Histopathological characteristics of microfocal prostate cancer detected during systematic prostate biopsy

Objective To evaluate the prevalence of adverse pathological features and the percentage of multifocal and/or bilateral disease in a series of patients who underwent radical prostatectomy ( RP ) for unique, microfocal prostate cancer (mi PC a) detected on prostate biopsy in the pre‐active surveillance ( AS ) era. Patients and Methods In this retrospective, multi‐institutional study, we analysed the clinical records of 131 consecutive patients who underwent either retropubic or robot‐assisted RP for mi PC a at two referral centres from January 2000 to December 2011. mi PC a was defined as a neoplastic lesion present in ≤10% of core with biopsy Gleason score not applicable or biopsy Gleason score 6. Results There were 17 (13%) pT 3–4 prostate cancers and a single case (0.8%) of pN + tumour. Moreover, 31 (24.1%) patients had a Gleason score of >6 in the RP specimen. Therefore, unfavourable pathological features ( pT 3–4/N+ and/or Gleason score >6) were present in 40 (30.5%) patients. The median (interquartile range) prostate‐specific antigen ( PSA ) density was 0.11 (0.09–0.17) and 0.16 (0.11–0.24) ng/mL/mL in patients with favourable and unfavourable pathological characteristics, respectively ( P = 0.003). The receiver operating characteristic curve had an area under the curve value of 0.67 (95% confidence interval 0.56–0.77) for PSA density to predict the risk of unfavourable pathological features. Conclusion Patients with mi PC a who are candidates for an AS protocol should be adequately informed that in ≈30% of cases the cancer might be locally advanced and/or with a Gleason score of >6. Those unfavourable pathological characteristics could be predicted by the PSA density value. Further studies should investigate the role of a more extensive biopsy sampling to reduce the risk of under‐staging and/or under‐grading in patients with an initial diagnosis of mi PC a.