THE "NEW" PROSTATE CANCER INFOLINK

Today’s news reports discuss such issues as:

• Sextant biopsy in diagnosis of unilateral prostate cancer
• Aggressiveness of prostate cancer in man diagnosed with PSA < 4 ng/ml
• The potential of 3T MRI in prostate cancer prognosis pre-surgery
• Surgical margins and risk for biochemical recurrence post-surgery

Mayes et al. have reported data showing that the historically conventional sextant (6-core) biopsy can not accurately diagnose prostate cancer in low-risk patients with unilateral, organ-confined (pT2a,b) disease.

Bonet et al. have used data from the Geneva Cancer Registry to confirm that prostate cancer in men with PSA values < 4 ng/ml at diagnosis is not necessarily indolent. They compared data from 59 patients with PSA values < 4 ng/ml at diagnosis with data from 1,330 patients with PSA levels > 4 ng/ml at diagnosis. The patients with low PSA values more frequently had early-stage, well differentiated tumors. However, 21/59 low PSA patients (35 percent) presented with aggressive tumor characteristics or metastases, and the authors state that prostate cancer-specific mortality was similar for the groups with PSA values < 4 and ≥ 4 ng/ml.

Augustin et al. have reported data suggesting that the use of 3T MRI is a more accurate method for assessing risk of organ-confined and extracapsular prostate cancer prior to treatment than the Partin tables. The “New” Prostate Cancer InfoLink is not exactly surprised by such data. However, we would note that: (a) 3T MRI equipment is not exactly universally available; (b) the cost of 3T MRI scanning is significant; (c) interpretation of the results of the scans is highly specialized; (d) this particular study was based on data from only 27 patients; and (e) 3T MRI was still only accurate in predicting extracapsular disease in 4/6 patients (66.7 percent) who were shown to have extracapsular extension on surgery (i.e., the men who were most in need of an accurate pre-surgical assessment of risk).

Shikanov et al. have published data indicating that surgical margin status and length of positive surgical margins are independent predictors of biochemical recurrence following robotic radical prostatectomy. Their report is based on data collected prospectively from 1,398 consecutive men undergoing robotic radical prostatectomy for clinically localized prostate cancer between 2003 and 2008 at a single institution. Positive margins were present in 243/1,398 patients (17 percent). Preoperative PSA level, pathological stage, Gleason score, margin status, and margin length as a continuous and categorical variable (< 1, 1 to 3, and > 3 mm) were independent predictors of biochemical recurrence. Patients with negative margins and those with a positive margin < 1 mm had similar rates of biochemical recurrence. Surgical margin location was not independently associated with biochemical recurrence.

Filed under: Uncategorized | Tagged: 3T MRI, aggressiveness, biopsy, low PSA levels, prognosis, risk, sextant, surgical margins |