Oncologic Outcomes after Radical Retropubic Prostatectomy in Patients Meeting the Epstein Criteria

Objective: The Epstein criteria are used for the prediction of clinically insignificant prostate cancer and the determination of the patients who are suitable for avoiding or delaying active treatments that have many potential serious side-effects. In the present study, we aimed to retrospectively evaluate and interpret the oncologic outcomes of the patients who underwent radical retropubic prostatectomy (RRP) but were potentially eligible for active surveillance based on the Epstein criteria. Methods: Records of 305 patients who underwent RRP in our clinic between the years 2000 and 2014 for clinically localized prostate cancer were analyzed. Of these patients, 18 who met all the conditions of the Epstein criteria [clinical T1c, biopsy Gleason score (GS) <7, the number of cancer positive biopsy cores <3, cancer involvement in any core <50%, and prostate specific antigen (PSA) density <0.15 ng/mL2] were included. The patients with an increased surgical specimen GS compared with that of biopsy or those with non-organ-confined disease were considered to have clinically significant disease. Results: The mean age, serum PSA level, and prostate volume of all the 305 patients were 62.8±6.1 years, 10.8±6.9 ng/mL, and 46.2±22.1 mL, respectively. Eighty-six patients (28.2%) were with extracapsular extension (ECE), 58 (19.0%) with positive surgical margin (PSM), 39 (12.8%) with seminal vesicle invasion (SVI), and 16 (5.2%) with lymph node involvement (LNI). Biochemical recurrence was detected in 55 of the 305 patients (20.9%) during the mean follow-up period of 71.2±37.3 months after RRP. Of the 305 patients who underwent RRP, 18 (5%) met the Epstein criteria. The mean age, serum PSA level, and prostate volume of these patients were 61.6±6.01 years, 5.51±1.1 ng/mL, and 45.2±10.13 mL, respectively. Five patients (27.8%) were with extracapsular extension (ECE), 4 (22.5%) with an increased GS, and 1 (5.5%) with both ECE and increased GS. A total of eight patients (44.4%) were detected to have clinically significant disease. None of the patients was with SVI or LNI. Biochemical recurrence was not detected in any of the patients during the mean follow-up period of 48.7±31.2 months after RRP. Conclusion: Our results showed that the Epstein criteria may misguide us for the prediction of clinically insignificant prostate cancers. A notable proportion of our patients potentially eligible for active surveillance based on the Epstein criteria were postoperatively revealed to have clinically significant disease. If those patients had not undergone surgery, they may have lost their chance to undergo active treatment for their cancer. (JAREM 2015; 5: 6-9)