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Clinical Utility of the Percentage of Positive Prostate Biopsies in Defining Biochemical Outcome After Radical Prostatectomy for Patients With Clinically Localized Prostate Cancer

From the Joint Center for Radiation Therapy, Harvard Medical School, and Departments of Pathology and Urology, Brigham and Women’s Hospital, Boston; Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA; Departments of Radiation Oncology, Urology, and Pathology, Hospital of the University of Pennsylvania, Philadelphia; and Department of Mathematics, Millersville University, Millersville, PA.

Address reprint requests to Anthony V. D’Amico, MD, PhD, Joint Center for Radiation Therapy, Harvard Medical School, 330 Brookline Ave, 5th Floor, Boston, MA 02215; email adamico{at}jcrt.harvard.edu

PURPOSE: To determine the clinical utility of the percentage of positive prostate biopsies in predicting prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) for men with PSA-detected or clinically palpable prostate cancer.

METHODS: A Cox regression multivariable analysis was used to determine whether the percentage of positive prostate biopsies provided clinically relevant information about PSA outcome after RP in 960 men while accounting for the previously established risk groups that are defined according to pretreatment PSA level, biopsy Gleason score, and the 1992 American Joint Committee on Cancer (AJCC) clinical T stage. The findings were then tested using an independent surgical database that included data for 823 men.

RESULTS: Controlling for the known prognostic factors, the percentage of positive prostate biopsies added clinically significant information (P < .0001) regarding time to PSA failure after RP. Specifically, 80% of the patients in the intermediate-risk group (1992 AJCC T2b, or biopsy Gleason 7 or PSA > 10 ng/mL and 20 ng/mL) could be classified into either an 11% or 86% 4-year PSA control cohort using the preoperative prostate biopsy data. These findings were validated in the intermediate-risk patients using an independent surgical data set.

CONCLUSION: The validated stratification of PSA outcome after RP using the percentage of positive prostate biopsies in intermediate-risk patients is clinically significant. This information can be used to identify men with newly diagnosed and clinically localized prostate cancer who are at high risk for early ( 2 years) PSA failure and, therefore, may benefit from the use of adjuvant therapy.

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