Journal List > Korean J Urol > v.49(10) > 1005197

Chung, Han, Jeong, Hong, Byun, Choe, and Lee: Pathologic Outcome of Unilateral Low Risk Prostate Cancers on Multicore Prostate Biopsy after Radical Prostatectomy



To investigate clinicopathologic characteristics of unilateral, low risk prostate cancers detected via multi (≥12)-core prostate biopsy.

Materials and Methods

One hundred four patients who underwent radical retropubic prostatectomy (RRP) for unilateral, low risk prostate cancer (clinical stage ≤T2a, biopsy Gleason sum ≤6, PSA ≤10ng/ml, and ipsilateral positive cores ≤2) detected via multi (≥12)-core prostate biopsy were enrolled. In this retrospective study, we reviewed the patients' preoperative and pathologic data to assess potential predictors of pT2c or greater disease at the time of RRP, as well as characteristics of such disease.


Of the 104 subjects, only 34 (32.7%) were pathologically-proven to have unilateral disease, while the others showed pathologically-bilateral or worse disease from analysis of the RRP specimens. Subjects pathologically found to have uni- and bi-lateral disease showed no significant differences regarding age, prostate-specific antigen (PSA), free-to-total PSA ratio, prostate volume, clinical stage, number of positive cores, biopsy Gleason score, number of total biopsy sites, and highest percentage of tumor at any biopsy site. Multivariate logistic regression analysis revealed no significant preoperative predictors of pT2c or greater disease at RRP.


Most patients with unilateral, low risk prostate cancer detected on multi (≥12)-core prostate biopsy actually had pathologically-worse disease. For clinically-localized prostate cancer, a more accurate method to identify appropriate candidates for unilateral or focal ablative therapy should be developed.

Figures and Tables

Table 1
Preoperative characteristics of subjects according to transrectal ultrasonography-guide prostate biopsy specimens (Clinical stage T1c or T2a, biopsy Gleason sum <6, PSA <10ng/ml, and 1 or 2 ipsilateral positive cores)

BMI: body mass index, PSA: prostate-specific antigen

Table 2
Preoperative characteristics of subjects according to pathologic outcome (uni-or bi-lateral disease) after surgery

BMI: body mass index, PSA: prostate-specific antigen

Table 3
Multivariate logistic regression analysis of potential predictors for bilateral or worse disease after surgery

CI: confidence interval, OR: odds ratio, BMI: body mass index, PSA: prostate-specific antigen


1. Bahn DK, Silverman PD. Focal cryoablation of prostate: a review. Scientific World Journal. 2008. 8:486–491.
2. Eggener SE, Scardino PT, Carroll PR, Zelefsky MJ, Sartor O, Hricak H, et al. Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol. 2007. 178:2260–2267.
3. Pinthus JH, Witkos M, Fleshner NE, Sweet J, Evans A, Jewett MA, et al. Prostate cancers scored as Gleason 6 on prostate biopsy are frequently Gleason 7 tumors at radical prostatectomy: implication on outcome. J Urol. 2006. 176:979–984.
4. Mikami Y, Manabe T, Epstein JI, Shiraishi T, Furusato M, Tsuzuki T, et al. Accuracy of Gleason grading by practicing pathologists and the impact of education on improving agreement. Hum Pathol. 2003. 34:658–665.
5. Lattouf JB, Saad F. Gleason score on biopsy: is it reliable for predicting the final grade on pathology? BJU Int. 2002. 90:694–698.
6. Fukagai T, Namiki T, Namiki H, Carlile RG, Shimada M, Yoshida H. Discrepancies between Gleason scores of needle biopsy and radical prostatectomy specimens. Pathol Int. 2001. 51:364–370.
7. Miller DC, Gruber SB, Hollenbeck BK, Montie JE, Wei JT. Incidence of initial local therapy among men with lower risk prostate cancer in the United States. J Natl Cancer Inst. 2006. 98:1134–1141.
8. Sakr WA, Haas GP, Cassin BF, Pontes JE, Crissman JD. The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. J Urol. 1993. 150:379–385.
9. Konety BR, Bird VY, Deorah S, Dahmoush L. Comparison of the incidence of latent prostate cancer detected at autopsy before and after the prostate specific antigen era. J Urol. 2005. 174:1785–1788.
10. Kirkham AP, Emberton M, Allen C. How good is MRI at detecting and characterising cancer within the prostate? Eur Urol. 2006. 50:1163–1174.
11. Connolly SS, O'Malley KJ, O'Brien A, Kelly DG, Mulvin DW, Quinlan DM. Can prostate biopsies predict suitability for nerve-sparing radical prostatectomy? Scand J Urol Nephrol. 2004. 38:216–220.
12. Scales CD Jr, Presti JC Jr, Kane CJ, Terris MK, Aronson WJ, Amling CL, et al. Predicting unilateral prostate cancer based on biopsy features: implications for focal ablative therapy-results from the SEARCH database. J Urol. 2007. 178:1249–1252.
13. Noguchi M, Stamey TA, McNeal JE, Nolley R. Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers. J Urol. 2003. 170:459–463.
14. Häggman M, Nordin B, Mattson S, Busch C. Morphometric studies of intra-prostatic volume relationships in localized prostatic cancer. Br J Urol. 1997. 80:612–617.
15. Wise AM, Stamey TA, McNeal JE, Clayton JL. Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology. 2002. 60:264–269.
16. Ruijter ET, van de Kaa CA, Schalken JA, Debruyne FM, Ruiter DJ. Histological grade heterogeneity in multifocal prostate cancer. Biological and clinical implications. J Pathol. 1996. 180:295–299.
17. Gburek BM, Kollmorgen TA, Qian J, D'Souza-Gburek SM, Lieber MM, Jenkins RB. Chromosomal anomalies in stage D1 prostate adenocarcinoma primary tumors and lymph node metastases detected by fluorescence in situ hybridization. J Urol. 1997. 157:223–227.
18. Chung JS, Han BK, Jeong SJ, Moon KH, Choe G, Park DS, et al. Prognostic significance of multifocal tumor in radical prostatectomy. Korean J Urol. 2008. 49:510–514.
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