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Insignificant disease among men with intermediate-risk prostate cancer

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Abstract

Purpose

A paucity of data exists on the insignificant disease potentially suitable for active surveillance (AS) among men with intermediate-risk prostate cancer (PCa). We tried to identify pathologically insignificant disease and its preoperative predictors in men who underwent radical prostatectomy (RP) for intermediate-risk PCa.

Methods

We analyzed data of 1,630 men who underwent RP for intermediate-risk disease. Total tumor volume (TTV) data were available in 332 men. We examined factors associated with classically defined pathologically insignificant cancer (organ-confined disease with TTV ≤0.5 ml with no Gleason pattern 4 or 5) and pathologically favorable cancer (organ-confined disease with no Gleason pattern 4 or 5) potentially suitable for AS. Decision curve analysis was used to assess clinical utility of a multivariable model including preoperative variables for predicting pathologically unfavorable cancer.

Results

In the entire cohort, 221 of 1,630 (13.6 %) total patients had pathologically favorable cancer. Among 332 patients with TTV data available, 26 (7.8 %) had classically defined pathologically insignificant cancer. Between threshold probabilities of 20 and 40 %, decision curve analysis demonstrated that using multivariable model to identify AS candidates would not provide any benefit over simply treating all men who have intermediate-risk disease with RP.

Conclusion

Although a minority of patients with intermediate-risk disease may harbor pathologically favorable or insignificant cancer, currently available conventional tools are not sufficiently able to identify those patients.

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Acknowledgments

Supported by the Sidney Kimmel Center for Prostate and Urologic Cancers. Supported in part by funds provided by David H. Koch through the Prostate Cancer Foundation. Supported in part by NIH/NCI Cancer Center Support Grant to MSKCC under award number P30 CA008748.

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Authors and Affiliations

  1. Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA

    Sung Kyu Hong, Peter T. Scardino & James A. Eastham

  2. Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea

    Sung Kyu Hong

  3. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Emily Vertosick & Daniel D. Sjoberg

  4. Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY, USA

    Peter T. Scardino & James A. Eastham

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  1. Sung Kyu Hong
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  2. Emily Vertosick
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  3. Daniel D. Sjoberg
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  4. Peter T. Scardino
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  5. James A. Eastham
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Correspondence to Sung Kyu Hong.

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Hong, S.K., Vertosick, E., Sjoberg, D.D. et al. Insignificant disease among men with intermediate-risk prostate cancer. World J Urol 32, 1417–1421 (2014). https://doi.org/10.1007/s00345-014-1413-3

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  • DOI: https://doi.org/10.1007/s00345-014-1413-3

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