Premium
Assessment of the optimal number of positive biopsy cores to discriminate between cancer‐specific mortality in high‐risk versus very high‐risk prostate cancer patients
Author(s) -
Wenzel Mike,
Würnschimmel Christoph,
Chierigo Francesco,
Tian Zhe,
Shariat Shahrokh F.,
Terrone Carlo,
Saad Fred,
Tilki Derya,
Graefen Markus,
Roos Frederik C.,
Kluth Luis,
Mandel Philipp,
Chun Felix K. H.,
Karakiewicz Pierre I.
Publication year - 2021
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.24202
Subject(s) - prostate cancer , medicine , hazard ratio , biopsy , prostate biopsy , prostate , proportional hazards model , urology , prostate specific antigen , cancer , oncology , gynecology , confidence interval
Background Number of positive prostate biopsy cores represents a key determinant between high versus very high‐risk prostate cancer (PCa). We performed a critical appraisal of the association between the number of positive prostate biopsy cores and CSM in high versus very high‐risk PCa. Methods Within Surveillance, Epidemiology, and End Results database (2010–2016), 13,836 high versus 20,359 very high‐risk PCa patients were identified. Discrimination according to 11 different positive prostate biopsy core cut‐offs (≥2–≥12) were tested in Kaplan–Meier, cumulative incidence, and multivariable Cox and competing risks regression models. Results Among 11 tested positive prostate biopsy core cut‐offs, more than or equal to 8 (high‐risk vs. very high‐risk: n = 18,986 vs. n = 15,209, median prostate‐specific antigen [PSA]: 10.6 vs. 16.8 ng/ml, <.001) yielded optimal discrimination and was closely followed by the established more than or equal to 5 cut‐off (high‐risk vs. very high‐risk: n = 13,836 vs. n = 20,359, median PSA: 16.5 vs. 11.1 ng/ml, p < .001). Stratification according to more than or equal to 8 positive prostate biopsy cores resulted in CSM rates of 4.1 versus 14.2% (delta: 10.1%, multivariable hazard ratio: 2.2, p < .001) and stratification according to more than or equal to 5 positive prostate biopsy cores with CSM rates of 3.7 versus 11.9% (delta: 8.2%, multivariable hazard ratio: 2.0, p < .001) in respectively high versus very high‐risk PCa. Conclusions The more than or equal to 8 positive prostate biopsy cores cutoff yielded optimal results. It was very closely followed by more than or equal to 5 positive prostate biopsy cores. In consequence, virtually the same endorsement may be made for either cutoff. However, more than or equal to 5 positive prostate biopsy cores cutoff, based on its existing wide implementation, might represent the optimal choice.