THE EXTENT OF BIOPSY INVOLVEMENT AS AN INDEPENDENT PREDICTOR OF EXTRAPROSTATIC EXTENSION AND SURGICAL MARGIN STATUS IN LOW RISK PROSTATE CANCER:: IMPLICATIONS FOR TREATMENT SELECTION

The combination of millimetres of cancer and Gleason index in core biopsy is a predictor of extraprostatic disease

AIMS

The Gleason index (GI) is related to several pathological endpoints in radical prostatectomy (RP) specimens, including the risk of extraprostatic disease (ED). The amount of tumour (TM) in core biopsy (CB) specimens also correlates with staging. The aim was to determine whether the sum of the relative statistical weights of GI and TM in CBs strengthens the prediction of ED in RPs.

METHODS AND RESULTS

A series of 290 RPs and their previous respective CBs were reviewed. TM and the GI were blindly evaluated in CBs and statistically correlated with ED in RPs. A total of 60 (20.6%) RPs showed ED. The logistic regression model indicated that all cases with > 22 mm of cancer in CB showed ED in RP. All cases with a GI > 7 and > 12 mm of cancer in CB displayed ED. Finally, Pearson's chi2 revealed that 80% of cases with a GI > 7 and > or = 5 mm of cancer in CB showed ED in RP.

CONCLUSIONS

The combined evaluation of GI and TM in CB is a useful method to strengthen the prediction of ED, is based on two simple morphological criteria and may be used as an additional tool to choose the best treatment modality.

Imaging with radiolabelled monoclonal antibody (MUJ591) to prostate-specific membrane antigen in staging of clinically localized prostatic carcinoma: comparison with clinical, surgical and histological staging

OBJECTIVE

To evaluate the reliability of prostate scintigraphy using a radiolabelled antibody (MUJ591) raised against the external domain of prostate-specific membrane antigen (PSMA) in the staging of early prostate cancer.

PATIENTS AND METHODS

This was a prospective study of 16 patients who had radical retropubic prostatectomies (median PSA 9.75 ng/mL). All patients underwent PSMA imaging using MUJ591 radiolabelled with (99m)Tc using a photo-reduction technique.

RESULTS

The findings of prostate imaging and histology were identical in seven patients. Scans showed understaging and overstaging in six and three patients, respectively.

CONCLUSIONS

PSMA scintigraphy using (99m)Tc-labelled MUJ591 identifies the presence of prostate cancer, but is not sensitive in delineating micro-invasion of the capsule, seminal vesicles or bladder neck. As in other studies it seems to be useful in detecting prostate bed recurrence and distant micrometastasis.