Objective: To explore the clinicopathological implications of single positive core prostate cancer.
Methods: A total of 45 patients with transrectal ultrasound (TRUS)-guided prostate biopsy were diagnosed with single positive core prostate cancer and subsequently underwent radical prostatectomy (RP). Their clinicopathological parameters were examined to identify the factors for disease upgrading or upstaging.
Results: On final pathology, only 31.1% patients had unilateral prostate cancer. And 37.8% patients experienced Gleason score upgrading, 66.7% patients had upstaging and 31.1% were found positive surgical margins. On multivariable analyses, the percentage of positive cores was an independent predictor of stage upgrading and perineural invasion at RP pathology. Age, prostate volume and preoperative prostate-specific antigen/prostate-specific antigen density (PSA/PSAD) had no significant effect on underestimated tumor burden.
Conclusions: Most single positive core prostate cancer diagnosed by 12-core biopsy may be underestimated. The percentage of positive cores is an independent predictor of underestimated prostate cancer. Currently we have no instruments for accurately identifying microfocal or unilateral prostate cancer.