Histological Findings in Very Low Risk Prostate Cancer Patients Managed with Radical Prostatectomy

Carlos Gustavo Trujillo Ordoñez, Anamaria Ramos Hernández, Daniela Robledo Cárdenas, Ángela Marcela Mariño Álvarez, Juan Guillermo Cataño Cataño, Juan Ignacio Caicedo Cárdenas, Rebeca Escobar Monroy, Mauricio Plata Salazar



Objectives: To describe the histological findings in patients with prostate cancer (PCa) clinically classified as very low risk who underwent treatment with radical prostatectomy (RP). Material and methods: A retrospective observational study was conducted. Clinical records of patients who underwent RP between 2007-2015 who met Epstein criteria for very low risk disease were reviewed. Histological diagnosis was described and analyzed to determine if such criteria predicted very low risk. Results: A total of 609 records were reviewed; 83 (13.6%) met Epstein’s criteria. Mean age was 59 (SD±7) years and median PSA at diagnosis was 5.4 ng/dl (IQR 4.3 – 6.8). Pathology showed a median tumor volume of 4% (IQR 1 – 10%). Gleason score was 3+3 in 55 (66.3%) cases, but 28 (33.7%) were reclassified to a greater score. Two (2.4%) patients were reclassified as pT3a, 80 (96.4%) as pT2 and 1 (1.2%) was found to be pT0. In those subjected to pelvic lymphadenectomy (42.2%) no positive lymph nodes were found. Conclusions: Up to one-third of the patients clinically classified with very low risk PCa had a greater Gleason score. Only 3% had locally advanced tumors, which is comparable to previous studies. Epstein’s criteria seem to be adequate in predicting organ-confined disease. 

Palabras clave

very low risk prostate cancer;radical prostatectomy;tumor stage

Texto completo:



Schröder FH. Prostate cancer: To screen? BMJ. 1993;306:407-8.

Venderos Lionne DF, Roobol M, De Hoogh A. Active surveillance for prostate cáncer: A legal perspective. Am J Clin Exp Urol. 2014;2(4):323-31.

Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L. et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33(3):272-7.

Schroder F, Roach M, Scardino P. Management of prostate cancer. N Engl J Med. 2008;359:2605-9.

Tosoian JJ, Carter HB, Lepor A, Loeb S. Active surveillance for prostate cancer: current evidence and contemporary state of practice. Nat Rev Urol. 2016;13(4):205-15.

Epstein JI, Walsh PC, Carmichael M, et al. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA. 1994;271:368-74.

Wein A, Kavoussi L, Partin A, Peters C. Campbell-Walsh urology. 10 th ed. Philadelphia: Elsevier; 2012.

Klotz L. Active surveillance for favorable-risk prostate cancer: Who, how and why? Nat Clin Pract Oncol. 2007;4:692-8.

D’Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280(11):969-74.

Laurence. Active surveillance for prostate cancer: Trials and tribulations. World J Urol. 2008;26:437-42.

Parker C. Active surveillance: towards a new paradigm in the management of early prostate cancer. Lancet Oncol. 2004;5:101-6.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer [internet]. Available from: http://www.nccn.org/professionals/physician_gls/PDF/prostate.pdf

American Urological Association. Guideline for the management of clinically localized prostate cancer [internet]. Available from: https://www.auanet.org/documents/education/clinical-


Jeldres C, Suardi N, Walz J, et al. Validation of the contemporary Epstein criteria for insignificant prostate cancer in European men. Eur Urol. 2008;54:1306-13.

Epstein JI, Chan DW, Sokoll LJ, et al. Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. J Urol. 1998;160:2407-11.

Kattan MW, Eastham JA, Wheeler TM, et al. Counseling men with prostate cancer: a nomogram for predicting the presence of small, moderately differentiated confined tumors. J Urol. 2003;170:1792-7.

Chun FK-H, Steuber T, Erbersdobler A, et al. Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol. 2006;49:820-6.

Bastian PJ, Mangold LA, Epstein JI, Partin AW. Characteristics of insignificant clinical T1c prostate tumors: A contemporary analysis. Cancer. 2004;101:2001-5.

Beauval JB, Ploussard G, Soulié M, Pfister C, Vanagt S, Vincendeau S, Larue S. Pathologic findings in radical prostatectomy specimens from patients eligible for active surveillance with highly selective criteria: a multicenter study. J. Urology. 2012;80:656-60.

Tosoian J, Sundi D, Trock BJ, Landis P, Epstein J, Schaeffer EM. Pathologic outcomes in favorable-risk prostate cancer: comparative analysis of men electing active surveillance and immediate surgery. Eur Urol. 2016;69:575-81.

Kulkarni JN, Valsangkar RS, Jadhav YR, Singh DP. Impact of Gleason pattern up gradation after radical prostatectomy for carcinoma prostate patients with low biopsy score (≤6). J Cancer Res Ther. 2011;7:459-62.

Cookson MS, Fleshner NE, Soloway SM, Fair WR. Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J Urol. 1997;157:559-62.

Chang JM, Lee HJ, Lee SE, et al. Pictorial review: unusual tumors involving the prostate: radiological-pathological findings. Br J Radiol. 2008;81:907-15.

Dall’Era MA, Konety BR, Cowan JE, et al. Active surveillance for the management of prostate cancer in a contemporary cohort. Cancer. 2008;112:2664-70.

Villers A, Lemaitre L, Haffner J, Puech P. Current status of MRI for the diagnosis, staging and prognosis of prostate cancer: Implications for local therapy and active surveillance. Curr Opin Urol. 2009;19:274-82.

Lindenberg L, AhLman M, Turkbey B, Mena E, Choyke P. Advancement of MR and PET/MR in Prostate Cancer. Semin Nucl Med. 2016;46(6):536-43.

Bouchelouche K, Choyke PL. Prostate-specific membrane antigen positron emission tomography in prostate cancer: A step toward personalized medicine. Curr Opin Oncol. 2016;28:216-21.

DOI: http://dx.doi.org/10.11144/Javeriana.umed58-3.risk

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