Prostate Cancer Assessment of Pathological Prostate Cancer Characteristics in Men with Favorable Biopsy Features on Predominantly Sextant Biopsy Felix K.-H. Chun a,b,1 , Nazareno Suardi a,c,1 , Umberto Capitanio a,c , Claudio Jeldres a , Sascha Ahyai d , Markus Graefen d , Alexander Haese b , Thomas Steuber b , Andreas Erbersdobler e , Francesco Montorsi c , Hartwig Huland b,d , Pierre I. Karakiewicz a, * a Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada b Department of Urology, University of Hamburg, Hamburg, Germany c Vita-Salute University, Department of Urology, Milan, Italy d Martini Clinic–Prostate Cancer Center, University of Hamburg, Hamburg, Germany e Department of Pathology, University of Hamburg, Hamburg, Germany european urology 55 (2009) 617–628 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted April 30, 2008 Published online ahead of print on May 15, 2008 Keywords: Prostate cancer Minimal disease Radical prostatectomy Abstract Background: The rate of insignificant prostate cancer (IPCa) is increasing. Objectives: To examine three end points in patients with a single, positive core and no high- grade prostate cancer (PCa) at biopsy, namely (1) rate of clinical IPCa at radical prostatectomy (RP), defined as organ-confined PCa with a Gleason score of 6 or lower and tumor volume < 0.5 cc; (2) rate of pathologically unfavorable PCa at RP (Gleason 7–10 or non-organ-confined disease); and (3) ability to predict either insignificant or unfavorable PCa at RP. Design, Setting, and Participants: Retrospective analysis of 209 men with one positive biopsy core showing Gleason 6 or lower. Measurements: : Detailed clinical and RP data were used in multivariable logistic regression models. Their bias-corrected accuracy estimates were quantified using the area under the curve (AUC) method. Results and Limitations: At RP, IPCa was present in 28 patients (13.4%) and pathologically unfavorable PCa, defined as Gleason 7 or higher or non-organ-confined PCa, was reported in 70 (33.5%) of 209 men; when Gleason 8 or higher or non-organ-confined PCa was considered, the proportion fell to 11%. Our multivariable models predicting different categories of patholo- gically unfavorable PCa at RP had an accuracy rate between 56% and 68% for predicting IPCa at RP versus 65.1% to 66.1% and 61.7% for the IPCa nomograms of Kattan et al and Nakanishi et al, respectively. Our data are not applicable to screening because they originate from a referral population. Conclusions: Despite highly favorable biopsy features, between 11% and 33% of men had unfavorable PCa at RP and only a minority (13.4%) had pathologically confirmed IPCa. Neither clinically insignificant nor pathologically unfavorable features could be predicted with suffi- cient accuracy for clinical decision making. # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved. 1 Both authors contributed to the manuscript equally. * Corresponding author. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), 1058, rue St-Denis, Montreal, Quebec, Canada, H2X 3J4. Tel: +1 514 890 8000 35336; Fax: +1 514 227 5103. E-mail address: pierre.karakiewicz@umontreal.ca (P.I. Karakiewicz). 0302-2838/$ – see back matter # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2008.04.099