The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy

PURPOSE

Pretreatment clinical staging of prostatic adenocarcinoma is important due to the increasing use of nonsurgical treatment options. Using multivariate analysis we assessed the predictive value of biopsy cores positive for cancer as a percent of all cores obtained as well as the percent surface area of needle cores involved with tumor for determining tumor volume and pathological stage at radical prostatectomy. Candidate variables for the multivariate model included patient age, clinical disease stage, serum prostate specific antigen (PSA) and Gleason score of cancer in the needle biopsy.

MATERIALS AND METHODS

We reviewed prostate needle biopsy findings in 207 consecutive patients who subsequently underwent radical retropubic prostatectomy. Each biopsy specimen was assessed for tumor involvement by calculating the percent of cores positive for cancer, percent surface area involved in all cores and Gleason score. Initial serum PSA and preoperative clinical disease stage were incorporated with biopsy results into a multivariate model to determine the parameters most predictive of pathological stage and tumor volume at radical retropubic prostatectomy.

RESULTS

Of the 207 patients 152 (73.4%) had organ confined cancer and 55 (26.6%) had extraprostatic extension (pathological stages T2 and T3 or greater, respectively). Preoperative clinical staging information was available in 195 cases, in which disease was clinically confined and not confined in 184 (94.4%) and 11 (5.6%), respectively. Needle biopsy revealed a surface area of cancer ranging from less than 5% in 69 patients (33.3%) to 90% (mean 16, median 10). Univariate analysis demonstrated that the risk of extraprostatic extension was predicted by preoperative serum PSA (p = 0.027), the percent of cores and percent of surface area positive for cancer (p <0.0001), and Gleason score (p = 0.0009). Clinical stage approached significance (p = 0.071). Multivariate analysis showed that the percent of positive cores (p = 0.0003), initial serum PSA (p = 0.005) and Gleason score of cancer in the needle biopsy (p = 0.03) were the only parameters that jointly predicted pathological stage (T2 versus T3). Percent of tumor surface area involvement in the needle biopsies did not add any more information after the percent of positive cores was known. Univariate analysis revealed that the percent of cores positive for cancer (Spearman r = 0.52, p <0.0001), Gleason score (Spearman r = 0.34, p <0.0001) and initial serum PSA (Spearman r = 0.24, p = 0.003) were predictive of log tumor volume at radical prostatectomy, while clinical stage was not (rank sum test p = 0.14). On multivariate analysis the percent of positive cores (p <0.0001), Gleason score (p <0.0001) and initial serum PSA (0.0033) were the only variables that jointly were predictive of tumor volume.

CONCLUSIONS

The percent of needle biopsy cores and surface area positive for cancer are the strongest predictors of pathological stage and tumor volume on multivariate analysis incorporating preoperative serum PSA and Gleason score.

An air pollution model for use in epidemiological studies: evaluation with measured levels of nitrogen dioxide and benzene

The aim of the study was to evaluate the predictions derived from the Danish Operational Street Pollution Model (OSPM) when the input data are obtained by simple methods that could be used in large-scale epidemiological studies. The model calculations were thus compared with passive sampler measurements of nitrogen dioxide and benzene at 103 street locations in Copenhagen, Denmark, and at 101 locations in rural areas. Data on traffic and street configuration were collected by means of a simple registration scheme in which forms were filled out by local municipal authorities. Meteorological data were derived from routine measurements at Copenhagen airport, and data on background air pollution were based on a simple empirical model. Differences in air pollution levels between rural areas and Copenhagen and differences in nitrogen dioxide concentrations at various locations in Copenhagen were well reproduced by the OSPM. The correlation coefficients (r) between the measured and the predicted half-year average concentrations of nitrogen dioxide in Copenhagen were between 0.75 and 0.80 for various degrees of precision of the input data for the model. The results indicate that the OSPM used with the presented methods for generation of input data might be useful in assessing long-term exposure to air pollutants in epidemiological studies.

