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Chen C, Chen Y, Hu LK, Jiang CC, Xu RF, He XZ. The performance of the new prognostic grade and stage groups in conservatively treated prostate cancer. Asian J Androl 2018; 20:366-371. [PMID: 29493549 PMCID: PMC6038159 DOI: 10.4103/aja.aja_5_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We evaluated the prognosis of the new grade groups and American Joint Committee on Cancer (AJCC) stage groups in men with prostate cancer (PCa) who were treated conservatively. A total of 13 798 eligible men were chosen from the Surveillance Epidemiology and End Results database. The new grade and AJCC stage groups were investigated on prostate biopsy specimens. Kaplan–Meier survival analysis and multivariable hazards models were applied to estimate the association of new grade and stage groups with overall survival (OS) and PCa-specific survival (CSS). Mean follow-up was 42.65 months (95% confidence interval: 42.47–42.84) in the entire cohort. The 3-year OS and CSS rates stepped down for grade groups 1–5 and AJCC stage groups I–IVB, respectively. After adjusting for clinical and pathological characteristics, all grade groups and AJCC stage groups were associated with higher all-cause and PCa-specific mortality compared to the reference group (all P ≤ 0.003). In conclusion, we evaluated the oncological outcome of the new grade and AJCC stage groups on biopsy specimens of conservatively treated PCa. These two novel clinically relevant classifications can assist physicians to determine different therapeutic strategies for PCa patients.
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Affiliation(s)
- Cheng Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Ye Chen
- Department of Urology, Nanyang Second General Hospital, Nanyang 473012, China
| | - Lin-Kun Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chang-Chuan Jiang
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA
| | - Ren-Fang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Xiao-Zhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
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Margolin EJ, Matulay JT, Li G, Meng X, Chao B, Vijay V, Silver H, Clinton TN, Krabbe LM, Woldu SL, Singla N, Bagrodia A, Margulis V, Huang WC, Bjurlin MA, Shah O, Anderson CB. Discordance between Ureteroscopic Biopsy and Final Pathology for Upper Tract Urothelial Carcinoma. J Urol 2018; 199:1440-1445. [PMID: 29427584 DOI: 10.1016/j.juro.2018.02.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE We evaluated the discordance between ureteroscopic biopsy and surgical pathology findings for grading and staging upper tract urothelial carcinoma. We also sought to establish preoperative predictors of aggressive tumors. MATERIALS AND METHODS We retrospectively reviewed the records of 314 patients who underwent ureteroscopic biopsy followed by surgical management of upper tract urothelial carcinoma from 2000 to 2016 at a total of 3 institutions. Our primary outcomes were muscle invasive (pT2 or greater) disease at surgical pathology and upgrading of clinical low grade tumors to pathological high grade. RESULTS At biopsy 61% of the patients had clinical high grade tumors and 21% had subepithelial connective tissue invasion (cT1+). On final pathology 79% of the patients had pathological high grade tumors and 45% had stage pT2 or greater. On multivariate analysis advanced patient age, clinical high grade and cT1+ were independently associated with pT2 or greater. The combined presence of clinical high grade and cT1+ had 86% positive predictive value for muscle invasion while the combined absence of clinical high grade and cT1+ had 80% negative predictive value. The likelihood of missing invasion on biopsy in patients with muscle invasive disease was increased when biopsy fragments were limited to 1 mm or less. Of clinical low grade cases on biopsy 51% were upgraded at surgery. The presence of positive urine cytology was associated with an increased risk of upgrading but this was not statistically significant. CONCLUSIONS Clinical high grade, cT1+ on biopsy and advanced patient age are independent risk factors for muscle invasive upper tract urothelial carcinoma. There is a significant risk of upgrading in patients with clinical low grade tumors on biopsy, especially when urine cytology is positive. The predictive value of biopsy can likely be improved by more extensive ureteroscopic sampling.
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Affiliation(s)
- Ezra J Margolin
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Justin T Matulay
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Gen Li
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Xiaosong Meng
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Brian Chao
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Varun Vijay
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Hayley Silver
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Timothy N Clinton
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - William C Huang
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Marc A Bjurlin
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Ojas Shah
- Department of Urology, Columbia University Medical Center, New York, New York
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Calio BP, Sidana A, Sugano D, Gaur S, Maruf M, Jain AL, Merino MJ, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Risk of Upgrading from Prostate Biopsy to Radical Prostatectomy Pathology-Does Saturation Biopsy of Index Lesion during Multiparametric Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy Help? J Urol 2018; 199:976-982. [PMID: 29154904 DOI: 10.1016/j.juro.2017.10.048] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE We sought to determine whether saturation of the index lesion during magnetic resonance imaging-transrectal ultrasound fusion guided biopsy would decrease the rate of pathological upgrading from biopsy to radical prostatectomy. MATERIALS AND METHODS We analyzed a prospectively maintained, single institution database for patients who underwent fusion and systematic biopsy followed by radical prostatectomy in 2010 to 2016. Index lesion was defined as the lesion with largest diameter on T2-weighted magnetic resonance imaging. In patients with a saturated index lesion transrectal fusion biopsy targets were obtained at 6 mm intervals along the long axis of the index lesion. In patients with a nonsaturated index lesion only 1 target was obtained from the lesion. Gleason 6, 7 and 8-10 were defined as low, intermediate and high risk, respectively. RESULTS Included in the study were 208 consecutive patients, including 86 with a saturated and 122 with a nonsaturated lesion. Median patient age was 62.0 years (IQR 10.0) and median prostate specific antigen was 7.1 ng/ml (IQR 8.0). The median number of biopsy cores per index lesion was higher in the saturated lesion group (4 vs 2, p <0.001). The risk category upgrade rate from systematic only, fusion only, and combined fusion and systematic biopsy results to prostatectomy was 40.9%, 23.6% and 13.8%, respectively. The risk category upgrade from combined fusion and systematic biopsy results was lower in the saturated than in the nonsaturated lesion group (7% vs 18%, p = 0.021). There was no difference in the upgrade rate based on systematic biopsy between the 2 groups. However, fusion biopsy results were significantly less upgraded in the saturated lesion group (Gleason upgrade 20.9% vs 36.9%, p = 0.014 and risk category upgrade 14% vs 30.3%, p = 0.006). CONCLUSIONS Our results demonstrate that saturation of the index lesion significantly decreases the risk of upgrading on radical prostatectomy by minimizing the impact of tumor heterogeneity.
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Affiliation(s)
- Brian P Calio
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Dordaneh Sugano
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sonia Gaur
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit L Jain
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J Merino
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Gearman DJ, Morlacco A, Cheville JC, Rangel LJ, Karnes RJ. Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer: Considerations for Active Surveillance. J Urol 2018; 199:1188-95. [PMID: 29225057 DOI: 10.1016/j.juro.2017.11.116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Recent NCCN® (National Comprehensive Cancer Network®) Guidelines® show that patients with biopsy Gleason score 3 + 4/Grade Group 2 but otherwise favorable features are active surveillance candidates. However, little is known about the long-term outcomes compared to that in men in the low risk Gleason score 6/Grade Group 1 group. We sought to clarify the risk of adverse features and oncologic outcomes in surgically treated, favorable Grade Group 2 vs 1 cases. MATERIALS AND METHODS We queried our prospectively maintained radical prostatectomy database for all 8,095 patients with biopsy Grade Group 1 or 2 prostate cancer who otherwise fulfilled the NCCN low risk definition of prostate specific antigen less than 10 ng/ml and cT2a or less, and who underwent radical prostatectomy from 1987 to 2014. Multivariable logistic regression and Kaplan-Meier methods were used to compare pathological and oncologic outcomes. RESULTS Organ confined disease was present in 93.9% and 82.6% of Grade Group 1 and favorable intermediate risk Grade Group 2 cases while seminal vesicle invasion was noted in 1.7% and 4.7%, and nodal disease was noted in 0.3% and 1.8%, respectively (all p <0.0001). On multivariable logistic regression biopsy proven Grade Group 2 disease was associated with a threefold greater risk of nonorgan confined disease (OR 3.1, 95% CI 1.7-5.7, p <0.001). The incidence of late treatment (more than 90 days from surgery) in Grade Group 1 vs 2 was 3.1% vs 8.5% for hormonal therapy and 6.0% vs 12.2% for radiation (p <0.001). In the Grade Group 1 vs 2 cohorts the 10-year biochemical recurrence-free survival rate was 88.9% vs 81.2% and the 10-year systemic progression-free survival rate was 99% vs 96.5% (each p <0.001). CONCLUSIONS Men at favorable risk with Grade Group 2 disease who are considering active surveillance should be informed of the risks of harboring adverse pathological features which impact secondary therapies and an increased risk of cancer progression.
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Audenet F, Vertosick EA, Fine SW, Sjoberg DD, Vickers AJ, Reuter VE, Eastham JA, Scardino PT, Touijer KA. Biopsy Core Features are Poor Predictors of Adverse Pathology in Men with Grade Group 1 Prostate Cancer. J Urol 2017; 199:961-968. [PMID: 29030317 DOI: 10.1016/j.juro.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Active surveillance is often restricted to patients with low risk prostate cancer who have 3 or fewer positive cores. We aimed to identify predictors of adverse pathology results for low risk prostate cancer treated with radical prostatectomy and determine whether a threshold number of positive cores could help the decision process for active surveillance. MATERIALS AND METHODS A total of 3,359 men with low risk prostate cancer underwent radical prostatectomy between January 2000 and August 2016. We analyzed the relationship between biopsy core features and adverse pathology at radical prostatectomy, defined as Grade Group 3 or greater, seminal vesicle invasion or lymph node involvement. RESULTS Of the 171 cases (5.1%) with adverse pathology findings at radical prostatectomy 144 (4.3%) were upgraded to Grade Group 3 or greater, 31 (0.9%) had seminal vesicle invasion and 15 (0.4%) had lymph node involvement. Prostate specific antigen and patient age were the only predictors of adverse pathology results. There was no significant association with the number of positive cores, the total mm of cancer or the maximum percent of cancer in any core. When we expanded the definition of adverse pathology to include Grade Group 2 and extraprostatic extension, the association between core features and outcome was statistically significant but clinically weak, and with no evidence of threshold effects. CONCLUSIONS There is little basis for excluding patients with otherwise low risk prostate cancer on biopsy from active surveillance based on criteria such as the number of positive cores or the maximum cancer involvement of biopsy cores.
