Capacité de la biopsie de la prostate à prédire le score réel du cancer de la prostate?

But: Evaluer la capacité de la biopsie de la prostate à prédire le score réel du cancer de la prostate. Sujets et Méthodes: Etude rétrospective concernant 47 patients traités pour cancer de la prostate par prostatectomie radicale. L’évaluation de la concordance a été faite selon des groupes de différenciation (bien, moyennement et peu différencié). Résultats: La concordance du score de Gleason était de 70%, une sous-stadification de 25.5%, une sur-stadification de 4.2%. La valeur prédictive positive (VPP) était de 81.25% et 100% pour les groupes bien et moyennement différencié. Un coefficient de concordance Kappa était de 0.36 avec une meilleure concordance constatée dans le groupe moyennement différencié. Conclusion: Le score de Gleason ne reflète qu’imparfaitement celui de la pièce opératoire, ainsi ces limites de stadification doivent être bien comprises lors de la détermination des stratégies thérapeutiques

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