Open Access

ARTICLE

Updating the prostate cancer risk indicator for contemporary biopsy schemes

Meelan Bul¹, Nicolas B. Delongchamps², Ewout W. Steyerberg³, Gustavo de la Roza⁴, Pim J. van Leeuwen¹, Xiaoye Zhu¹, Heidi A. van Vugt¹, Gabriel P. Haas⁵, Fritz H. Schröder¹, Monique J. Roobol¹

1 Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
2 Department of Urology, Cochin Hospital, Paris Descartes University, France
3 Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
4 Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
5 Astellas Pharma Global Development Inc, Deerfield, Illinois, USA
Address correspondence to Dr. Meelan Bul, Erasmus MC, University Medical Center Rotterdam, Department of Urology, Room NH-224, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

Canadian Journal of Urology 2011, 18(2), 5625-5629.

Abstract

Introduction and objective: The Prostate Cancer Risk Indicator is a validated tool used to predict the likelihood that a screen-detected prostate cancer is indolent, partially based on lateralized sextant biopsies. Our objective was to derive correction factors for updating this model to reflect contemporary extended biopsy schemes.
Materials and methods: Post-mortem 18-core biopsy results from men who died of unrelated causes but were diagnosed with prostate cancer post-mortem were analyzed. These data included details from both biopsy samples and whole-mount pathological specimens. For each positive 18-core biopsy, the Gleason score, number of positive cores, tumor location within the gland, and percentage of cancer involvement were recorded and correlated with final pathology findings. Total cancer length in a 6-core biopsy scheme was compared to that in 12-core and 18-core schemes to calculate correction factors. Additionally, changes in Gleason score (upgrading) between sextant and extended biopsy schemes, as well as final pathology, were assessed.
Results: Data from 33 autopsied men were included. The total length of cancer detected by 18-core and 12-core biopsy schemes was 192.72 mm and 143.76 mm, respectively, compared to 70.80 mm with the lateralized sextant biopsy. This yielded correction factors of 2.72 for the 18-core scheme and 2.03 for the 12-core scheme. Gleason score upgrading occurred in 33% (11 out of 33 cases) when comparing extended biopsy regimens to the sextant approach.
Conclusion: Based on autopsy-derived data, these correction factors support the adaptation of the Prostate Cancer Risk Indicator to modern extended biopsy protocols. This adjustment can improve the accuracy of predicting indolent disease, thereby aiding both clinicians and patients in making more informed decisions regarding diagnosis and management in daily clinical practice.

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