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Affiliation(s)
- François Audenet
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James A Eastham
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter T Scardino
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karim A Touijer
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
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56
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Chang E, Jones TA, Natarajan S, Sharma D, Simopoulos D, Margolis DJ, Huang J, Dorey FJ, Marks LS. Value of Tracking Biopsy in Men Undergoing Active Surveillance of Prostate Cancer. J Urol 2018; 199:98-105. [PMID: 28728993 DOI: 10.1016/j.juro.2017.07.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE We compared the upgrading rate obtained by resampling precise spots of prostate cancer (tracking biopsy) vs conventional systematic resampling during followup of men on active surveillance. MATERIALS AND METHODS From 2009 to 2017 in 352 men prostate cancer was Gleason 3 + 3 in 268 and Gleason 3 + 4 in 84 at initial magnetic resonance imaging-ultrasound fusion biopsy. These men subsequently underwent a second fusion biopsy. At the first biopsy session all men underwent 12-core systematic biopsies and, when magnetic resonance imaging visible lesions were present, targeted biopsies. All cancerous sites were recorded electronically. During active surveillance at a second fusion biopsy session 6 to 18 months later tracking and systematic nontracking samples were obtained. The primary outcome measure was an increase in Gleason score (upgrading) at followup sampling, which was stratified by biopsy method. RESULTS Overall 91 of the 352 men (25.9%) experienced upgrading at the second biopsy during a median 11-month interval. The upgrade rate in the Gleason 3 + 3 and 3 + 4 groups was 26.9% and 22.6%, respectively. The mean number of cores taken at second biopsy was 12.2 ± 3.3 in men with upgrading and 12.4 ± 4.1 in those who remained stable (p not significant). Men with grade 0 to 4 magnetic resonance imaging targets were all upgraded at approximately the same rate of 20% to 30% (p not significant). However, 58.8% of the men with grade 5 magnetic resonance imaging targets were upgraded. Of the 91 upgrades 48 (53%) were detected only by tracking. CONCLUSIONS The tracking function of magnetic resonance imaging-ultrasound fusion biopsy warrants further study. When specific sites are resampled in men undergoing active surveillance of prostate cancer, upgrading is detected more often than by nontracking biopsy.
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McGinley KF, Sun X, Howard LE, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, Freedland SJ. Characterization of a "low-risk" cohort of grade group 2 prostate cancer patients: Results from the Shared Equal Access Regional Cancer Hospital database. Int J Urol 2017; 24:611-617. [PMID: 28589550 DOI: 10.1111/iju.13387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/01/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine if there is a subset of men with grade group 2 prostate cancer who could be potential candidates for active surveillance. METHODS We used the Shared Equal Access Regional Cancer Hospital database to identify 776 men undergoing radical prostatectomy from 2006 to 2015 with >8 biopsy cores obtained and complete information. We compared men who fulfilled low-risk disease criteria (clinical stage T1c/T2a; grade group 1; prostate-specific antigen ≤10 ng/mL) with the exception of grade group 2 versus men who met all three low-risk criteria. Logistic regression was used to test the association between grade group and radical prostatectomy pathological features. Biochemical recurrence was examined using Cox models. To examine whether there was a subset of men with low-volume grade group 2 with comparable outcomes to low-risk men, we repeated all analyses limiting the percentage of positive cores in the grade group 2 group to ≤33%, and positive cores to ≤4, ≤3 or ≤2. RESULTS Grade group 2 low-risk men had increased risk of pathological grade group 3 or higher (P < 0.001), extraprostatic extension (P < 0.001), seminal vesicle invasion (P < 0.001) and higher risk of biochemical recurrence (hazard ratio = 1.76, P = 0.006). Using increasingly strict definitions of low-volume disease, at ≤2 positive cores there was no difference in adverse pathology between groups (all P > 0.2), except higher pathological grade group (P = 0.006). Biochemical recurrence was similar in men in grade group 1 and grade group 2 (hazard ratio = 1.24; P = 0.529). CONCLUSIONS Among men with prostate-specific antigen ≤10 ng/mL and clinical stage T1c/T2a, those in grade group 2 with ≤2 total positive cores have similar rates of adverse pathology and biochemical recurrence as men with grade group 1.
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Affiliation(s)
- Kathleen F McGinley
- Division of Urology, Department of Surgery, Duke University, Durham, North Carolina, USA.,Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Xizi Sun
- Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Lauren E Howard
- Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - William J Aronson
- Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Urology, UCLA School of Medicine, Los Angeles, California, USA
| | - Martha K Terris
- Section of Urology, Veterans Affairs Medical Center, Augusta, Georgia, USA.,Department of Urology, Georgia Regents University, Augusta, Georgia, USA
| | - Christopher J Kane
- Urology Department, University of California San Diego Health System, San Diego, California, USA
| | | | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Stephen J Freedland
- Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA.,Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Teloken PE, Li J, Woods CG, Cohen RJ. The Impact of Prostate Cancer Zonal Origin on Pathological Parameters at Radical Prostatectomy and Subsequent Biochemical Failure. J Urol 2017; 198:1316-1323. [PMID: 28554811 DOI: 10.1016/j.juro.2017.05.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We assessed the impact of prostatic zone tumor origin on pathological prognostic features and subsequent biochemical outcomes after radical prostatectomy. MATERIALS AND METHODS A total of 7,051 patients who underwent radical prostatectomy between September 1998 and December 2016 in Western Australia were divided into a high grade group, defined as Gleason sum 4 + 3, 8 and 9 or greater and ISUP (International Society of Urological Pathology) groups 3, 4 and 5, and a low grade group, defined as Gleason sum 6 or less and 3 + 4, and ISUP groups 1 and 2. The t-test and the Pearson chi-square test were used to evaluate differences between transition zone and peripheral/central zone cancer. The Kaplan-Meier method with the log rank test was used to determine differences in biochemical recurrence-free survival at 5 years in patients with high grade disease. Univariate and multivariable Cox proportional hazard regression analyses were performed. Model calibration was determined by the internal validation method. RESULTS High grade transition zone cancer was associated with significantly increased prostate specific antigen, tumor volume and incidence of positive surgical margins but a lower incidence of intraductal carcinoma, extraprostatic spread, seminal vesicle invasion, lymph node involvement and biochemical failure after radical prostatectomy. Patients with low grade prostate cancer had excellent biochemical recurrence-free survival regardless of tumor origin. The high grade multivariable model had a c-index of 0.78 and improved predictive accuracy, particularly for high grade transition zone disease. CONCLUSIONS Transition zone tumor origin independently and positively impacts biochemical outcomes of high grade prostate cancer. A high grade postoperative prognostic model including transition zone tumor origin as an independent predictor was developed and predictive accuracy was significantly improved in patients with high grade, transition zone disease.
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Affiliation(s)
- Patrick E Teloken
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland
| | - Jian Li
- Uropath Pty Ltd and School of Pathology and Laboratory Medicine, University of Western Australia, Western Australia, Australia
| | - Clifton G Woods
- Uropath Pty Ltd and School of Pathology and Laboratory Medicine, University of Western Australia, Western Australia, Australia
| | - Ronald J Cohen
- Uropath Pty Ltd and School of Pathology and Laboratory Medicine, University of Western Australia, Western Australia, Australia.
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Ham WS, Chalfin HJ, Feng Z, Trock BJ, Epstein JI, Cheung C, Humphreys E, Partin AW, Han M. The Impact of Downgrading from Biopsy Gleason 7 to Prostatectomy Gleason 6 on Biochemical Recurrence and Prostate Cancer Specific Mortality. J Urol 2017; 197:1060-7. [PMID: 27847296 DOI: 10.1016/j.juro.2016.11.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Gleason score is one of the most important prognostic indicators for prostate cancer. Downgrading from biopsy Gleason score 7 to radical prostatectomy Gleason score 6 occurs commonly and yet to our knowledge the impact on survival outcomes is unknown. We examined biochemical recurrence and prostate cancer specific mortality risk in a large cohort evaluated by a single group of expert urological pathologists. MATERIALS AND METHODS Of 23,918 men who underwent radical prostatectomy at our institution between 1984 and 2014, 10,236 with biopsy and radical prostatectomy Gleason score 6 or 7 without upgrading were included in analysis. The cohort was divided into 3 groups, including group 1-biopsy and radical prostatectomy Gleason score 6 in 6,923 patients (67.6%), group 2-Gleason score 7 downgraded to radical prostatectomy Gleason score 6 in 648 (6.3%) and group 3-biopsy and radical prostatectomy Gleason score 7 in 2,665 (26.0%). Biochemical recurrence and prostate cancer specific mortality risks were compared using Cox regression and competing risk analyses adjusting for clinicopathological variables. RESULTS At a median followup of 5 years (range 1 to 29), 992 men experienced biochemical recurrence and 95 had died of prostate cancer. Biochemical recurrence-free survival in downgraded cases (group 2) was better than in group 3 cases, which had Gleason score 7 on biopsy and radical prostatectomy (p <0.001), but worse than group 1 cases, which had Gleason score 6 on biopsy and radical prostatectomy (p <0.001). Downgrading was independently associated with biochemical recurrence (adjusted HR 1.87, p <0.0001) but not with prostate cancer specific mortality (adjusted HR 1.65, p = 0.636). CONCLUSIONS Downgrading from biopsy Gleason score 7 to radical prostatectomy Gleason score 6 was an independent predictor of biochemical recurrence but not prostate cancer specific mortality, likely due to the presence of minor amounts of Gleason pattern 4.
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Guedes LB, Tosoian JJ, Hicks J, Ross AE, Lotan TL. PTEN Loss in Gleason Score 3 + 4 = 7 Prostate Biopsies is Associated with Nonorgan Confined Disease at Radical Prostatectomy. J Urol 2017; 197:1054-9. [PMID: 27693448 DOI: 10.1016/j.juro.2016.09.084] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE Men with intermediate risk prostate cancer have widely variable outcomes. Some suggest that active surveillance or less invasive therapies (brachytherapy or focal therapy) may be appropriate for some men with Gleason score 3 + 4 = 7 disease. Molecular markers may help further distinguish prostate cancers with aggressive behavior. We tested whether loss of the PTEN (phosphatase and tensin homolog) tumor suppressor in 3 + 4 = 7 tumor biopsies is associated with adverse pathology at prostatectomy. MATERIALS AND METHODS We queried prostate needle biopsies from 2000 to 2014 with a maximum Gleason score of 3 + 4 = 7 followed by prostatectomy. A total of 260 cases had PTEN status evaluable by clinical grade immunohistochemistry. Biopsy PTEN status was correlated with preoperative and postoperative clinicopathological parameters. RESULTS PTEN loss was detected in 27% of 3 + 4 = 7 biopsies. Loss of PTEN was less common in tumors of African American men compared to European American men (9% vs 31%, p = 0.002). At prostatectomy, tumors with PTEN loss were more likely to show nonorgan confined disease compared to those with PTEN intact (52% vs 27%, p <0.001). In logistic regression models including age, race, prostate specific antigen, clinical stage and biopsy tumor involvement, PTEN loss at biopsy remained significantly associated with an increased risk of nonorgan confined disease (HR 2.46, 95% CI 1.34-4.49, p = 0.004). On ROC analysis, the AUC for models including prostate specific antigen and clinical stage was increased from 0.61 to 0.67 upon inclusion of PTEN status. CONCLUSIONS PTEN loss in a Gleason score 3 + 4 = 7 biopsy is independently associated with an increased risk of nonorgan confined disease at prostatectomy. It adds to the preoperative parameters commonly used to predict pathological stage.
