임상적으로 무의미한 전립선암의 예측인자와 그 진단적 유용성 = The Diagnostic Value of Predictive Factors for Clinically Insignificant Prostate Cancer

다국어 초록 (Multilingual Abstract)

Purpose: In the present study, we identified the pre-operative predictive factors of insignificant prostate cancer and we analyzed their diagnostic accuracy.
Material and Methods: Of a total 343 patients who had undergone radical prostatectomy, 33 patients(9.6%) were diagnosed with insignificant cancer that was characterized by a total cancer volume ≤0.5cc, a Gleason score (GS)≤6, a T stage≤2c and no positive surgical margin. We found the statistically significant factors after comparing of preoperative clinico- pathological findings between two groups and determined the diagnostic accuracy of the identified predictors.
Results: Of several factors, prostate-specific antigen(PSA) level(p=0.04, odds ratio(OR)=4.3 3.589≤95%confidence interval(CI)≤5.692), PSA density(PSAD)(p=0.01, OR=6.6, 2.115≤95%CI≤278.826), biopsy GS(p=0.03, OR=4.6, 1.114≤95%CI≤12.568) and volume of the largest cancer(p=0.02, OR=5.6, 2.471≤95%CI≤9.725) were analyzed as independent predictors of insignificant cancer. The volume of the largest cancer was the most precise predictor(AUC=0.791), followed by the PSAD (AUC=0.748) and the PSA level(AUC=0.677) in the ROC (receiver operating characteristic) curve analysis. The sensitivity, specificity and positive predictive value for predicting insignificant cancer were 10.3%, 63.7% and 12.8% at a PSA level of 10ng/ml, and 44.8%, 16.8% and 26.3% at a PSAD of 0.15ng/ml/ml, and 13.8%, 53.8% and 14.2% at a volume of the largest cancer of 50%, respectively. Even with using a combination of these three factors as well as a biopsy GS≤6, only 53% of insignificant prostate cancer could be predicted preoperatively.
Conclusions: In our study, PSA level, PSAD, biopsy GS and volume of the largest cancer were identified as predictors of insignificant cancer in spite of their unsatisfactory diagnostic accuracy. (Korean J Urol 2008;49: 398-403)

다국어 초록 (Multilingual Abstract)

Purpose: In the present study, we identified the pre-operative predictive factors of insignificant prostate cancer and we analyzed their diagnostic accuracy.
Material and Methods: Of a total 343 patients who had undergone radical prostatectomy, 33 patients(9.6%) were diagnosed with insignificant cancer that was characterized by a total cancer volume ≤0.5cc, a Gleason score (GS)≤6, a T stage≤2c and no positive surgical margin. We found the statistically significant factors after comparing of preoperative clinico- pathological findings between two groups and determined the diagnostic accuracy of the identified predictors.
Results: Of several factors, prostate-specific antigen(PSA) level(p=0.04, odds ratio(OR)=4.3 3.589≤95%confidence interval(CI)≤5.692), PSA density(PSAD)(p=0.01, OR=6.6, 2.115≤95%CI≤278.826), biopsy GS(p=0.03, OR=4.6, 1.114≤95%CI≤12.568) and volume of the largest cancer(p=0.02, OR=5.6, 2.471≤95%CI≤9.725) were analyzed as independent predictors of insignificant cancer. The volume of the largest cancer was the most precise predictor(AUC=0.791), followed by the PSAD (AUC=0.748) and the PSA level(AUC=0.677) in the ROC (receiver operating characteristic) curve analysis. The sensitivity, specificity and positive predictive value for predicting insignificant cancer were 10.3%, 63.7% and 12.8% at a PSA level of 10ng/ml, and 44.8%, 16.8% and 26.3% at a PSAD of 0.15ng/ml/ml, and 13.8%, 53.8% and 14.2% at a volume of the largest cancer of 50%, respectively. Even with using a combination of these three factors as well as a biopsy GS≤6, only 53% of insignificant prostate cancer could be predicted preoperatively.
Conclusions: In our study, PSA level, PSAD, biopsy GS and volume of the largest cancer were identified as predictors of insignificant cancer in spite of their unsatisfactory diagnostic accuracy. (Korean J Urol 2008;49: 398-403)

