Open Access Research

The role of the maximum involvement of biopsy core in predicting outcome for patients treated with dose-escalated radiation therapy for prostate cancer

Jure Murgic1, Matthew H Stenmark1, Schuyler Halverson1, Kevin Blas1, Felix Y Feng1,2 and Daniel A Hamstra1,3*

Author Affiliations

1 The Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, MI, USA

2 Veterans Affairs Medical Center, Ann Arbor, MI, USA

3 University of Michigan Health System, Department of Radiation Oncology, 1500 E. Medical Center Drive, UH B2-C490, Ann Arbor, MI, 48109-5010, USA

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Radiation Oncology 2012, 7:127 doi:10.1186/1748-717X-7-127

Published: 1 August 2012

Abstract

Purpose

To evaluate the influence of the maximum involvement of biopsy core (MIBC) on outcome for prostate cancer patients treated with dose-escalated external beam radiotherapy (EBRT).

Methods and materials

The outcomes of 590 men with localized prostate cancer treated with EBRT (≥75 Gy) at a single institution were retrospectively analyzed. The influence of MIBC on freedom from biochemical failure (FFBF), freedom from metastasis (FFM), cause-specific survival (CSS), and overall survival (OS) was compared to other surrogates for biopsy tumor volume, including the percentage of positive biopsy cores (PPC) and the total percentage of cancer volume (PCV).

Results

MIBC correlated with PSA, T-stage, Gleason score, NCCN risk group, PPC, PCV, and treatment related factors. On univariate analysis, MIBC was prognostic for all endpoints except OS; with greatest impact in those with Gleason scores of 8–10. However, on multivariate analysis, MIBC was only prognostic for FFBF (hazard ratio [HR] 1.9, p = 0.008), but not for FFM (p = 0.19), CSS (p = 0.16), and OS (p = 0.99).

Conclusions

In patients undergoing dose-escalated EBRT, MIBC had the greatest influence in those with Gleason scores of 8–10 but provided no additional prognostic data as compared to PPC and PCV, which remain the preferable prognostic variables in this patient population.

Keywords:
Prostate cancer; Biopsy; prognostic factors; Maximum involvement; Tumor in Core; Radiotherapy