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Maurice MJ, Sundi D, Schaeffer EM, Abouassaly R. Risk of Pathological Upgrading and Up Staging among Men with Low Risk Prostate Cancer Varies by Race: Results from the National Cancer Database. J Urol 2016; 197:627-631. [PMID: 27582435 DOI: 10.1016/j.juro.2016.08.095] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The impact of African-American race on oncologic outcomes for low risk prostate cancer is unclear due to conflicting data. We investigated the effect of African-American race on pathological upgrading and/or up staging at prostatectomy in men with clinically low risk prostate cancer. MATERIALS AND METHODS We queried the National Cancer Database for men with low risk prostate cancer (clinical stage T2a or less, Gleason score 6 or less, prostate specific antigen less than 10 ng/ml) treated with radical prostatectomy between 2010 and 2013. The outcomes were pathological upgrading to Gleason score greater than 6 (primary) or Gleason score greater than 3+4=7 (secondary) and/or up staging (pathological T3-4 or N1 disease). The association between race and the end points was assessed using multivariable logistic regression. To further adjust for potential confounders, stratification by urban residence and comorbidity score, and subgroup analyses were performed. RESULTS With adjustment for age, comorbidity, income, urban residence, T stage, prostate specific antigen and percentage of positive biopsy cores, African-American race conferred 1.2-fold higher odds of pathological upgrading to Gleason score greater than 6 and/or up staging (OR 1.2, 95% CI 1.1-1.3, p <0.01). African-American race also was an independent predictor of pathological upgrading to Gleason score greater than 3+4=7 and/or up staging (p=0.03). CONCLUSIONS African-American men with low risk prostate cancer are more likely to harbor higher risk disease, which may lead to adverse outcomes. This finding alone does not preclude active surveillance. However, race should be considered as men weigh the risks and benefits of active surveillance vs treatment.
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Affiliation(s)
- Matthew J Maurice
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Debasish Sundi
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert Abouassaly
- Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio.
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Klein EA, Santiago-Jiménez M, Yousefi K, Robbins BA, Schaeffer EM, Trock BJ, Tosoian J, Haddad Z, Ra S, Karnes RJ, Jenkins RB, Cheville JC, Den RB, Dicker AP, Davicioni E, Freedland SJ, Ross AE. Molecular Analysis of Low Grade Prostate Cancer Using a Genomic Classifier of Metastatic Potential. J Urol 2016; 197:122-128. [PMID: 27569435 DOI: 10.1016/j.juro.2016.08.091] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE We determined how frequently histological Gleason 3 + 3 = 6 tumors have the molecular characteristics of disease with metastatic potential. MATERIALS AND METHODS We analyzed prostatectomy tissue from 337 patients with Gleason 3 + 3 disease. All tissue was re-reviewed in blinded fashion by genitourinary pathologists using 2005 ISUP (International Society of Urological Pathology) Gleason grading criteria. A previously validated Decipher® metastasis signature was calculated in each case based on a locked model. To compare patient characteristics across pathological Gleason score categories we used the Fisher exact test or the ANOVA F test. The distribution of Decipher scores among different clinicopathological groups was compared with the Wilcoxon rank sum test. The association of Decipher score with adverse pathology features was examined using logistic regression models. The significance level of all statistical tests was 0.05. RESULTS Of men with Gleason 3 + 3 = 6 disease only 269 (80%) had a low Decipher score with intermediate and high scores in 43 (13%) and 25 (7%), respectively. Decipher scores were significantly higher among pathological Gleason 3 + 3 = 6 specimens from cases with adverse pathological features such as extraprostatic extension, seminal vesicle involvement or positive margins (p <0.001). The median Decipher score in patients with margin negative pT2 disease was 0.23 (IQR 0.09-0.42) compared to 0.30 (IQR 0.17-0.42) in patients with pT3 disease or positive margins (p = 0.005). CONCLUSIONS Using a robust and validated prognostic signature we found that a small but not insignificant proportion of histological Gleason 6 tumors harbored molecular characteristics of aggressive cancer. Molecular profiling of such tumors at diagnosis may better select patients for active surveillance at diagnosis and trigger appropriate intervention during followup.
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Affiliation(s)
- Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
| | | | - Kasra Yousefi
- GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | | | | | - Bruce J Trock
- The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jeffrey Tosoian
- The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Zaid Haddad
- GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Seong Ra
- San Diego Pathology LLC, San Diego, California
| | | | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Robert B Den
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam P Dicker
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elai Davicioni
- GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Stephen J Freedland
- Division of Urology, Department of Surgery, Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California; Surgery Section, Durham Veteran Affairs Medical Center, Durham, North Carolina
| | - Ashley E Ross
- The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
OBJECTIVE The aims of this study were to evaluate the reproducibility of the Gleason grading system and to compare its interobserver variability with the novel Gleason grade grouping proposal using a large sample volume. MATERIALS AND METHODS In total, 407 pathology slides of prostate needle biopsies from 34 consecutive patients with prostate cancer were re-evaluated. The International Society of Urological Pathology 2005 modified Gleason grading system with Epstein's modification was used. Two pathologists, blind to each other and to the initial pathology report, performed the pathological evaluation. To determine interobserver concordance, the kappa (κ) coefficient test was used. RESULTS Pathologist 1 and pathologist 2 detected a tumor in 202 and 231 cores, respectively (p < 0.001). The two pathologists disagreed on the presence of a tumor in 31 cores. Of these 31 cores, 74% (n = 23/31) were Gleason pattern 3. The mean length of the cancer foci in these 31 disputed cores was 1.54 ± 0.8 mm. Concordance rates between the two observers for primary and secondary Gleason patterns were 63.96% (κ = 0.34) and 63.45% (κ = 0.37), respectively. Concordance with respect to the Gleason sum was 57.9% (κ = 0.43). When the Gleason scores were classified into the novel Gleason grade grouping, concordance was found to be 51.7% (κ = 0.39). CONCLUSIONS The agreement between observers on the Gleason sum was moderate. The novel Gleason grade grouping did not improve interobserver agreement. Further studies are needed to confirm these results on interobserver variability.
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Affiliation(s)
- Tayyar A Ozkan
- a Department of Urology , Kocaeli Derince Training and Research Hospital , Kocaeli , Turkey
| | - Ahmet T Eruyar
- b Department of Pathology , Kocaeli Derince Training and Research Hospital Kocaeli , Turkey
| | - Oguz O Cebeci
- a Department of Urology , Kocaeli Derince Training and Research Hospital , Kocaeli , Turkey
| | - Omur Memik
- a Department of Urology , Kocaeli Derince Training and Research Hospital , Kocaeli , Turkey
| | - Levent Ozcan
- a Department of Urology , Kocaeli Derince Training and Research Hospital , Kocaeli , Turkey
| | - Ibrahim Kuskonmaz
- b Department of Pathology , Kocaeli Derince Training and Research Hospital Kocaeli , Turkey
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Leapman MS, Freedland SJ, Aronson WJ, Kane CJ, Terris MK, Walker K, Amling CL, Carroll PR, Cooperberg MR. Pathological and Biochemical Outcomes among African-American and Caucasian Men with Low Risk Prostate Cancer in the SEARCH Database: Implications for Active Surveillance Candidacy. J Urol 2016; 196:1408-1414. [PMID: 27352635 DOI: 10.1016/j.juro.2016.06.086] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE Racial disparities in the incidence and risk profile of prostate cancer at diagnosis among African-American men are well reported. However, it remains unclear whether African-American race is independently associated with adverse outcomes in men with clinical low risk disease. MATERIALS AND METHODS We retrospectively analyzed the records of 895 men in the SEARCH (Shared Equal Access Regional Cancer Hospital) database in whom clinical low risk prostate cancer was treated with radical prostatectomy. Associations of African-American and Caucasian race with pathological biochemical recurrence outcomes were examined using chi-square, logistic regression, log rank and Cox proportional hazards analyses. RESULTS We identified 355 African-American and 540 Caucasian men with low risk tumors in the SEARCH cohort who were followed a median of 6.3 years. Following adjustment for relevant covariates African-American race was not significantly associated with pathological upgrading (OR 1.33, p = 0.12), major upgrading (OR 0.58, p = 0.10), up-staging (OR 1.09, p = 0.73) or positive surgical margins (OR 1.04, p = 0.81). Five-year recurrence-free survival rates were 73.4% in African-American men and 78.4% in Caucasian men (log rank p = 0.18). In a Cox proportional hazards analysis model African-American race was not significantly associated with biochemical recurrence (HR 1.11, p = 0.52). CONCLUSIONS In a cohort of patients at clinical low risk who were treated with prostatectomy in an equal access health system with a high representation of African-American men we observed no significant differences in the rates of pathological upgrading, up-staging or biochemical recurrence. These data support continued use of active surveillance in African-American men. Upgrading and up-staging remain concerning possibilities for all men regardless of race.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California.
| | | | - William J Aronson
- Department of Urology, University of California-Los Angeles Medical Center, Los Angeles, California
| | - Christopher J Kane
- Department of Urology, University of California-San Diego Health System, San Diego, California
| | - Martha K Terris
- Department of Urology, Georgia Regents Health System, Augusta, Georgia
| | - Kelly Walker
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
| | | | - Peter R Carroll
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California
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Kryvenko ON, Epstein JI, Cote RJ. Do Black NonHispanic Men Produce Less Prostate Specific Antigen in Benign Prostate Tissue or Cancer Compared to White NonHispanic Men with Gleason Score 6 (Grade Group 1) Prostate Cancer? J Urol 2016; 196:1659-63. [PMID: 27343801 DOI: 10.1016/j.juro.2016.06.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE We evaluated prostate specific antigen production by benign prostate tissue and Gleason score 3+3=6 (Grade Group 1) prostate cancer in black and white nonHispanic men. MATERIALS AND METHODS We used Gleason score 3+3=6 (Grade Group 1) cases to assess prostate specific antigen production by benign prostate tissue in cases with low volume cancer that did not influence prostate specific antigen and in those with high volume cancer in which gland weight did not influence prostate specific antigen. We then created age, prostate specific antigen and prostate weight adjusted cohorts to demonstrate tumor volume per 1 ng/ml prostate specific antigen and 1 μg prostate specific antigen mass. Prostate specific antigen density and prostate specific antigen mass density were used to adjust for prostate weight. RESULTS Comparison of 58 black and 301 white men with low volume cancer demonstrated equal prostate specific antigen production by benign prostate tissue. Comparison of 30 black and 75 white men with high volume cancer indicated that prostate specific antigen was being driven by cancer volume, with lower prostate specific antigen production in black men. In the cohort of 54 black and 134 white men matched by age, prostate specific antigen and prostate weight, tumor volume per 1 ng/ml prostate specific antigen or 1 μg prostate specific antigen mass adjusted for prostate weight was 25% and 26% higher in black men, respectively. CONCLUSIONS Benign prostate tissue produces equal amounts of prostate specific antigen in black and white men. Gleason score 3+3=6 (Grade Group 1) prostate cancer produces less prostate specific antigen in black men. These data should be considered for lowering prostate specific antigen and its derivatives in determining biopsy thresholds and for adjusting values for active surveillance criteria in black men.
