information
1. Department of Urology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea. chung646@yuhs.ac
- Publication Type:Original Article
- Keywords:
Prostate cancer;
gleason score;
prostate;
clinically insignificant
- MeSH:
Aged;
Humans;
Male;
Middle Aged;
Prostate-Specific Antigen/blood;
Prostatectomy;
Prostatic Neoplasms/blood/*diagnosis/surgery;
Retrospective Studies
- From:Yonsei Medical Journal
2012;53(2):358-362
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: We aimed to determine whether 12 core-extended biopsies of the prostate could predict insignificant prostate cancer (IPCa) in Koreans reliably enough to recommend active surveillance. MATERIALS AND METHODS: Two hundred and ninety-seven patients who underwent radical prostatectomy after 12 core-extended prostate biopsies were retrospectively reviewed. 38 cases (12.8%) were shown to be IPCa. RESULTS: The average age was 65.2 years, serum PSA was 5.49 ng/dL, and the PSA density was 0.11. The Gleason scores (GS) were 6 (3+3) in 31, 5 (3+2) in 4, and 4 (2+2) in 3. After radical prostatectomy, higher GS was given in 16 (42.1%), whereas lower GS was given in 1 case (2.6%), as compared with the GS obtained from biopsy. 11 (28.9%) had GS of 7 (3+4) and 5 (13.2%) had GS of 7 (4+3). 6 in GS 7 (4+3) and 1 in GS 7 (3+4) showed prostate capsule invasion and 1 in GS 7 (4+3) had seminal vesicle invasion. Prostate capsule invasion was observed in 1 with GS 6 (3+3). The rate of inaccuracy of the contemporary Epstein criteria was 42.1%. Only PSA density was a reliable indicator of clinically IPCa (odds ratio=1.384, 95% CI, 1.103 to 2.091). CONCLUSION: Diagnosis of IPCa from a prostate biopsy underestimated the true nature of prostate cancer in as many as 42.1% of Koreans.
