The importance of the quantification of the extent of cancer in prostatic biopsies in prediction of biochemical recurrence: a global perspective.

Biochemical recurrence (BCR) after definitive therapy for localized prostate cancer represents an important surrogate end point and heralds metastatic progression and possibly cancer-specific mortality. At 20 yr after radical prostatectomy (RP), as much as 41% of patients demonstrate BCR [1]. Of those with BCR, 10 yr after BCR diagnosis, 25% progress to distant metastases and 11% die of prostate cancer (PCa). Although only a proportion of individuals with BCR will progress to clinically meaningful end points, BCR represents a worrisome finding to both patients and clinicians. Several variables have been examined with respect to their ability to predict BCR after definitive therapy. After RP, pretreatment prostate-specific antigen (PSA), clinical stage, and biopsy Gleason patterns represent the standard predictors. The ability of these variables to predict BCR is substantially improved when they are combined within multivariable models. Kattan and colleagues were the first to apply these variables within a prognostic nomogram that quantified the individual probability of BCR after prostatectomy [2]. These three variables were 79% accurate in predicting BCR at 5 yr after RP in the original 1998 nomogram (n = 168) and 77% accurate in predicting BCR at 10 yr after RP within an updated 2006 version of the nomogram [2,3]. In an