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Harding-Jackson N, Kryvenko ON, Whittington EE, Eastwood DC, Tjionas GA, Jorda M, Iczkowski KA. Outcome of Gleason 3 + 5 = 8 Prostate Cancer Diagnosed on Needle Biopsy: Prognostic Comparison with Gleason 4 + 4 = 8. J Urol 2016; 196:1076-81. [PMID: 27265220 DOI: 10.1016/j.juro.2016.05.105] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE ISUP (International Society for Urologic Pathology) and WHO adopted prognostic Grade Groups 1 to 5 that simplify prostate cancer grading for prognosis. Grade Group 4 is Gleason score 8 cancer, which is heterogeneous, and it encompasses Gleason score 4 + 4 = 8, 3 + 5 = 8 and 5 + 3 = 8. The comparative prognostic implications of these various Gleason scores had not been studied by urological pathologists after a re-review of slides. MATERIALS AND METHODS Patients with a highest biopsy Gleason score of 3 + 5 = 8 or 4 + 4 = 8 were included in the study. Controls were cases with a highest Gleason score of 4 + 3 = 7 or 9-10. A total of 423 prostatic biopsy cases accessioned from 2005 to 2013 at 2 institutions were reviewed. Clinicopathological findings and followup (median 33.4 months) were assessed. RESULTS Among Gleason score 8 cancers the cancer status outcome in 51 men with Gleason score 3 + 5 = 8 was marginally worse than in 114 with Gleason score 4 + 4 = 8 (p = 0.04). This was driven by a persistent nonmetastatic (after radiation/hormone therapy) cancer rate of 37% among Gleason score 3 + 5 = 8 cases vs 24% among Gleason score 4 + 4 = 8 cases. Conversely, cancer specific survival at 36-month followup was 97.8% in 3 + 5 cases vs 92.6% in 4 + 4 cases but this was not significant (p = 0.089). Cancer specific survival in the Gleason score 8 group was dichotomized by the presence of cribriform growth (p = 0.018). All Gleason score categories did not differ in the fraction of biopsy cores positive, clinical presentation or pathological findings, including the frequency of Gleason pattern 5, in 70 patients who underwent prostatectomy. CONCLUSIONS Using the most current standards of prostate cancer grading the prognosis is not different in Gleason score 3 + 5 = 8 and 4 + 4 = 8 cancers. This justifies including both in Grade Group 4.
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67
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Stephan C, Lein M, Matalon J, Kilic E, Zhao Z, Busch J, Jung K. Serum Vitamin D is Not Helpful for Predicting Prostate Cancer Aggressiveness Compared with the Prostate Health Index. J Urol 2016; 196:709-14. [PMID: 26976204 DOI: 10.1016/j.juro.2016.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE We evaluated the usefulness of serum 25-hydroxyvitamin D as a marker of aggressive prostate cancer and for active surveillance compared to PHI (Prostate Health Index). MATERIALS AND METHODS Of 480 prospectively biopsied men 222 had prostate cancer and 258 had no evidence of malignancy. In all men prostate specific antigen was less than 20 ng/ml. We measured 25-hydroxyvitamin D, prostate specific antigen, free prostate specific antigen and -2proPSA using a commercially available immunoassay system. PHI was calculated according to the equation, -2proPSA/free prostate specific antigen × √PSA. We determined 25-hydroxyvitamin D using a 2-step competitive binding immunoenzymatic vitamin D assay. RESULTS The 25-hydroxyvitamin D concentrations were not associated with Gleason grade according to the 2014 ISUP (International Society of Urological Pathology) consensus conference Gleason grading system. PHI values were higher with increasing Gleason grade. Median 25-hydroxyvitamin D did not differ between men with prostate cancer vs no evidence of malignancy (50.6 vs 48.2 nmol/l, p = 0.192) or in ISUP Gleason subgroups despite seasonal variations of 25-hydroxyvitamin D. However, PHI values significantly differed between the subgroup with no evidence of malignancy and all Gleason subgroups (p <0.0001). The ROCs of all men revealed an advantage of PHI over 25-hydroxyvitamin D (AUC 0.78 vs 0.535, p <0.0001). PHI could also significantly better separate patients with no evidence of malignancy from those with nonaggressive disease (ISUP Gleason grade 1) from those with aggressive prostate cancer (ISUP Gleason grades 2-5). CONCLUSIONS It remains highly improbable that 25-hydroxyvitamin D could be used as decision or selection marker for aggressive prostate cancer or for active surveillance compared to accepted markers, as recently suggested.
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Li J, Lin JP, Shi LH, Wang WJ, Li AQ, Si JM, Chen SJ. How reliable is the Ki-67 cytological index in grading pancreatic neuroendocrine tumors? A meta-analysis. J Dig Dis 2016; 17:95-103. [PMID: 26713749 DOI: 10.1111/1751-2980.12310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/11/2015] [Accepted: 12/20/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the accuracy of the cytological Ki-67 index in distinguishing intermediate and high-grade (G2 + G3) from low-grade (G1) pancreatic neuroendocrine tumors (PNETs). METHODS Two investigators independently searched databases to identify eligible studies using the following term: ('Ki-67') AND ('pancreatic endocrine tumor' OR 'pancreatic neuroendocrine tumor' OR 'pancreatic endocrine tumour' OR 'pancreatic neuroendocrine tumour' OR 'pancreatic endocrine tumors' OR 'pancreatic neuroendocrine tumors' OR 'pancreatic endocrine tumours' OR 'pancreatic neuroendocrine tumours'), and meta-analysis was performed to calculate the pooled sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). RESULTS A total of 263 lesions from 13 studies were included in the study. The pooled sensitivity and specificity of Ki-67 (cut-off value: 2%) in the differential diagnosis of G2 + G3 from G1 PNETs were 64% and 87%, respectively. The pooled PLR, NLR and DOR were 3.96, 0.42 and 11.21, respectively. The area under the summary receiver operating characteristic curve (AUROC) was 0.8397. While the cut-off value of Ki-67 index was set as 5%, the sensitivity and specificity were increased up to 69% and 93%, respectively, and the AUROC was increased to 0.955. CONCLUSION The cytological Ki-67 index is very useful in distinguishing intermediate and high-grade from low-grade PNETs, and a cut-off value of 5% had a better predictive value compared with that of 2%.
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Affiliation(s)
- Jun Li
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.,Institute of Gastroenterology, Zhejiang University
| | - Jin Ping Lin
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.,Institute of Gastroenterology, Zhejiang University
| | - Liu Hong Shi
- Department of Ultrasound, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Wei Jia Wang
- Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ai Qing Li
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.,Institute of Gastroenterology, Zhejiang University
| | - Jian Min Si
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.,Institute of Gastroenterology, Zhejiang University
| | - Shu Jie Chen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.,Institute of Gastroenterology, Zhejiang University
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Liszka Ł. [Tissue heterogeneity contributes to suboptimal precision of WHO 2010 scoring criteria for Ki67 labeling index in a subset of neuroendocrine neoplasms of the pancreas]. POL J PATHOL 2016; 67:318-31. [PMID: 28547959 DOI: 10.5114/pjp.2016.65864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Reporting of Ki67 labeling index (LI) is a routine in diagnostics of neuroendocrine neoplasms of the pancreas. The aim of the study was to examine whether heterogeneity of Ki67 LI distribution in primary tumoral tissue influences precision of reporting of Ki67 LI and Ki67-LI-based grade, both established in adherence to WHO 2010 guidelines. Seventy-one samples of neuroendocrine tumours (NET) and 6 samples of neuroendocrine carcinomas (NEC) of the pancreas were taken for manual counting of Ki67 LI in 25 portions of 100 cells (2500 cells in total) in 3 hot spots an in a single area of lower proliferation rate (cold spot) in each case. Both NET and NEC showed Ki67 LI heterogeneity within primary tumour. Almost 20% of NET showed higher grade when 500 cells rather than 2000 cells were counted in hot spot area. Suboptimal choice of hot spot resulted in under-grading of approximately 20% of NET. Cold spots were constantly present in NET. Heterogeneity of Ki67 LI was also present in NEC, but it virtually never resulted in under-grading. Concept and methodology of Ki67 LI counting in neuroendocrine neoplasms of the pancreas requires clarification. Efforts aiming to improve precision of assessment of Ki67 LI are needed.
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Yamamoto T, Musunuru HB, Vesprini D, Zhang L, Ghanem G, Loblaw A, Klotz L. Metastatic Prostate Cancer in Men Initially Treated with Active Surveillance. J Urol 2016; 195:1409-14. [PMID: 26707510 DOI: 10.1016/j.juro.2015.11.075] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Active surveillance is an approach to low and low intermediate risk prostate cancer that is designed to decrease overtreatment. Despite close monitoring a small subset of patients progress to metastatic disease. We analyzed the clinical and pathological correlates of surveillance in patients who eventually experienced metastasis. MATERIALS AND METHODS This was a single center, prospective cohort study. Eligible patients were treated with an expectant approach. The main outcome measure was metastasis-free survival. Predictive factors for metastasis were identified. RESULTS Metastasis developed in 30 of 980 patients, of whom 211 were classified at intermediate risk, including 14 who progressed to metastatic disease. Median followup was 6.3 years, median age was 70 years, median prostate specific antigen was 6.2 ng/ml and median time to metastasis was 8.9 years. Metastases developed in bone in 18 patients (60%) and in lymph nodes in 13 (43%). Prostate specific antigen doubling time less than 3 years (HR 3.7, 95% CI 1.4-9.4, p = 0.0006), Gleason score 7 (HR 3.0, 95% CI 1.2-7.3, p = 0.0018) and a total of 3 or more positive cores (HR 2.7, 95% CI 1.1-6.8, p = 0.0028) were independent predictors of metastasis. Although the intermediate risk group was at higher risk for metastasis, those with Gleason score 6 and prostate specific antigen greater than 10 ng/ml were not at increased risk for metastasis. Metastasis developed in only 2 patients with Gleason score 6 and neither had surgical pathology grading. CONCLUSION Active surveillance appears safe in patients at low risk and in select patients at intermediate risk, particularly those with Gleason score 6 and prostate specific antigen greater than 10 ng/ml. Patients with elements of Gleason pattern 4 on diagnostic biopsy are at increased risk for eventual metastasis when treated with an initial conservative approach.
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Sadidi H, Izadi-Mood N, Sarmadi S, Yarandi F, Amini-Moghaddam S, Esfahani F, Sadidi M. Comparison of clinicopathologic variables in coexistence cancers of the endometrium and ovary: A review of 55 cases in an academic center in Iran. J Res Med Sci 2015; 20:727-32. [PMID: 26664418 PMCID: PMC4652304 DOI: 10.4103/1735-1995.168315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: The coexistence primary cancers of the endometrium and ovary are relatively uncommon. The purpose of this study was to characterize patients diagnosed primary synchronous endometrial and ovarian cancer (SEOC), endometrial cancer (EC) with ovarian metastasis, and ovarian cancer (OC) with endometrial metastasis and compare clinicopathologic variables and prognosis. Materials and Methods: All the patients with diagnosis of both endometrium and OC, who hospitalized between 2002 and 2012 in an academic center affiliated to Tehran University of Medical Sciences, were evaluated with respect to different clinicopathologic variables, follow-up times, and outcomes. Results: Fifty-five patients had been diagnosed with both endometrium and OC. 17, 26, and 12 patients were diagnosed as SEOC, EC, and OC, respectively. The frequency of abnormal uterine bleeding was significantly lower in OC (16.7%) compared to others (58.8% in SEOC and 53.8% in EC). However, the abdominal/pelvic pain was significantly higher in OC (50%) compared to others (35.3% in SEOC and 34.6% in EC) (P < 0.05). Complex atypical hyperplasia (87.5%), endometriosis (88.8%), and endometrioid carcinoma (54.5%) was observed most in SEOC group. The duration of follow-up time was between 3 and 171 months with a mean of 16 months. There was no death in SEOC who followed. Survivals of patients between three group were statistically significant (P = 0.032). Conclusion: Our results showed that overall survival (OS) and progression-free survival (PFS) of SEOC patients is better than those with EC and OC (P = 0.032).
