Validation of Epstein biopsy criteria for insignificant prostate cancer in contemporary cohort of Croatian patients [Patohistološki nalazi bolesnika s rakom prostate liječenih radikalnom prostatektomijom koji su bili podobni za aktivni nadzor]

Tomašković, Igor and Ulamec, Monika and Tomić, Miroslav and Pezelj, Ivan and Grubišić, Igor and Krušlin, Božo (2015) Validation of Epstein biopsy criteria for insignificant prostate cancer in contemporary cohort of Croatian patients [Patohistološki nalazi bolesnika s rakom prostate liječenih radikalnom prostatektomijom koji su bili podobni za aktivni nadzor]. Collegium Antropologicum, 39 (3). pp. 709-711. ISSN 0350-6134

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Abstract

Only few reports validated contemporary Epstein criteria for insignificant prostate cancer, and only one being from Europe. Patients with insignificant prostate cancer should be offered active surveillance and spared radical treatment. In our study we tested Epstein biopsy criteria for predicting unfavorable final pathology and biochemical relapse in low risk prostate cancer patients, who were eligible for active surveillance but where treated with radical prostatectomy. Between January 2003 and January 2008, 586 patients were subjected to radical prostatectomy in our institution. Among them, 106 where eligible for active surveillance according to Epstein biopsy criteria for insignificant prostate cancer. We analyzed the presence of adverse pathological findings in the final pathohistological specimen after radical prostatectomy which excludes low risk disease. Adverse pathohistological findings were noted in 41 (38.6%) patients, who could have been offered active surveillance. During the follow up of 48 (12-72) months, biochemical relapse was noted in 6 (5.6%) patients. Although active surveillance is becoming more popular because of the long natural course of prostate cancer and fear of overtreatment of patients with indolent course of disease, both doctors and patients must be aware of potentially significant disease in this group and limitations of current preoperative criteria defining low risk patients.

Abstract in Croatian

Samo je nekoliko radova koji potvrđuju Epsteinove kriterije za karcinome prostate niskog rizika od kojih je samo jedan iz Europe. Aktivni nadzor je legitimna opcija kod lokaliziranog karcinoma prostate niskog rizika. U našem istraživanju testirali smo u skupini bolesnika niskog rizika, koja je liječena radikalnom prostatektomijom, najstrože preoperativne kriterije za aktivni nadzor. Od siječnja 2003. do siječnja 2008. retropubičnoj radikalnoj prostatektomiji podvrgnuto je 586 bolesnika od kojih je 106 bilo podobno za aktivni nadzor prema kombiniranim preoperativnim kriterijima koje su definirali van den Bergh i Carter. Analizirali smo prisutnost nepovoljnih patoloških nalaza na konačnom patohistološkom preparatu nakon prostatektomije koji isključuju bolest niskog rizika. Ukupno, nepovoljan patohistološki nalaz bio je prisutan u 41 bolesnika, što je 38,6% bolesnika kojima je mogao biti ponuđen i aktivni nadzor. Tijekom perioda praćenja od 48 (12-72) mjeseci biokemijski relaps zabilježen je u 6 bolesnika. Premda aktivni nadzor postaje popularan zbog dugog prirodnog tijeka raka prostate i straha od pretjeranog liječenja bolesnika sa indolentnim tijekom bolesti i liječnici i bolesnici moraju biti svjesni potencijalno signifikatne bolesti u ovoj skupini i ograničenja sadašnjih preoperativnih kriterija koji definiraju bolesnike niskog rizika.

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