Accuracy of the contemporary Epstein criteria to predict insignificant prostate cancer in North African Man
Objective: To determine the accuracy of the contemporary Epstein criteria for predicting insignificant and organ-confined prostate cancer in a North African ethnic group of patients who were eligible for active surveillance based on these criteria, but had been subjected to radical prostatectomy.
Patients and methods: A total of 340 North African men underwent radical prostatectomy for clinically localized prostate cancer at two academic institutions between January 2006 and September 2013. In 74 of these patients (21.76%), prostate cancer had been assumed to be insignificant based on the contemporary Epstein criteria. The radical prostatectomy specimens were analyzed in order to identify the rate of pathologically unfavorable prostate cancer, defined as either pathologic Gleason score 7–10 and/or a tumor volume > 0.5 cc, and/or non-organ-confined disease (stage ≥ pT3a and/or pN1 and/or positive surgical margins).
Results: Gleason sum upgrading (≥7) was necessary in 16 (21.6%) and upstaging of the radical prostatectomy specimens in 18 patients (24.3%). Simultaneous upstaging and upgrading of the specimens was observed in 12 patients (16%). A tumor volume ≤ 0.5 cc was found in 42 patients (57%). The rate of multifocality of prostate cancer (≥2 foci) was 59.5%. The accuracy of the contemporary Epstein criteria for predicting insignificant prostate cancer was 57%, while it predicted organ-confined disease in 85%.
Conclusion: The contemporary Epstein criteria used for the identification of clinically insignificant prostate cancer have been found to underestimate the real state of prostate cancer in as many as 43% of our patients. They were a good tool for predicting organ-confined rather than insignificant prostate cancer in our North African patients. Therefore, caution is advised when the decision on the implementation of active surveillance or focal therapy is solely based on these criteria.
Keywords: Insignificant prostate cancer; Organ-confined disease; Active surveillance; Epstein criteria; Upgrading; Upstaging; North Africa