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Affiliation(s)
- Hossein Sadidi
- Research Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Izadi-Mood
- Department of Pathology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Sarmadi
- Department of Pathology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Yarandi
- Department of Obstetrics and Gynecology, Division of Oncology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Amini-Moghaddam
- Department of Obstetrics and Gynecology, Division of Oncology, Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Esfahani
- Research Development Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadidi
- Research Development Center, Tehran University of Medical Sciences, Tehran, Iran
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Garmer M, Busch M, Mateiescu S, Fahlbusch DE, Wagener B, Grönemeyer DH. Accuracy of MRI-Targeted in-Bore Prostate Biopsy According to the Gleason Score with Postprostatectomy Histopathologic Control--a Targeted Biopsy-Only Strategy with Limited Number of Cores. Acad Radiol 2015; 22:1409-18. [PMID: 26343218 DOI: 10.1016/j.acra.2015.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/17/2015] [Accepted: 06/24/2015] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES Accuracy of ultrasound-guided biopsy and Gleason score is limited, and diagnosis of insignificant cancer with Gleason score ≤6 is frequent when extended biopsy schemes are used. We evaluated whether the magnetic resonance imaging (MRI)-targeted in-bore prostate biopsy correctly identifies the Gleason score of prostate cancer in histopathologic correlation after prostatectomy. Simultaneously a targeted concept is expected to keep down the rate of insignificant cancer. MATERIALS AND METHODS We compared retrospectively the Gleason score of the MRI-targeted in-bore biopsy with prostatectomy specimens in 50 men with prostate cancer. Endorectal MRI included T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and spectroscopy. Lesions with a prostate imaging-reporting and data system (PI-RADS) score ≥3 were considered. Upgrading and downgrading of tumors was evaluated, and significant upgrading was defined as a shift in Gleason score from 6 to 7 or more. RESULTS Gleason score was concordant in 66% of the patients, overall upgraded in 30% of patients, and downgraded in 4% of patients. Significant upgrading of the Gleason score from 6 to 7 occurred in eight patients; upgrading did not exceed one step in the Gleason score. After prostatectomy the Gleason score 6 was found in 20% of patients. The median number of cores obtained was 4 (range 2-6), and the median number of positive cores was 2 (range 1-4). CONCLUSIONS In-bore MRI-targeted biopsy offers good accuracy in the Gleason score with postprostatectomy histopathologic control when compared to the literature. A limited number of cores are sufficient to achieve these results. The fraction of insignificant cancer identified by targeted only-biopsy is low. Upgrading is restricted to one step in the Gleason score. Clinicians should be aware of positive findings in MRI and the biopsy technique used when assessing prostate biopsy results.
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73
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Maurice MJ, Zhu H, Kiechle JE, Kim SP, Abouassaly R. Comorbid Disease Burden is Independently Associated with Higher Risk Disease at Prostatectomy in Patients Eligible for Active Surveillance. J Urol 2015; 195:919-24. [PMID: 26519653 DOI: 10.1016/j.juro.2015.10.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE Comorbid medical conditions are highly prevalent among patients with prostate cancer and may be associated with more aggressive disease. We investigated the association between comorbidity burden and higher risk disease among men eligible for active surveillance. MATERIALS AND METHODS Using the National Cancer Data Base we identified 29,447 cases of low risk (Gleason score 6 or less, cT1/T2a, prostate specific antigen less than 10 ng/ml) prostate cancer managed with prostatectomy from 2010 to 2011. The primary outcome was pathological upgrading (Gleason score greater than 6) or up staging (T3-T4/N1). The association between Charlson score and upgrading/up staging was analyzed using multivariate logistic regression. RESULTS The study sample comprised 29,447 men, of which 449 (1.5%) had Charlson scores greater than 1. At prostatectomy 44% of cases were upgraded/up staged. On multivariate analysis Charlson score greater than 1, age 70 years or greater, nonwhite race, higher prostate specific antigen and higher percentage of cores involved with disease were significantly associated with upgrading/up staging. After further adjusting for age, race, prostate specific antigen and core involvement, Charlson score remained a significant predictor of upgrading/up staging for younger white men. Specifically, white men less than 70 years old with Charlson comorbidity index greater than 1 had 1.3-fold higher odds of upgrading/up staging than men with Charlson comorbidity index 1 or less (OR 1.31, 95% CI 1.03-1.67, p=0.029). CONCLUSIONS Comorbidity burden is strongly and independently associated with pathological upgrading/up staging in men with clinically low risk prostate cancer. This finding may help improve disease risk assessment and clinical decision making in men with comorbidities considering active surveillance.
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Affiliation(s)
- Matthew J Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hui Zhu
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | - Jonathan E Kiechle
- Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Simon P Kim
- Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Robert Abouassaly
- Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
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Komisarenko M, Wong LM, Richard PO, Timilshina N, Toi A, Evans A, Zlotta A, Kulkarni G, Hamilton R, Fleshner N, Finelli A. An Increase in Gleason 6 Tumor Volume While on Active Surveillance Portends a Greater Risk of Grade Reclassification with Further Followup. J Urol 2015; 195:307-12. [PMID: 26417646 DOI: 10.1016/j.juro.2015.09.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE We evaluated the relative risk of later grade reclassification and outcomes of patients in whom high volume Gleason 6 prostate cancer develops while on active surveillance. MATERIALS AND METHODS A prospectively maintained database was used to identify patients on active surveillance between 1998 and 2013. Tumor volume was assessed based on the number of positive cores and proportion of core involvement. The chi-square and Fisher exact tests were used for analysis as appropriate. The primary end point was the development of grade reclassification, defined as grade only and/or grade and volume at the event biopsy. RESULTS A total of 555 men met the study inclusion criteria. Mean followup was 46 months. Overall 70 patients demonstrated an increase in tumor volume at or after biopsy 2. Compared to those men never experiencing volume or grade reclassification, prostate specific antigen at diagnosis was not significantly different (p=0.95), but median prostate volume was smaller in patients who demonstrated volume reclassification (p <0.001). The incidence of pure volume reclassification was 6.8%, 6.1% and 7.8% at biopsy 2, 3 and 4, respectively. Men with volume reclassification were more likely to experience later grade reclassification than those without at 33.3% vs 9.3%, respectively (p <0.0001). CONCLUSIONS While Gleason 6 prostate cancer has a favorable natural history, it appears that patients on active surveillance who experience volume reclassification are at substantially higher risk for grade reclassification. Thus, urologists should pay close attention to tumor core involvement, and monitoring should be adjusted accordingly for early volume reclassification in younger men and those in good health.
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Affiliation(s)
- Maria Komisarenko
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Lih-Ming Wong
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Patrick O Richard
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Narhari Timilshina
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Ants Toi
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Andrew Evans
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Alexandre Zlotta
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Girish Kulkarni
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Robert Hamilton
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Neil Fleshner
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW)
| | - Antonio Finelli
- Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network; Department of Pathology, Toronto General Hospital, University of Toronto (AE), Toronto, Ontario, Canada; Department of Urology, St. Vincent's Hospital, Melbourne, Australia (L-MW).
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75
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Kryvenko ON, Balise R, Soodana Prakash N, Epstein JI. African-American Men with Gleason Score 3+3=6 Prostate Cancer Produce Less Prostate Specific Antigen than Caucasian Men: A Potential Impact on Active Surveillance. J Urol 2015; 195:301-6. [PMID: 26341575 DOI: 10.1016/j.juro.2015.08.089] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE We assess the difference in prostate specific antigen production between African-American and Caucasian men with Gleason score 3+3=6 prostate cancer. MATERIALS AND METHODS We measured tumor volume in 414 consecutive radical prostatectomies from men with National Comprehensive Cancer Network(®) low risk prostate cancer (348 Caucasian, 66 African-American) who had Gleason score 3+3=6 disease at radical prostatectomy. We then compared clinical presentation, pathological findings, prostate specific antigen, prostate specific antigen density and prostate specific antigen mass (an absolute amount of prostate specific antigen in patient's circulation) between African-American and Caucasian men. The t-test and Wilcoxon rank sum were used for comparison of means. RESULTS African-American and Caucasian men had similar clinical findings based on age, body mass index and prostate specific antigen. There were no statistically significant differences between the dominant tumor nodule volume and total tumor volume (mean 0.712 vs 0.665 cm(3), p=0.695) between African-American and Caucasian men. Prostates were heavier in African-American men (mean 55.4 vs 46.3 gm, p <0.03). Despite the significantly greater weight of benign prostate tissue contributing to prostate specific antigen in African-American men, prostate specific antigen mass was not different from that of Caucasian men (mean 0.55 vs 0.558 μg, p=0.95). Prostate specific antigen density was significantly less in African-American men due to larger prostates (mean 0.09 vs 0.105, p <0.02). CONCLUSIONS African-American men with Gleason score 3+3=6 prostate cancer produce less prostate specific antigen than Caucasian men. African-American and Caucasian men had equal serum prostate specific antigen and prostate specific antigen mass despite significantly larger prostates in African-American men with all other parameters, particularly total tumor volume, being the same. This finding has practical implications in T1c cases diagnosed with prostate cancer due to prostate specific antigen screening. Lowering the prostate specific antigen density threshold in African-American men may account for this disparity, particularly in selecting patients for active surveillance programs.
