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Can prostatic biopsy predict insignificant disease in Western Australia (WA)

Introduction:  Numerous criteria for predicting insignificant disease based on PSA density, Gleason score, number of and extent of involvement of each core with cancer have been described. Epstein et al have used this to attempt to delay or prevent surgery for low risk or insignificant disease. Epstein's criteria were applied to prostatic biopsies from the WA Uropath database. Method:  The database was searched to identify cases of Gleason score 6 or less, less than 3 cores involved with cancer, and PSA density less than 0.15. Using these criteria 37 cases were identified. All of these cases went on to have a radical prostatectomy. Results:  Nineteen had Tumour Gleason 6 or less and/or volume 0.5cc. Conclusion:  Epstein's criteria when applied to the WA database was inefficient at predicting insignificant disease.