A pretreatment table for the prediction of final histopathology after radical prostatectomy in clinical unilateral T3a prostate cancer

Abstract

Objectives: Partin tables are the most widely used tool to predict histopathologic stage after radical prostatectomy (RP) in organ-confined tumors. Such a predictive table in clinical T3 disease is still lacking. Our objective was to create a reference table for clinical unilateral T3a prostate cancer.

Patients and methods: Between 1987 and 2004, 200 patients with clinical unilateral T3a disease underwent a RP and bilateral pelvic lymphadenectomy at our institution. No patient had received neoadjuvant treatment. Patients were divided into three prostate-specific antigen (PSA) subgroups (<or=10 ng/ml, >10-20 ng/ml, and >20 ng/ml) and two biopsy Gleason sum (GS) subgroups (<or=7 [3+4] and >or=7 [4+3]). These parameters were used in the table as predictors for final histopathology. Margin and nodal status were also recorded. The multinomial log-linear regression analysis was used to construct the table.

Results: The table stratifies patients into six demarcated risk groups. In the first group, consisting of patients with PSA <or=10 and GS <or=7 (3+4), understaging was only 6% (5% pT3b and 1% pT4). The risk for understaging cT3a prostate cancer increases further with increasing PSA and GS. In the sixth group, consisting of patients with PSA >20 and GS >or=7 (4+3), understaging was as high as 68% (44% pT3b and 22% pT4). Receiver operating characteristic analyses showed good accurate predictive ability of the table for seminal vesicle involvement and adjacent structure involvement, with moderate predictive ability for extraprostatic extension only.

Conclusions: We present a table combining preoperative serum PSA and biopsy GS to predict histopathologic results in clinical unilateral T3a prostate cancer. The table may provide a basis for decision-making and patient counseling before treating this cancer.