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Affiliation(s)
- Oleksandr N Kryvenko
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
| | - Raymond Balise
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida; Department of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Jonathan I Epstein
- Departments of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Eggener SE, Badani K, Barocas DA, Barrisford GW, Cheng JS, Chin AI, Corcoran A, Epstein JI, George AK, Gupta GN, Hayn MH, Kauffman EC, Lane B, Liss MA, Mirza M, Morgan TM, Moses K, Nepple KG, Preston MA, Rais-Bahrami S, Resnick MJ, Siddiqui MM, Silberstein J, Singer EA, Sonn GA, Sprenkle P, Stratton KL, Taylor J, Tomaszewski J, Tollefson M, Vickers A, White WM, Lowrance WT. Gleason 6 Prostate Cancer: Translating Biology into Population Health. J Urol 2015; 194:626-34. [PMID: 25849602 PMCID: PMC4551510 DOI: 10.1016/j.juro.2015.01.126] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Gleason 6 (3+3) is the most commonly diagnosed prostate cancer among men with prostate specific antigen screening, the most histologically well differentiated and is associated with the most favorable prognosis. Despite its prevalence, considerable debate exists regarding the genetic features, clinical significance, natural history, metastatic potential and optimal management. MATERIALS AND METHODS Members of the Young Urologic Oncologists in the Society of Urologic Oncology cooperated in a comprehensive search of the peer reviewed English medical literature on Gleason 6 prostate cancer, specifically focusing on the history of the Gleason scoring system, histological features, clinical characteristics, practice patterns and outcomes. RESULTS The Gleason scoring system was devised in the early 1960s, widely adopted by 1987 and revised in 2005 with a more restrictive definition of Gleason 6 disease. There is near consensus that Gleason 6 meets pathological definitions of cancer, but controversy about whether it meets commonly accepted molecular and genetic criteria of cancer. Multiple clinical series suggest that the metastatic potential of contemporary Gleason 6 disease is negligible but not zero. Population based studies in the U.S. suggest that more than 90% of men newly diagnosed with prostate cancer undergo treatment and are exposed to the risk of morbidity for a cancer unlikely to cause symptoms or decrease life expectancy. Efforts have been proposed to minimize the number of men diagnosed with or treated for Gleason 6 prostate cancer. These include modifications to prostate specific antigen based screening strategies such as targeting high risk populations, decreasing the frequency of screening, recommending screening cessation, incorporating remaining life expectancy estimates, using shared decision making and novel biomarkers, and eliminating prostate specific antigen screening entirely. Large nonrandomized and randomized studies have shown that active surveillance is an effective management strategy for men with Gleason 6 disease. Active surveillance dramatically reduces the number of men undergoing treatment without apparent compromise of cancer related outcomes. CONCLUSIONS The definition and clinical relevance of Gleason 6 prostate cancer have changed substantially since its introduction nearly 50 years ago. A high proportion of screen detected cancers are Gleason 6 and the metastatic potential is negligible. Dramatically reducing the diagnosis and treatment of Gleason 6 disease is likely to have a favorable impact on the net benefit of prostate cancer screening.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - William T. Lowrance
- Correspondence: Department of Surgery, Division of Urology, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, #6405, Salt Lake City, Utah 84112 (telephone: 801-587-4282; FAX: 801-585-3749; )
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77
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Renard-Penna R, Cancel-Tassin G, Comperat E, Varinot J, Léon P, Roupret M, Mozer P, Vaessen C, Lucidarme O, Bitker MO, Cussenot O. Multiparametric Magnetic Resonance Imaging Predicts Postoperative Pathology but Misses Aggressive Prostate Cancers as Assessed by Cell Cycle Progression Score. J Urol 2015; 194:1617-23. [PMID: 26272031 DOI: 10.1016/j.juro.2015.06.107] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We identified prognostic biomarkers in prostate cancer by a radiogenomics strategy that integrates gene expression using the cell cycle progression score and medical images. MATERIALS AND METHODS We obtained institutional review board approval and written informed consent from 106 men with prostate cancer, including 60% at low risk, who underwent multiparametric magnetic resonance imaging before radical prostatectomy was done and a cell cycle progression score was determined. The correlation between the results of multiparametric magnetic resonance imaging and Gleason grade or cell cycle progression score was assessed by logistic regression. RESULTS Patients with primary Gleason grade greater than 3 had a longer median maximal tumor diameter (13 vs 10 mm) and a lower median apparent diffusion coefficient (0.745 vs 0.88×10(-3) mm2 per second, each p=0.0001) than those with primary Gleason grade 3 or less. Maximal diameter 10 mm or greater (OR 4.9, 95% CI 1.7 to 14.0, p=0.0012) and apparent diffusion coefficient 0.80×10(-3) mm2 per second or less (OR 7.5, 95% CI 3.0 to 18.7, p<0.0001) were significantly associated with primary Gleason grade greater than 3. The combined measure of maximal diameter less than 10 mm and apparent diffusion coefficient greater than 0.80×10(-3) mm2 per second identified only index lesions harboring primary Gleason grade 3. However, 7 of those lesions showed a molecular pattern of high risk lethal prostate cancer (cell cycle progression score greater than 0). CONCLUSIONS Multiparametric magnetic resonance imaging is able to predict low and high risk Gleason scores in the tumor. However, the cell cycle progression score did not completely match the imaging result. These findings suggest that management of early stages prostate cancer could strongly benefit by performing magnetic resonance imaging targeted biopsy coupled with molecular analysis.
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Affiliation(s)
- Raphaële Renard-Penna
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Department of Radiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Géraldine Cancel-Tassin
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris and Centre Recherche Pathologies Prostatique, Paris, France
| | - Eva Comperat
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Department of Pathology, Pitié-Salpêtrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris and Centre Recherche Pathologies Prostatique, Paris, France
| | - Justine Varinot
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Department of Pathology, Pitié-Salpêtrière Hospital, Paris, France
| | - Priscilla Léon
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Department of Urology, Pitié-Salpêtrière Hospital, Paris, France
| | - Morgan Roupret
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Department of Urology, Pitié-Salpêtrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris and Centre Recherche Pathologies Prostatique, Paris, France
| | - Pierre Mozer
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Department of Urology, Pitié-Salpêtrière Hospital, Paris, France
| | - Christophe Vaessen
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Department of Urology, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Marc-Olivier Bitker
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Department of Urology, Pitié-Salpêtrière Hospital, Paris, France
| | - Olivier Cussenot
- Institut Universitaire de Cancérologie, ONCOTYPE-URO, GRC No. 5, Université Pierre et Marie Curie, Université Paris 06, Pitié-Salpêtrière Hospital, Paris, France; Department of Urology, Pitié-Salpêtrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris and Centre Recherche Pathologies Prostatique, Paris, France.
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Kates M, Sopko NA, Han M, Partin AW, Epstein JI. Importance of Reporting the Gleason Score at the Positive Surgical Margin Site: Analysis of 4,082 Consecutive Radical Prostatectomy Cases. J Urol 2015; 195:337-42. [PMID: 26264998 DOI: 10.1016/j.juro.2015.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Since 2010 pathologists at our institution have routinely been documenting the Gleason score at the margin and length of the positive surgical margin after prostatectomy. In this study we evaluate how the Gleason score and positive surgical margin length correlate with the grade and adverse pathological characteristics of the final specimen, and whether the positive surgical margin Gleason score affects the risk of early biochemical recurrence. MATERIALS AND METHODS A total of 4,082 consecutive patients undergoing radical prostatectomy and pelvic lymph node dissection between 2010 and 2014 for localized prostate cancer were included in the study, of whom 405 had a Gleason score of 7 or greater of the primary nodule and a positive surgical margin with the length and Gleason score recorded at the margin. Concordance rates between the Gleason score at the margin and the final pathological specimen were compared. Logistic regression models were used to predict the risk of unfavorable pathology. Cox proportional hazards models controlling for Gleason score, preoperative prostate specific antigen, pathological stage and adjuvant radiation were used to predict biochemical recurrence, and Kaplan-Meier estimates of recurrence-free survival were calculated by Gleason score. RESULTS Among patients with positive margins biochemical recurrence was identified in 22% (vs 5.6% without positive margins), metastases in 3% (vs 0.5%) and adjuvant radiation in 30% (vs 4.1%). Mean followup was 22 months (range 12 to 48). The Gleason score at the positive surgical margin was the same as the final pathology specimen in 44% of patients, and a lower Gleason score in 56% of patients. A shorter positive surgical margin was independently associated with a lower Gleason score at the margin (p=0.02). Kaplan-Meier estimates demonstrated improved freedom from biochemical recurrence among patients with a lower Gleason score at the margin. In multivariate Cox models having a lower grade margin was associated with a decreased risk of biochemical recurrence (HR 0.50, OR 0.25-0.97). CONCLUSIONS A lower Gleason score at the positive surgical margin is independently associated with a shorter margin length and a decreased risk of early biochemical recurrence. Thus, the Gleason score at the margin should be documented.
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Affiliation(s)
- Max Kates
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Nikolai A Sopko
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Misop Han
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Alan W Partin
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jonathan I Epstein
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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79
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Ording AG, Horváth-Puhó E, Lash TL, Ehrenstein V, Borre M, Vyberg M, Sørensen HT. Prostate cancer, comorbidity, and the risk of venous thromboembolism: A cohort study of 44,035 Danish prostate cancer patients, 1995-2011. Cancer 2015; 121:3692-9. [PMID: 26149752 DOI: 10.1002/cncr.29535] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/16/2015] [Accepted: 04/22/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a serious complication of cancer. It is unknown whether comorbidity interacts clinically with prostate cancer (PC) to increase the VTE rate beyond that explained by PC and comorbidity alone, for example, by delaying diagnosis or precluding treatment. METHODS A nationwide, registry-based cohort study of all 44,035 Danish patients diagnosed with PC from 1995 to 2011 and 213,810 men from the general population matched 5:1 on age, calendar time, and comorbidities. The authors calculated VTE rate ratios and the interaction contrast as a measure on the additive scale of the excess VTE rate explained by synergy between PC and comorbidity. RESULTS In total, 849 patients in the PC cohort and 2360 men from the general population had VTE during 5 years of follow-up, and their risk of VTE was 2.2% and 1.3%, respectively. The 1-year VTE standardized rate among PC patients who had high comorbidity levels was 15 per 1000 person-years (PYs) (95% confidence interval, 6.8-24 per 1000 PYs), and 29% of that rate was explained by an interaction between PC and comorbidity. The VTE risk was increased among older patients, those with metastases, those with high Gleason scores, those in the D'Amico high-risk group, and those who underwent surgery. CONCLUSIONS PC interacted clinically with high comorbidity levels and increased the VTE rate. Because of the large PC burden, reducing VTEs associated with comorbidities may have an impact on VTE risk and the potential to improve prognosis. Clinical interactions between high levels of comorbidity and PC on the risk of VTE were observed. Almost 30% of all episodes of VTE occurred among patients who had high levels of comorbidity.
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Affiliation(s)
- Anne G Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Mogens Vyberg
- Institute of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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80
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Pham KN, Porter CR, Odem-Davis K, Wolff EM, Jeldres C, Wei JT, Morgan TM. Transperineal Template Guided Prostate Biopsy Selects Candidates for Active Surveillance--How Many Cores are Enough? J Urol 2015; 194:674-9. [PMID: 25963186 DOI: 10.1016/j.juro.2015.04.109] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE Most prostate cancer active surveillance protocols recommend a confirmatory biopsy within 3 to 6 months of diagnosis. Transperineal template guided biopsy is an approach to improve the detection of high grade prostate cancer. However, to our knowledge the optimal technique is unknown. We evaluated the relative performance of 2 transperineal template guided biopsy approaches. MATERIALS AND METHODS Institutional review board approved prospective databases at Virginia Mason and University of Michigan were used. Men eligible for active surveillance based on initial 12-core biopsy demonstrating NCCN® guideline low risk prostate cancer were included in study. All men underwent confirmatory transperineal template guided biopsy between 2005 and 2014, and within 6 months of diagnosis. The biopsy technique was based on a 24-core template with 12 anterior and 12 posterior cores or a template based on gland volume with an average of 1 core per cc. Outcome comparisons were made by the chi-square and Fisher exact tests, the Welch t-test and linear regression. RESULTS Of the 135 men 46 underwent 24-core biopsy and 89 underwent volume based biopsy (median 62 cores). No statistically significant difference was noted in the prevalence of upgrading (35% vs 29%, p = 0.64) or complications (9% vs 16%, p = 0.38) between the 24-core and volume based groups. The difference in the probability of upgrading by volume based biopsy adjusted for age, prostate specific antigen, prostate volume, clinical stage and number of prior biopsies was -4% (95% CI -24 to 14%, p = 0.63). CONCLUSIONS A significant difference was not detected in upgrading or morbidity between a 24-core template and a more exhaustive volume based template. A less invasive 24-core transperineal template guided biopsy strategy may suffice to accurately identify men who are appropriate for active surveillance.