Ambient air levels and the exposure of children to benzene, toluene, and xylenes in Denmark

The aims of the study were to evaluate if the front-door concentrations of benzene, toluene, and xylenes can be used to classify the personal exposures of Danish children and to identify factors that affect their personal exposure. Average concentrations were measured over 1 week with diffusive samplers, and the personal exposures of 98 children and the concentrations outside the front doors of their homes were measured simultaneously. Time and activity patterns were noted in diaries. The front-door concentrations were significantly higher in Copenhagen than in rural areas (all P < 0.0001), but the personal exposures were only slightly higher. Even though the personal exposures were highly significantly associated with front-door concentrations in urban areas (all P < 0.004), use of the residential front-door concentration as an exposure surrogate would imply misclassification, as it cannot be used for rural children. Multiple regression analyses brought to light several factors that affect the exposure of children independently, including front-door concentration, riding in cars, and activities involving potential exposure to gasoline vapors like motocross, moped driving, and refueling of cars.

Front-door concentrations and personal exposures of Danish children to nitrogen dioxide

The aims of the study were to evaluate the front-door concentration of traffic exhaust fumes as a surrogate for the personal exposure of children and to study factors in the behavior and the environment of children that affect their personal exposure to nitrogen dioxide (NO(2)). The exposure to NO(2) of 103 children living in Copenhagen and 101 children living in rural areas of Denmark was studied by measuring average concentrations over 1 week with diffusive badge samplers placed outside the front door of the home, inside the child's bedroom, and on each child. Detailed information about the activities of the children involving potential exposure to NO(2) was noted in diaries. The results indicated that the front-door concentration of traffic pollution might be used to classify the personal exposure of urban children, although misclassification would be introduced. Multiple regression analysis showed several factors that affected the personal NO(2) exposure of the children independently, including the front-door concentration, the bedroom concentration, time spent outdoors, gas appliances used at home, passive smoking, and burning candles.

Exposure of Danish children to traffic exhaust fumes

This exposure study addresses the validity of the exposure assessment method of an epidemiological study of traffic-related air pollution and childhood cancer. In particular, this paper concerns the question of whether the concentration of nitrogen dioxide (NO2) outside the front door is a valid marker of the exposure of the child living at the address. The study includes 100 children living on streets with dense traffic in central parts of Copenhagen and 100 children living in rural areas. Preliminary results, based on 25% of the study subjects, suggest that both the outdoor NO2-concentration and the exposure of the children are two to three times higher in Copenhagen than in the rural districts. Moreover, the results suggest that the NO2-concentration outside the front door is a poor marker of the exposure of the children in Copenhagen, but a marker of some relevance for the exposure of the children in rural districts. The preliminary results must be treated with caution, as among other things, the analysis did not consider seasonal changes and indoor NO2-sources such as passive smoking, candles, and gas appliances.

Mutagenicity and chemical analysis of airborne particulates from a rural area in Italy

Mutagenic activities of a sample of characterized airborne particulates collected in a rural location near Ispra (Italy) during the summer of 1980 were detected by the Ames test using TA 1537, TA 1538, TA 98, and TA 100 Salmonella strains. Eight chemical classes fractionated from the CH2Cl2 extract of the particulates were bioassayed, and their mutagenicities (TA 98 plus S9) were as follows: organic bases I greater than polar neutrals greater than insolubles in cyclohexane greater than organic acid II greater than aerosol "in toto" greater than intermediate neutrals greater than polycyclic aromatic hydrocarbons greater than organic acids I greater than nonpolar neutrals. Periodical samples were taken in the same location from March to December 1981, extracted in dimethyl sulfoxide (DMSO), and directly tested with TA 1537, TA 98, and TA 100 Salmonella strains. For all the strains the mutagenicity varied markedly according to the season, the cold-month samples being much more mutagenic than the summer-month samples. The additional of S9 increased the mutagenicity (twofold) of the cold-month samples. The higher mutagenicity of the samples collected during the cold months could be due to greater amounts of mutagens produced by the combustion processes of domestic heating.