Virchows Archiv

, Volume 457, Issue 5, pp 547–553 | Cite as

Measurements of cancer extent in a conservatively treated prostate cancer biopsy cohort

  • Ramzi Rajab
  • Gabrielle Fisher
  • Michael W. Kattan
  • Christopher S. Foster
  • Tim Oliver
  • Henrik Møller
  • Victor Reuter
  • Peter Scardino
  • Jack Cuzick
  • Daniel M. BerneyEmail author
  • on behalf of the Transatlantic Prostate Group
Original Article


The optimal method for measuring cancer extent in prostate biopsy specimens is unknown. Seven hundred forty-four patients diagnosed between 1990 and 1996 with prostate cancer and managed conservatively were identified. The clinical end point was death from prostate cancer. The extent of cancer was measured in terms of number of cancer cores (NCC), percentage of cores with cancer (PCC), total length of cancer (LCC) and percentage length of cancer in the cores (PLC). These were correlated with prostate cancer mortality, in univariate and multivariate analysis including Gleason score and prostate-specific antigen (PSA). All extent of cancer variables were significant predictors of prostate cancer death on univariate analysis: NCC, hazard ration (HR) = 1.15, 95% confidence interval (CI) = 1.04–1.28, P = 0.011; PPC, HR = 1.01, 95% CI = 1.01–1.02, P < 0.0001; LCC, HR = 1.02, 95% CI = 1.01–1.03, P = 0.002; PLC, HR = 1.01, 95% CI = 1.01–1.02, P = 0.0001. In multivariate analysis including Gleason score and baseline PSA, PCC and PLC were both independently significant P = 0.004 and P = 0.012, respectively, and added further information to that provided by PSA and Gleason score, whereas NNC and LCC were no longer significant (P = 0.5 and P = 0.3 respectively). In a final model, including both extent of cancer variables, PCC was the stronger, adding more value than PLC (χ 2 (1df) = 7.8, P = 0.005, χ 2 (1df) = 0.5, P = 0.48 respectively). Measurements of disease burden in needle biopsy specimens are significant predictors of prostate-cancer-related death. The percentage of positive cores appeared the strongest predictor and was stronger than percentage length of cancer in the cores.


Prostate biopsy Prostate cancer Biopsy prognostic factors Tumour extent 



This study was supported by Cancer Research UK, a Specialised Programme of Research Excellence (SPORE) grant from the US National Cancer Institute (USA), Orchid and The David Koch Foundation. Funding bodies had no involvement in the design and conduct of the study; in collection management, analysis and interpretation of the data; or in preparation, review and approval of the paper.

Conflict of interest statement

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Ramzi Rajab
    • 1
  • Gabrielle Fisher
    • 2
  • Michael W. Kattan
    • 3
  • Christopher S. Foster
    • 4
  • Tim Oliver
    • 1
  • Henrik Møller
    • 5
  • Victor Reuter
    • 6
  • Peter Scardino
    • 6
  • Jack Cuzick
    • 2
  • Daniel M. Berney
    • 1
    • 7
    Email author
  • on behalf of the Transatlantic Prostate Group
  1. 1.Centre for Molecular Oncology and Imaging, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
  2. 2.Cancer Research UK Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
  3. 3.Department of Biostatistics and EpidemiologyCleveland Clinic FoundationClevelandUSA
  4. 4.Department of Cellular Pathology and Molecular GeneticsLiverpool University HospitalLiverpoolUK
  5. 5.King’s College London, Thames Cancer RegistryLondonUK
  6. 6.Departments of Pathology and UrologyMemorial Sloan Kettering Cancer CentreNew YorkUSA
  7. 7.Centre for Molecular Oncology and Imaging St. Bartholomew’s Medical SchoolQueen Mary, University of LondonLondonUK

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