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Liu CH, Peng YJ, Wang HH, Chen YC, Tsai CL, Chian CF, Huang TW. Heterogeneous prognosis and adjuvant chemotherapy in pathological stage I non-small cell lung cancer patients. Thorac Cancer 2015; 6:620-8. [PMID: 26445611 PMCID: PMC4567008 DOI: 10.1111/1759-7714.12233] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/22/2014] [Indexed: 01/02/2023] Open
Abstract
Background Even after curative resection, the prognosis of pathological stage I non-small cell lung cancer (NSCLC) can be heterogeneous, and the use of adjuvant chemotherapy in these patients is controversial. We aimed to identify the prognostic factors and role of adjuvant chemotherapy in pathological stage I NSCLC. Methods We retrospectively analyzed the correlations between clinicopathological factors and survival in 179 patients with resected pathological stage I NSCLC. Results After a median follow-up of 93 months, overall and disease-free survival were not significantly different between pathological stage IA (n = 138) and IB (n = 41) patients. The prognosis of pathological stage I patients with poorly differentiated tumors was significantly worse than that of those with non-poorly differentiated tumors (P = 0.003). Multivariate analysis revealed that poor tumor differentiation was an independent factor for poor survival (hazard ratio = 6.889). A marginally significant survival benefit was observed in poorly differentiated pathological stage I patients who received adjuvant chemotherapy (P = 0.053). Pathological stage IA patients who received adjuvant chemotherapy had a worse prognosis than those who did not receive adjuvant chemotherapy (P < 0.001), whereas pathological stage IA patients with poorly differentiated tumors who received adjuvant chemotherapy had better survival than who did not receive adjuvant chemotherapy (P < 0.001). Conclusions Poor differentiation is an independent prognostic factor in pathological stage I NSCLC after surgical resection. Adjuvant chemotherapy may be beneficial in poorly differentiated pathological stage IA NSCLC patients.
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Affiliation(s)
- Chia-Hsin Liu
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Hong-Hau Wang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan ; Department of Radiology, Tri-Service General Hospital Songshan Branch, National Defense Medical Center Taipei, Taiwan
| | - Ying-Chieh Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Chih-Feng Chian
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
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Dinh KT, Mahal BA, Ziehr DR, Muralidhar V, Chen YW, Viswanathan VB, Nezolosky MD, Beard CJ, Choueiri TK, Martin NE, Orio PF, Sweeney CJ, Trinh QD, Nguyen PL. Incidence and Predictors of Upgrading and Up Staging among 10,000 Contemporary Patients with Low Risk Prostate Cancer. J Urol 2015; 194:343-9. [PMID: 25681290 DOI: 10.1016/j.juro.2015.02.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE We determined the incidence of pathological upgrading and up staging for contemporary, clinically low risk patients, and identified predictors of having occult, advanced disease to inform the selection of patients for active surveillance. MATERIALS AND METHODS We studied 10,273 patients in the SEER database diagnosed with clinically low risk disease (cT1c/T2a, prostate specific antigen less than 10 ng/ml, Gleason 3 + 3 = 6) in 2010 to 2011 and treated with prostatectomy. The primary outcome was the incidence of upgrading to pathological Gleason score 7-10 or up staging to pathological T3-T4/N1 disease. Multivariable logistic regression of cases with complete biopsy data (5,581) identified significant predictors of upgrading or up staging, which were then used to create a risk stratification table. RESULTS At prostatectomy 44% of cases were upgraded and 9.7% were up staged. Multivariable analysis of 5,581 patients showed age, prostate specific antigen and percent positive cores (all p < 0.001) but not race were associated with occult, advanced disease. With these variables dichotomized at the median, age older than 60 years (AOR 1.39), prostate specific antigen greater than 5.0 ng/ml (AOR 1.28) and more than 25% positive cores (AOR 1.76) were significantly associated with upgrading (all p < 0.001). Similarly, age older than 60 years (AOR 1.42), prostate specific antigen greater than 5.0 ng/ml (AOR 1.44) and more than 25% positive cores (AOR 2.26) were associated with up staging (all p < 0.001). Overall 60% of 5,581 low risk cases with prostate specific antigen 7.5 to 9.9 ng/ml and more than 25% positive cores were upgraded. This study is limited by possible bias introduced by only using patients selected for prostatectomy. CONCLUSIONS Nearly half of clinically low risk patients harbor Gleason 7 or greater, or pT3 or greater disease, and should be risk stratified by prostate specific antigen and percent positive cores for consideration of further testing before deciding on active surveillance.
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Affiliation(s)
| | | | | | | | - Yu-Wei Chen
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vidya B Viswanathan
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle D Nezolosky
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Clair J Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neil E Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter F Orio
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher J Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc D Trinh
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Jain S, Loblaw A, Vesprini D, Zhang L, Kattan MW, Mamedov A, Jethava V, Sethukavalan P, Yu C, Klotz L. Gleason Upgrading with Time in a Large Prostate Cancer Active Surveillance Cohort. J Urol 2015; 194:79-84. [PMID: 25660208 DOI: 10.1016/j.juro.2015.01.102] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE We report the percentage of patients on active surveillance who had disease pathologically upgraded and factors that predict for upgrading on surveillance biopsies. MATERIALS AND METHODS Patients in our active surveillance database with at least 1 repeat prostate biopsy were included. Histological upgrading was defined as any increase in primary or secondary Gleason grade on repeat biopsy. Multivariate analysis was used to determine baseline and dynamic factors associated with Gleason upgrading. This information was used to develop a nomogram to predict for upgrading or treatment in patients electing for active surveillance. RESULTS Of 862 patients in our cohort 592 had 2 or more biopsies. Median followup was 6.4 years. Of the patients 20% were intermediate risk, 0.3% were high risk and all others were low risk. During active surveillance 31.3% of cases were upgraded. On multivariate analysis clinical stage T2, higher prostate specific antigen and higher percentage of cores involved with disease at the time of diagnosis predicted for upgrading. A total of 27 cases (15% of those upgraded) were Gleason 8 or higher at upgrading, and 62% of all 114 upgraded cases went on to have active treatment. The nomogram incorporated clinical stage, age, prostate specific antigen, core positivity and Gleason score. The concordance index was 0.61. CONCLUSIONS In this large re-biopsy cohort with medium-term followup, most cases have not been pathologically upgraded to date. A model predicting for upgrading or radical treatment was developed which could be useful in counseling patients considering active surveillance for prostate cancer.
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Affiliation(s)
- Suneil Jain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Health Policy, Measurement and Evaluation, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Danny Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Liying Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Alexandre Mamedov
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Vibhuti Jethava
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Perakaa Sethukavalan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Changhong Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Laurence Klotz
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Hussein AA, Welty CJ, Ameli N, Cowan JE, Leapman M, Porten SP, Shinohara K, Carroll PR. Untreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course and Pathological Outcomes. J Urol 2015; 194:85-90. [PMID: 25623742 DOI: 10.1016/j.juro.2015.01.077] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE We describe the outcomes of patients with low risk localized prostate cancer who were upgraded on a surveillance biopsy while on active surveillance and evaluated whether delayed treatment was associated with adverse outcome. MATERIALS AND METHODS We included men in the study with lower risk disease managed initially with active surveillance and upgraded to Gleason score 3+4 or greater. Patient demographics and disease characteristics were compared. Kaplan-Meier curve was used to estimate the treatment-free probability stratified by initial upgrade (3+4 vs 4+3 or greater), Cox regression analysis was used to examine factors associated with treatment and multivariate logistic regression analysis was used to evaluate the factors associated with adverse outcome at surgery. RESULTS The final cohort comprised 219 men, with 150 (68%) upgraded to 3+4 and 69 (32%) to 4+3 or greater. Median time to upgrade was 23 months (IQR 11-49). A total of 163 men (74%) sought treatment, the majority (69%) with radical prostatectomy. The treatment-free survival rate at 5 years was 22% for 3+4 and 10% for 4+3 or greater upgrade. Upgrade to 4+3 or greater, higher prostate specific antigen density at diagnosis and shorter time to initial upgrade were associated with treatment. At surgical pathology 34% of cancers were downgraded while 6% were upgraded. Cancer volume at initial upgrade was associated with adverse pathological outcome at surgery (OR 3.33, 95% CI 1.19-9.29, p=0.02). CONCLUSIONS After Gleason score upgrade most patients elected treatment with radical prostatectomy. Among men who deferred definitive intervention, few experienced additional upgrading. At radical prostatectomy only 6% of cases were upgraded further and only tumor volume at initial upgrade was significantly associated with adverse pathological outcome.
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Affiliation(s)
- A A Hussein
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; Department of Urology, Cairo University, Cairo, Egypt
| | - C J Welty
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - N Ameli
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - J E Cowan
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - M Leapman
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - S P Porten
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - K Shinohara
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - P R Carroll
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
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Mahdavinezhad A, Mousavi-Bahar SH, Poorolajal J, Yadegarazari R, Jafari M, Shabab N, Saidijam M. Evaluation of miR-141, miR-200c, miR-30b Expression and Clinicopathological Features of Bladder Cancer. Int J Mol Cell Med 2015; 4:32-9. [PMID: 25815280 PMCID: PMC4359703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 11/22/2014] [Accepted: 12/27/2014] [Indexed: 11/11/2022]
Abstract
Bladder cancer (BC) ranks the second most common genitourinary tract malignant tumor with high mortality and 70% recurrence rate worldwide. MiRNAs expression has noticeable role in bladder tumorigenesis. The purpose of this study was to assess miR-200c, miR-30b and miR-141 in tissue samples of patients with BC and healthy adjacent tissue samples and their association with muscle invasion, grade and the size of the tumor. Transurethral resection tissue samples were collected from thirty- five newly diagnosed untreated patients with BC from 2013 to 2014. The control group consisted of adjacent normal urothelium. All samples, observed by two pathologists, were diagnosed transitional cell carcinomas (TCC) with the proportion of tumor cells greater than 80%. Total RNA including miRNAs was extracted from about 50 mg tissue samples by applying TRIzol reagent. 2((-ΔΔ CT)) method was used to calculate relative quantification of miRNA expression. Two of 35 patients were females and the other 33 were males. Invasion to bladder muscle was observed in 13 (37%) cases. MiR-141, miR-200-c and miR30-b were up-regulated in 91%, 79% and 64% of malignant tissues, respectively. Down-regulation of miR-141 had a strong association with muscle invasion (P= 0.017). Significant inverse correlation between grading and miRNA-141 level was observed (P= 0.043).
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Affiliation(s)
- Ali Mahdavinezhad
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | | | - Jalal Poorolajal
- Research Center for Modeling of Non-communicable Diseases, Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Reza Yadegarazari
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Mohammad Jafari
- Department of Pathology, Medical School, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Nooshin Shabab
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Massoud Saidijam
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.,Corresponding author: Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
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Mahmood U, Levy LB, Nguyen PL, Lee AK, Kuban DA, Hoffman KE. Current clinical presentation and treatment of localized prostate cancer in the United States. J Urol 2014; 192:1650-6. [PMID: 24931803 PMCID: PMC10988984 DOI: 10.1016/j.juro.2014.06.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE SEER recently released patient Gleason scores at biopsy/transurethral resection of the prostate. For the first time this permits accurate assessment of prostate cancer presentation and treatment according to clinical factors at diagnosis. MATERIALS AND METHODS We used the SEER database to identify men diagnosed with localized prostate cancer in 2010 who were assigned NCCN(®) risk based on clinical factors. We identified sociodemographic factors associated with high risk disease and analyzed the impact of these factors along with NCCN risk on local treatment. RESULTS Of the 42,403 men identified disease was high, intermediate and low risk in 38%, 40% and 22%, respectively. On multivariate analysis patients who were older, nonwhite, unmarried or living in a county with a higher poverty rate were more likely to be diagnosed with high risk disease (each p <0.05). Of the 38,634 men in whom prostate cancer was the first malignancy 23% underwent no local treatment, 40% were treated with prostatectomy, 36% received radiation therapy and 1% underwent local tumor destruction, predominantly cryotherapy. On multivariate analysis patients who were older, black, unmarried or living in a county with a higher poverty rate, or who had low risk disease were less likely to receive local treatment (each p <0.05). CONCLUSIONS Our analysis provides information on the current clinical presentation and treatment of localized prostate cancer in the United States. Nonwhite and older men living in a county with a higher poverty rate were more likely to be diagnosed with high risk disease and less likely to receive local treatment.
