XXXX : analysis of preoperative parameters.

@entity1 @entity263 @entity5 @entity1486
OBJECTIVES: Analyzing preoperative parameters to help determine the risk of a random or systematic prostate needle biopsy specimen detecting an incidental microscopic @entity263 . METHODS: We reviewed the charts of 28 @entity1 who had < or = 3 mm of Gleason grade (Glgr) < or = 2 (score < or = 4) @entity263 in their prostate biopsy specimen and subsequently underwent a radical retropubic prostatectomy (RRP). Histopathologic review of the RRP specimen was carefully performed to determine the respective @entity5 volume, number of @entity5 foci, pathologic stage, Glgr, and score. @entity1486 (PSA) levels and the calculated PSA density (PSAD) were recorded for each case. RESULTS: Sixteen of the 28 (57%) RRP specimens contained a very small well-differentiated @entity5 (< or = 0.2 cc); 7 (25%) @entity5 were minimally larger (0.2 to 0.5 cc); and 2 specimens (7%) contained a large @entity5 (4 and 6 cc) only sampled by the biopsy specimen. Mean PSA levels and PSAD values both significantly differentiated @entity5 < or = 0.5 cc from those > 0.5 cc (p < 0.005). PSA < or = 4 vs PSAD < or = 0.1 correctly identified 12 of 23 (52%) vs 22 of 23 (96%) @entity5 < or = 0.5 cc, and 10 of 16 (63%) vs 15 of 16 (94%) @entity5 < or = 0.2 cc, respectively; both parameters excluded 4 of 5 (80%) @entity5 > 0.5 cc. PSA < or = 4 vs PSAD < or = 0.1 identified 13 of 25 (52%) vs 24 of 25 (96%) organ-confined @entity5 , respectively, and both parameters excluded the 2 specimen-confined and 1 margin-positive @entity5 . Thus, PSAD had an excellent ability to differentiate the @entity5 based on their volumes. All @entity5 < or = 0.5 cc in the RRP specimen were organ-confined and postoperative serial PSA levels remained < 0.4 in these @entity1 at a mean follow-up of 24 months. CONCLUSIONS: Our data indicate that a @entity1 who has a random or systematic prostate biopsy specimen that contains < or = 3 mm of Glgr < or = 2 @entity263 and a PSAD < or = 0.1 is at a substantial risk (82%) of being diagnosed with an incidental, organ-confined, and probably insignificant, microscopic @entity263 .
