© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 3, 228-229,
February 6, 2002
© 2002 Oxford University Press
CORRESPONDENCE |
RESPONSE: Re: Pathologic Features of Prostate Cancer Found at Population-Based Screening With a Four-Year Interval
Affiliations of authors: R. F. Hoedemaeker, T. H. van der Kwast (Department of Pathology), F. H. Schröder (Department of Urology), Erasmus University, Rotterdam, The Netherlands.
Correspondence to: Robert F. Hoedemaeker, M.D., Department of Pathology, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands (e-mail: Hoedemaeker{at}path.fgg.eur.nl).
Dr. Stamey questions whether the use of needle biopsy characteristics justifies the conclusions in our report. Indeed, a large number of studies report a limited predictive value of needle biopsies for tumor features in the prostate, for instance (1,2). We agree that the low correlation coefficients found in these studies constitute major limitations for the prediction of tumor characteristics from needle biopsy findings on an individual patient basis. This is unfortunate because a number of studies have shown that, especially in conjunction with prostate-specific antigen, needle biopsy parameters seem to be the best predictors of tumor characteristics (3,4).
Our study was not performed to predict prostate cancer characteristics on an individual patient basis but compares two large groups of patients (consisting of 210 and 94 men). Furthermore, the main purpose of our report was not to predict tumor characteristics in radical prostatectomy specimens but to reveal biopsy-related prognostic factors at rescreening after 4 years. With the current uncertainties concerning the effects of early detection and treatment of prostate cancer, the urgent clinical need remains to predict the outcome of localized prostate cancer by pretreatment parameters rather than on the characteristics of radical prostatectomy specimens. We are encouraged by the fact that, in a study comparing biopsy and radical prostatectomy characteristics (5) as well as in the most relevant natural history studies (6,7), progression-free survival and disease-specific survival show a statistically significant correlation with biopsy features.
Prostatic biopsy features, therefore, do have predictive value for clinical outcome, especially when large groups of patients are compared. The observed decline in the amount of cancer in the needle biopsies in the men with prostate cancer in the second screening round of our study was considerable. The median amount of tumor in needle biopsies in round 2 was nearly half that in round 1. Furthermore, men with high prostate-specific antigen levels (
10 ng/mL) showed an even more pronounced decline in the median amount of cancer (from 14.6 mm in round 1 to 4.2 mm in round 2) and in the tumor detection frequency (from 58% in round 1 to 23% in round 2). Especially when these results are viewed in the context of other observations in our study, such as the statistically significant decline in needle biopsy grade and the considerable shift toward more favorable tumor categories, both of which were observed in round 2, it is highly unlikely that the observed decreased amount of tumor in the biopsy cores of round 2 is a chance finding. In our view, the main conclusion of our report, which is not that the tumors in round 2 are smaller than the tumors in round 1 but that there is a lack of evidence for an increase in size and a decrease in degree of differentiation in round 2 tumors, seems justified.
REFERENCES
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2 Noguchi M, Stamey TA, McNeal JE, Yemoto CM. Relationship between systematic biopsies and histological features of 222 radical prostatectomy specimens: lack of prediction of tumor significance for men with nonpalpable prostate cancer. J Urol2001;166:104–9.[CrossRef][ISI][Medline]
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