846: Is a Positive Bladder Neck Margin Truly a T4 Lesion in the PSA ERA? Results from the Search Database
Year: 2007
Type: conference-abstract
Abstract: INTRODUCTION AND OBJECTIVE: Historically extended biopsy schemes were associated with increased detection of clinically insignificant prostate cancer (PCa).We assessed the difference in pathological stage and the rate of biochemical recurrence (BCR) after radical prostatectomy (RP) according to sextant versus extended (10 or more cores) biopsy scheme, in contemporary patients.METHODS: Between 2000 and 2006, 4525 patients underwent prostate biopsy followed by RP, at 6 different institutions in North America and Europe (sextant: 2246 [49.6%]; extended scheme: 2279 [50.4%]).Pathological stages were classified according to presence of extracapsular extension (ECE), seminal vesicle invasion (SVI) or lymph node invasion (LNI).Tumor grades were assigned according to the Gleason score.The median follow-up was 6 years.BCR was defined as PSA >0.1 ng/ml and rising.RESULTS: Mean age was 61 years (median 62) and mean PSA was 7.4 ng/ml (median 6).At RP, when Gleason sum was stratified according to sextant vs. extended biopsy schemes.Gleason 7-1 0 was recorded in 22.0% vs. 23.9%patients.ECE distribution was 22.6% vs. 20.5%,SVI 8.4% vs. 8.2% and LNI 3.8% vs. 3.4%.BCR status was available in 2980 (65.9%) patients.The actuarial BCR-free survival at 5 years was 78.0% vs. 84.9%,respectively for sextant vs. extended biopsy schemes (log rank p=0.01) as shown in figure 1.After adjustment for PSA, clinical stage and biopsy Gleason sum, extended biopsy scheme was associated with lower BCR rate (RR 0.62: p<0.001).CONCLUSIONS: Extended biopsy scheme is associated with the same rate of high grade PCa, ECE, SVI and LNI as sextant biopsy.However, the rate of BCR is lower in men diagnosed with extended biopsy schemes.Thus, extended biopsy has more favorable natural history despite similar pathological characteristics.
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2794733820