Relating biopsy and clinical variables to radical prostatectomy findings: can insignificant and advanced prostate cancer be predicted in a screening population?

Urology. 2004 Sep;64(3):544-50. doi: 10.1016/j.urology.2004.04.008.


Objectives: To assess the capacity of several clinical and needle biopsy pathologic parameters to predict insignificant and advanced prostate carcinoma (CaP) in radical prostatectomy tissue from men enrolled in a prostate-specific antigen screening program.

Methods: We captured multiple clinical variables and measures of needle biopsy tumor extent from 152 men with Stage T1c CaP with a mean of six biopsy cores who were treated with radical prostatectomy. Insignificant CaP was defined as a tumor volume of less than 0.5 cm(3) that was organ confined with a Gleason score less than 7. Advanced CaP was defined by a formula that combined the Gleason score, pathologic stage, and margin status. Bivariate and logistic regression analyses were used to identify variables predictive of either insignificant or advanced CaP.

Results: Of the cases of CaP, 25.7% were pathologically insignificant, and 14.5% were pathologically advanced. The best model for predicting insignificant CaP was less than 10% tumor as the greatest percentage of carcinoma in any core and a biopsy Gleason score of less than 7, yielding a sensitivity of 76.9% and specificity of 75.2%. For predicting advanced CaP, the best model was a total biopsy length of CaP greater than 3 mm, Gleason high-grade pattern 4 or 5 disease, perineural invasion in the biopsy, and more than one in six biopsy cores containing CaP, yielding a sensitivity of 13.6% and specificity of 100%.

Conclusions: The prediction of insignificant and advanced CaP on an individual basis in patients from a prostate-specific antigen screening study is a challenging problem. However, several histopathologic features of CaP in needle biopsy tissue contain useful information about the severity of disease.

Publication types

  • Evaluation Study

MeSH terms

  • Adenocarcinoma / blood
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Biomarkers, Tumor / blood
  • Biopsy, Needle* / statistics & numerical data
  • Humans
  • Male
  • Mass Screening* / statistics & numerical data
  • Middle Aged
  • Neoplasm Proteins / blood
  • Predictive Value of Tests
  • Prostate-Specific Antigen / blood
  • Prostatectomy*
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / pathology*
  • Prostatic Neoplasms / surgery
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tumor Burden


  • Biomarkers, Tumor
  • Neoplasm Proteins
  • Prostate-Specific Antigen