Epstein criteria for insignificant prostate cancer

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Abstract
Study Type – Prognosis (systematic review) Level of Evidence 2b What’s known on the subject? and What does the study add? Overtreatment of prostate cancer is a major problem in contemporary urological practice. The Epstein Criteria reduces overtreatment by identifying insignificant prostate cancers that may be amenable to surveillance therapy. This systematic review of the Epstein Criteria validation studies provides a collective insight into the application and accuracy of the Epstein Criteria to predict for insignificant prostate cancer across different institutions and geographies. OBJECTIVE: • To review the accuracy of the Epstein Criteria for insignificant prostate cancer and to explore the effect of the modified Gleason classification system on this system. METHODS: • We searched PubMed, EMBASE and the Cochrane Database using search terms ‘Epstein Criteria’, ‘Prostate Cancer’, ‘Validation’ and ‘Insignificant Cancer’ between 1994 to 2010 for validation articles. • These were divided into pre‐2005 and post‐2005 and concordances for organ‐confined status, Gleason score ≤6 and insignificant cancer were analysed. RESULTS: • A pre‐2005 study showed concordance for insignificant prostate cancer, Gleason score ≤6 and organ‐confined status at 84%, 90.3% and 91.6%, respectively. • Five post‐2005 validation studies were concordant for insignificant cancer, Gleason score ≤6 and organ‐confined status at 37–76%, 54.3–75.9% and 80.0–96.9%, respectively. CONCLUSIONS: • The Epstein Criteria has a suboptimal accuracy for predicting for insignificant prostate cancer. • The modification to Gleason scoring may be responsible for a reduced accuracy over time. • However, significant heterogeneity in the validation studies means better quality validation studies are required.

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