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Endothelin‐1: a predictor of extracapsular extension in clinically localized prostate cancer?
Author(s) -
Menard Johann,
Durlach Anne,
Barbe Coralie,
Joseph Karine,
Lorenzato Marianne,
Azemar MarieDominique,
Perez Thomas,
Birembault Philippe,
Staerman Frederic
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09879.x
Subject(s) - medicine , prostate cancer , prostatectomy , concordance , urology , univariate analysis , prostate , prostate specific antigen , biopsy , predictive value , multivariate analysis , oncology , cancer
What’s known on the subject? and What does the study add? ET‐1 expression on initial prostate biopsies combined with PSA > 10 ng/ml and Gleason score ≥7 provided the best model for predicting extracapsular extension. This is useful when making treatment decisions after the diagnosis of prostate cancer. OBJECTIVE To assess the value of endothelin‐1 (ET‐1) expression in predicting extracapsular extension (ECE) in clinically localized prostate cancer (PCa). PATIENTS AND METHODS ET‐1 expression was determined by immunohistochemistry on archival needle biopsies (NBs) from 94 patients (49 pT2 and 45 pT3a) who underwent radical prostatectomy (RP) for clinical T1‐T2 PCa. Each sample was analysed independently by two pathologists blinded to the clinical data. RESULTS In univariate analysis, high ET‐1 expression in NBs, pre‐operative prostate‐specific antigen (PSA) level >10 ng/ml, percentage of positive biopsy cores and NB Gleason score ≥7 were significantly associated with ECE as determined on subsequent RP. No significant association was found between clinical stage and ECE. In multivariate analysis, there was a significant association with high ET‐1 expression in NBs (p = 0.006), pre‐operative PSA level >10 ng/ml (p = 0.049), and NB Gleason score ≥7 (p = 0.002). These three pre‐operative factors combined provided the best model for predicting ECE with 93.3% sensitivity, 49% specificity, 62.5% positive predictive value, 88.9% negative predictive value. The combination yielded a higher concordance index (0.760 vs 0.720) and offered a higher log partial likelihood than the same model without ET1 (112.8 vs 105.7, p = 0.01). CONCLUSIONS ET‐1 expression was strongly associated with ECE and, when combined with pre‐operative PSA level and Gleason score, improved the predictive accuracy of pre‐operative NBs. Its assessment in patients with localized PCa might be useful when making treatment decisions. Further studies with standardisation of immunohistochemical staining and multi‐institutional validation are now needed to establish the appropriate use of ET‐1 staining in PCa staging and to evaluate inter‐observer reproducibility.