DNA-Cytometric Grading of Prostate Cancer - Systematic Review of the Literature

„Active surveillance“ is an internationally accepted alternative therapeutic strategy for patients with clinically insignificant microcarcinomas of the prostate. Gleason-score (GS) =< 6 in core biopsies represent the most crucial criterion for inclusion. Yet, Interobserver reproducibility of even the updated GS is low (48-70%) and its prognostic validity remains unsatisfactory. An option to complementary and objectively assess the malignant potential of prostatic carcinomas are DNA-ploidymeasurements on existing biopsies. For that purpose chromosomal heterogeneity is indirectly quantified by DNA-cytometry resulting in DNA-grades of malignancy 1-4. This review systematically trawls and evaluates all scientific publications on the potential diagnostic and prognostic validity and heterogeneity of DNA-ploidy measurements in cancers of the prostate between 1966 and 2013. 113 scientific articles had to be excluded because of different methodological reasons. All but one of the 67 methodologically acceptable articles report on a significant diagnostic resp. prognostic significance of DNA measurements in cancers of the prostate. 8 level 1b studies report that DNA-ploidy, assessed on punch biopsies independently predicts organ confinement as assessed after radical prostatectomy. 18 level 2b studies prove that DNA-ploidy measurements add statistically significant information to the Gleason-score. 16 level 2b investigations report a significant correlation of DNA-ploidy with recurrence-free survival after different types of therapy. 15 level 2b studies document a significant correlation of DNA-ploidy with overall survival after different types of therapy. 5 level 2b investigations prove a significant correlation with local recurrence or progress after radical prostatectomy. 3 level 2b publications show a significant correlation of DNAploidy with the occurrence of lymph nodeor bone metastases after radical