The D’Amico and Epstein criteria predict organ confined but not clinically insignificant prostate cancer

Abstract

Introduction & Objectives: The D’Amico and Epstein criteria represent mostly used models for prediction of low risk prostate cancer. We evaluate the rate of potentially clinically significant prostate cancer (Gleason score ≥7 and/or extra prostatic extension (EPE)) and prostate specific antigen (PSA) free survival in men who fulfilled the D’Amico and Epstein criteria before radical prostatectomy. Material & Methods: Between 2004 and 2007, 690 men underwent prostate biopsy and open radical retropubic prostatectomy at a single department of university hospital. Of those the 314 patients have met the D’Amico criteria and 64 among them – the Epstein criteria. The study end point was detection of potentially clinically significant prostate cancer in the groups using different criteria models. The secondary end point was detection of PSA free survival in the each group. Results: EPE was found in 39 (12.4%) of the “D’Amico group” and in 4 (6.3%) of the “Epstein group” patients (Chi Square test p=0.156, Fisher Exact test p=0.197). Gleason score ≥7 after radical prostatectomy was found in 94 (29.9%) and 12 (18.8%) respectively of study groups men (Chi Square test p=0.069, Fisher Exact test p=0.092). Clinically significant prostate cancer (EPE and/or upgrading) was detected in 109 (34.7%) and 14 (23.4%) those groups patients (Chi Square test p=0.08, Fisher Exact test p=0.102) respectively. At median 24 months follow up the overall PSA free survival in the “D’Amico group” was 91.8% (for insignificant PCa 94% and for clinically significant – 87.5%, long rank test p=0.048). According Epstein criteria the overall PSA free survival was 93.5% (for insignificant PCa 93.8% and for clinically significant – 92.9%, long rank test p=0.942). There was no different overall PSA free survival in study groups (Log rank test p=0.691). Conclusions: Using the D’Amico or Epstein criteri [...].