SciELO - Scientific Electronic Library Online

vol.37 issue1Urinary calculi composed of uric acid, cystine, and mineral salts: differentiation with dual-energy CT at a radiation dose comparable to that of intravenous pyelographyThe Epstein criteria predict for organ-confined but not insignificant disease and a high likelihood of cure at radical prostatectomy author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




Related links


International braz j urol

Print version ISSN 1677-5538

Int. braz j urol. vol.37 no.1 Rio de Janeiro Jan./Feb. 2011 



Application of the Epstein criteria for prediction of clinically insignificant prostate cancer in Korean men



Lee SE; Kim DS; Lee WK; Park HZ; Lee CJ; Doo SH; Jeong SJ; Yoon CY; Byun SS; Choe G; Hwang SI; Lee HJ; Hong SK

Department of Urology, Seoul National Bundang Hospital, Seongnam, Korea
BJU Int. 2010; 105: 1526-30



OBJECTIVE: To investigate the rate of pathologically confirmed unfavourable prostate cancers among Korean men who fulfilled the contemporary Epstein criteria for clinically insignificant prostate cancer.
PATIENTS AND METHODS: This was a retrospective study of 131 Korean men who underwent radical prostatectomy (RP) for clinically insignificant prostate cancer as defined by contemporary Epstein criteria. We assessed the percentage of unfavourable prostate cancer (pathological Gleason sum > or = 7 and/or extraprostatic extension [EPE]) among these men and tried to identify useful predictors for such unfavourable tumour profiles using uni- and multivariate analyses.
RESULTS: Among 131 men with clinically insignificant prostate cancer, 40 (30.5%) had pathological Gleason > or = 7 tumours after RP. Of these 40 men, four (3.1%) also had EPE on examination of RP specimen. All those who did not have Gleason score upgrading after RP had organ-confined disease from examination of RP specimen. Overall, 40 (30.5%) of the 131 men who fulfilled the contemporary Epstein criteria for clinically insignificant prostate cancer before RP had pathologically unfavourable disease. Among our patients, no significant preoperative predictor of pathologically unfavourable disease was identified using uni- and multivariate analyses.
CONCLUSION: Our results showed that a significant proportion of contemporary Korean patients who meet all the conditions of the contemporary Epstein criteria for prediction of clinically insignificant prostate cancer might actually harbour prostate cancer with unfavourable pathological features. Such findings should be considered when treatment options are contemplated based upon the Epstein criteria among Asian patients.



Watchful waiting (active surveillance) has gaining popularity as a management strategy for newly diagnosed low-grade, limited cancer on needle biopsy based on the large discrepancy between incidence and mortality rate of prostate cancer. Data from the European Randomized Study of Screening for Prostate Cancer Trial showed that PSA screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis (1).

Epstein proposed a set of criteria based on PSA and preoperative biopsy features that identify a high likelihood of organ-confined insignificant cancers at radical prostatectomy (2). Insignificant cancers are defined as cancers confined to the prostate (pT2), Gleason low-grade (score = 6), and low-volume (= 0.5 cc). It is important to be aware that insignificant cancer is not synonymous of latent (indolent) carcinoma. So far, there is no single marker of biological behavior for prostate cancer.

The preoperative biopsy and clinical features of Epstein's criteria for insignificant cancer are: clinical stage T1c, preoperative PSA density < 0.15, no Gleason pattern 4 or 5, no more than 2 cores with cancer, and no more than 50% of involvement of cancer in a single core. According to Bastian at Johns Hopkins, the predictive value using the Epstein's criteria for organ-confined disease and insignificant cancer is 92% and 84%, respectively.

Several studies have applied Epstein's criteria for prediction of clinically insignificant prostate cancer with differing results. In all studies, the criteria are predictive of a high frequency of organ-confined disease but differ for insignificant cancer. In the study from Korea, the frequency of organ-confined disease was 97% (vs. 92% from Johns Hopkins) but 69% for insignificant cancer (vs. 84% from Johns Hopkins).



1. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al.: Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009; 360: 1320-8.         [ Links ]

2. Bastian PJ, Mangold LA, Epstein JI, Partin AW: Characteristics of insignificant clinical T1c prostate tumors. A contemporary analysis. Cancer. 2004; 101: 2001-5.         [ Links ]


Dr. Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License