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Affiliation(s)
- Usama Mahmood
- Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts.
| | - Lawrence B Levy
- Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts
| | - Paul L Nguyen
- Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts
| | - Andrew K Lee
- Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts
| | - Deborah A Kuban
- Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts
| | - Karen E Hoffman
- Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts
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87
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Liang Y, Ketchum NS, Goodman PJ, Klein EA, Thompson IM Jr. Is there a role for body mass index in the assessment of prostate cancer risk on biopsy? J Urol 2014; 192:1094-9. [PMID: 24747090 DOI: 10.1016/j.juro.2014.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE We examine the role of body mass index in the assessment of prostate cancer risk. MATERIALS AND METHODS A total of 3,258 participants who underwent biopsy (including 1,902 men with a diagnosis of prostate cancer) were identified from the Selenium and Vitamin E Cancer Prevention Trial. The associations of body mass index with prostate cancer and high grade prostate cancer were examined using logistic regression, adjusting for age, race, body mass index adjusted prostate specific antigen, digital rectal examination, family history of prostate cancer, biopsy history, prostate specific antigen velocity, and time between study entry and the last biopsy. The prediction models were compared with our previously developed body mass index adjusted Prostate Cancer Prevention Trial prostate cancer risk calculator. RESULTS Of the study subjects 49.1% were overweight and 29.3% were obese. After adjustment, among men without a known family history of prostate cancer, increased body mass index was not associated with a higher risk of prostate cancer (per one-unit increase in logBMI OR 0.83, p=0.54) but was significantly associated with a higher risk of high grade prostate cancer (ie Gleason score 7 or greater prostate cancer) (OR 2.31, p=0.03). For men with a known family history of prostate cancer the risks of prostate cancer and high grade prostate cancer increased rapidly as body mass index increased (prostate cancer OR 3.73, p=0.02; high grade prostate cancer OR 7.95, p=0.002). The previously developed risk calculator generally underestimated the risks of prostate cancer and high grade prostate cancer. CONCLUSIONS Body mass index provided independently predictive information regarding the risks of prostate cancer and high grade prostate cancer after adjusting for other risk factors. Body mass index, especially in men with a known family history of prostate cancer, should be considered for inclusion in any clinical assessment of prostate cancer risk and recommendations regarding prostate biopsy.
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88
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Humphrey PA, Hickey TP, Riley TL, Mabie JE, Bellinger A, Strother M, Andriole GL. Modified Gleason grade of prostatic adenocarcinomas detected in the PLCO cancer screening trial. J Urol 2014; 192:391-5. [PMID: 24594407 DOI: 10.1016/j.juro.2014.02.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE We determined the modified Gleason grade of prostatic adenocarcinomas detected in PLCO to assess grade distribution and compare modified Gleason grades of cancer detected in the intervention arm (organized annual screening) vs the control arm (opportunistic screening). MATERIALS AND METHODS Modified Gleason grading was performed in 859 radical prostatectomy cases by a single urological pathologist. We compared the proportion of cases with high grade disease in the screened arm vs the control arm by logistic regression analysis. RESULTS In the intervention arm a modified Gleason score of 5, 6, 7 (3+4), 7 (4+3), 8, 9 and 10 was assigned in 3.6%, 43.3%, 39%, 7.4%, 3.5%, 3.2% and 0.1% of cases, respectively. In the control arm a modified Gleason score of 5, 6, 7 (3+4), 7 (4+3), 8, 9 and 10 was assigned in 3.0%, 35.7%, 46.4%, 7.1%, 5.4%, 1.9% and 0.5% of cases, respectively, after correcting for high grade disease over sampling. A high grade modified Gleason score of 7 or greater was detected in 53% of cases in the intervention arm vs 61.3% in the control arm after correction (p=0.019). The median modified Gleason score was 7 (3+4) in each arm. CONCLUSIONS A significant percent of cancers in each arm had a component of high grade disease. The modified Gleason grade of prostate cancers detected by organized annual screening was slightly lower than the modified grade of those detected by opportunistic screening. This is an expected consequence of more intensive screening.
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Affiliation(s)
- Peter A Humphrey
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
| | | | | | | | - Adam Bellinger
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Marshall Strother
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gerald L Andriole
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Han DH, Choi GH, Kim KS, Choi JS, Park YN, Kim SU, Park JY, Ahn SH, Han KH. Prognostic significance of the worst grade in hepatocellular carcinoma with heterogeneous histologic grades of differentiation. J Gastroenterol Hepatol 2013; 28:1384-90. [PMID: 23517197 DOI: 10.1111/jgh.12200] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Although tumor differentiation is a known prognostic factor after the treatment of hepatocellular carcinoma (HCC), there have not been any studies on the prognostic significance of tumor differentiation in HCC with heterogeneous histologic grades. In this study, we attempted to ascertain whether the major or the worst grade in mixed histologic type HCC determines the prognosis after liver resection. METHODS From January 1996 to March 2010, a total of 724 patients underwent curative resection of HCC at Yonsei University Health System, Korea. Of those, we excluded 99 patients who had total necrosis because of previous treatment. Among the remaining 625 patients, we compared the homogeneous moderately differentiated group (HG2, n = 241), mixed histologic grades with the worst component as poorly differentiated group (M2, n = 142), and homogeneous poorly differentiated group (HG3, n = 156). The clinicopathologic features, disease-free survival (DFS) and overall survival (OS) in each group were analyzed. RESULTS The DFS and OS were significantly lower in M2 than in HG2 (P = 0.004 and 0.025, respectively) whereas those of M2 were not significantly different from HG3. There were no significant differences in the clinicopathologic features of each group except that microvascular invasion was more frequently observed in M2 than in HG2. On multivariate analysis, being in the worst histologic group (M2 and HG3) was an independent poor prognostic factor for DFS and OS (P = 0.028 and < 0.001, respectively). CONCLUSIONS In patients with advanced histologic grade, the worst histologic grade may determine the prognosis after curative resection of HCC.
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Affiliation(s)
- Dai Hoon Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Sundi D, Kryvenko ON, Carter HB, Ross AE, Epstein JI, Schaeffer EM. Pathological examination of radical prostatectomy specimens in men with very low risk disease at biopsy reveals distinct zonal distribution of cancer in black American men. J Urol 2013; 191:60-7. [PMID: 23770146 DOI: 10.1016/j.juro.2013.06.021] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE Of men with very low risk prostate cancer at biopsy recent evidence shows that black American men are at greater risk for adverse oncologic outcomes after radical prostatectomy. We studied radical prostatectomy specimens from black and white men at very low risk to determine whether there are systematic pathological differences. MATERIALS AND METHODS Radical prostatectomy specimens were evaluated in men with National Comprehensive Cancer Network® (NCCN) very low risk prostate cancer. At diagnosis all men underwent extended biopsy sampling (10 or more cores) and were treated in the modern Gleason grade era. We analyzed tumor volume, grade and location in 87 black and 89 white men. For each specimen the dominant nodule was defined as the largest tumor with the highest grade. RESULTS Compared to white men, black men were more likely to have significant prostate cancer (61% vs 29%), Gleason 7 or greater (37% vs 11%, each p <0.001) and a volume of greater than 0.5 cm(3) (45% vs 21%, p = 0.001). Dominant nodules in black men were larger (median 0.28 vs 0.13 cm(3), p = 0.002) and more often anterior (51% vs 29%, p = 0.003). In men who underwent pathological upgrading the dominant nodule was also more frequently anterior in black than in white men (59% vs 0%, p = 0.001). CONCLUSIONS Black men with very low risk prostate cancer at diagnosis have a significantly higher prevalence of anterior cancer foci that are of higher grade and larger volume. Enhanced imaging or anterior zone sampling may detect these significant anterior tumors, improving the outcome in black men considering active surveillance.
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Affiliation(s)
- Debasish Sundi
- The Brady Institute of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Oleksandr N Kryvenko
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - H Ballentine Carter
- The Brady Institute of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ashley E Ross
- The Brady Institute of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Rais-Bahrami S, Siddiqui MM, Turkbey B, Stamatakis L, Logan J, Hoang AN, Walton-Diaz A, Vourganti S, Truong H, Kruecker J, Merino MJ, Wood BJ, Choyke PL, Pinto PA. Utility of multiparametric magnetic resonance imaging suspicion levels for detecting prostate cancer. J Urol 2013; 190:1721-1727. [PMID: 23727310 DOI: 10.1016/j.juro.2013.05.052] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE We determine the usefulness of multiparametric magnetic resonance imaging in detecting prostate cancer, with a specific focus on detecting higher grade prostate cancer. MATERIALS AND METHODS Prospectively 583 patients who underwent multiparametric magnetic resonance imaging and subsequent prostate biopsy at a single institution were evaluated. On multiparametric magnetic resonance imaging, lesions were identified and scored as low, moderate or high suspicion for prostate cancer based on a validated scoring system. Magnetic resonance/ultrasound fusion guided biopsies of magnetic resonance imaging lesions in addition to systematic 12-core biopsies were performed. Correlations between the highest assigned multiparametric magnetic resonance imaging suspicion score and presence of cancer and biopsy Gleason score on the first fusion biopsy session were assessed using univariate and multivariate logistic regression models. Sensitivity, specificity, negative predictive value and positive predictive value were calculated and ROC curves were developed to assess the discriminative ability of multiparametric magnetic resonance imaging as a diagnostic tool for various biopsy Gleason score cohorts. RESULTS Significant correlations were found between age, prostate specific antigen, prostate volume, and multiparametric magnetic resonance imaging suspicion score and the presence of prostate cancer (p<0.0001). On multivariate analyses controlling for age, prostate specific antigen and prostate volume, increasing multiparametric magnetic resonance imaging suspicion was an independent prognosticator of prostate cancer detection (OR 2.2, p<0.0001). Also, incremental increases in multiparametric magnetic resonance imaging suspicion score demonstrated stronger associations with cancer detection in patients with Gleason 7 or greater (OR 3.3, p<0.001) and Gleason 8 or greater (OR 4.2, p<0.0001) prostate cancer. Assessing multiparametric magnetic resonance imaging as a diagnostic tool for all prostate cancer, biopsy Gleason score 7 or greater, and biopsy Gleason score 8 or greater separately via ROC analyses demonstrated increasing accuracy of multiparametric magnetic resonance imaging for higher grade disease (AUC 0.64, 0.69, and 0.72, respectively). CONCLUSIONS Multiparametric magnetic resonance imaging is a clinically useful modality to detect and characterize prostate cancer, particularly in men with higher grade disease.
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Affiliation(s)
- Soroush Rais-Bahrami
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - M Minhaj Siddiqui
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Lambros Stamatakis
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jennifer Logan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Anthony N Hoang
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Annerleim Walton-Diaz
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Srinivas Vourganti
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hong Truong
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jochen Kruecker
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland; Philips Research North America, Briarcliff Manor, New York
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland.
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