참고문헌 (Reference)

1 김용준, "확대 전립선 생검을 통하여 발견된 단일 Core 양성의 임상적 의의" 대한비뇨기과학회 47 (47): 475-481, 2006

2 손동완, "혈청 전립선 특이항원 4ng/ml 이하의 군에서 전립선암의 예측인자 및 특성" 대한비뇨기과학회 46 (46): 565-568, 2005

3 박형근, "전립선특이항원 수치가 3.0-4.0ng/ml인 환자군과 4.1-10.0ng/ml인 환자군 사이에서 전립선암의 진단율 및 병리학적 특성의 비교" 대한비뇨기과학회 47 (47): 358-361, 2006

4 현창림, "경직장초음파유도 전립샘침생검 1,000예의 병리학적 검색:새로운 검체처리 방법의 수립 및 면역조직화학검사의 유용성 평가" 대한병리학회 40 (40): 406-419, 2006

5 Klein EA, "What is ‘insignificant' prostate carcinoma?" 101 : 1923-1925, 2004

6 Ohori M, "The pathological features and prognosis of prostate cancer detectable with current diagnostic tests" 152 : 1714-1730, 1994

7 Anast JW, "Relating biopsy and clinical variables to radical prostatectomy findings: can insignificant and advanced prostate cancer be predicted in a screening population?" 64 : 544-550, 2004

8 Carter HB, "Prospective evaluation of men with stage T1c adenocarcinoma of the prostate" 157 : 2206-2209, 1997

9 Terris MK, "Prediction of prostate cancer volume using prostate-specific antigen levels, transrectal ultrasound, and systematic sextant biopsies" 45 : 75-80, 1995

10 D'Amico AV, "Pathologic findings and prostate specific antigen outcome after radical prostatectomy for patients diagnosed on the basis of a single microscopic focus of prostate carcinoma with a gleason score ＜/= 7" 89 : 1810-1817, 2000

11 Epstein JI, "Pathologic and clinical findings to predict tumor extent of nonpalpable(stage T1c) prostate cancer" 271 : 368-374, 1994

12 Wang X, "One core positive prostate biopsy is a poor predictor of cancer volume in the radical prostatectomy specimen" 158 : 1431-1435, 1997

13 Thorson P, "Minimal carcinoma in prostate needle biopsy specimens: diagnostic features and radical prostatectomy follow-up" 11 : 543-551, 1998

14 Gardner TA, "Microfocal prostate cancer: biopsy cancer volume does not predict actual tumour volume" 81 : 839-843, 1998

15 Boccon-Gibod LM, "Micro-focal prostate cancer: a comparison of biopsy and radical prostatectomy specimen features" 48 : 895-899, 2005

16 Stamey TA, "Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer" 71(3 suppl) : 933-938, 1993

17 Augustin H, "Insignificant prostate cancer in radical prostatectomy specimen: time trends and preoperative prediction" 43 : 455-460, 2003

18 Andren O, "How well does the Gleason score predict prostate cancer death? A 20-year followup of a population based cohort in Sweden" 175 : 1337-1340, 2006

19 Soh S, "Has there been a recent shift in the pathological features and prognosis of patients treated with radical prostatectomy?" 157 : 2212-2218, 1997

20 King CR, "Extended prostate biopsy scheme improves reliability of Gleason grading: implications for radiotherapy patients" 59 : 386-391, 2004

21 Goto Y, "Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies" 156 : 1059-1063, 1996

22 Allan RW, "Correlation of minute(0.5 MM or less) focus of prostate adenocarcinoma on needle biopsy with radical prostatectomy specimen: role of prostate specific antigen density" 170 : 370-372, 2003

23 Lee AK, "Can the core length involved with prostate cancer identify clinically insignificant disease in low risk patients diagnosed on the basis of a single positive core?" 21 : 123-127, 2003

24 Steinberg GD, "An analysis of watchful waiting for clinically localized prostate cancer" 159 : 1431-1436, 1998

25 Klotz L, "Active surveillance for favorable risk prostate cancer: rationale, risks, and results" 25 : 505-509, 2007

26 Ravery V, "A single positive prostate biopsy in six does not predict a low-volume prostate tumour" 77 : 724-728, 1996