UroToday - Does the Extent of Carcinoma in Prostatic Biopsies Predict Prostate-Specific Antigen Recurrence? A Systematic Review - Abstract

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Monday, 14 July 2008

Cancer

Research UK Clinical Centre,

St 's University Hospital, Beckett Street, Leeds LS9 7TF,

United Kingdom.

The

biologic potential of prostate cancer (pCA) is variable, and the ability to

identify tumours that might cause morbidity and mortality is limited.

This

systematic review sought to establish whether measurement of tumour extent in

biopsies provides additional prognostic information on the risk of disease

progression.

A

comprehensive 31-step search strategy was run in MEDLINE, EMBASE, and the Web

of Knowledge (January 1990-July 2007) and supplemented by the hand-searching of

references in retrieved articles and relevant journals to identify publications

related to the measurement of the length of cancer in biopsies and biochemical

or clinical recurrence or pCA death. Thirteen papers reporting on at least 100

patients were identified and included patients treated by watchful waiting or

hormonal therapy (n=1), radical prostatectomy (n=11), or radiotherapy (n=1).

Only two studies reported on clinical progression or mortality. Sources of bias

included patient selection and missing data resulting from the retrospective

nature of the studies. Confounding factors included differences in biopsy

strategies and measurement methods.

The

percentage of cancer in biopsies (overall percentage or the greatest percentage

in the most involved core) was an independent predictor of prostate-specific

antigen (PSA) and clinical outcomes regardless of the form of treatment and was

generally superior to simply counting the number of positive cores. The marked

variability in study design, conduct, and reporting precluded meta-analysis of

the data and precise risk estimation.

Tumour

quantitation is a promising prognostic tool in the assessment of risk of pCA

progression. However, well-designed, population-based studies, controlling for

confounding factors, are required to provide more accurate risk estimation and

develop management strategies. This review highlights the need for new

approaches in the assessment of pathologic prognostic factors to reach the

level of evidence achieved in other areas of medical practice.

Written

by

Harnden P, MD, Naylor B, Coles B, Mason MD.

Reference

Eur Urol. 2008 Jun 26. Epub ahead of print.

doi:10.1016/j.eururo.2008.06.068

PubMed

Abstract

PMID:18603352