51
|
Prediction of Gleason score upgrading in low-risk prostate cancers diagnosed via multi (≥12)-core prostate biopsy. World J Urol 2008; 27:271-6. [DOI: 10.1007/s00345-008-0343-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 10/08/2008] [Indexed: 11/26/2022] Open
|
52
|
Turley RS, Terris MK, Kane CJ, Aronson WJ, Presti JC, Amling CL, Freedland SJ. The association between prostate size and Gleason score upgrading depends on the number of biopsy cores obtained: results from the Shared Equal Access Regional Cancer Hospital Database. BJU Int 2008; 102:1074-9. [PMID: 18778348 DOI: 10.1111/j.1464-410x.2008.08015.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test the hypothesis that the association between prostate size and risk of Gleason grade upgrading varies as a function of sampling. PATIENTS AND METHODS We examined the association between pathological prostate weight, prostate biopsy scheme and Gleason upgrading (Gleason > or =7 at radical prostatectomy, RP) among 646 men with biopsy Gleason 2-6 disease treated with RP between 1995 and 2007 within the Shared Equal Access Regional Cancer Hospital Database using logistic regression. In all, 204 and 442 men had a sextant (six or seven cores) or extended-core biopsy (eight or more cores), respectively. Analyses were adjusted for centre, age, surgery, preoperative prostate-specific antigen level, clinical stage, body mass index, race, and percentage of cores positive for cancer. RESULTS In all, 281 men (44%) were upgraded; a smaller prostate was positively associated with the risk of upgrading in men who had an extended-core biopsy (P < 0.001), but not among men who had a sextant biopsy (P = 0.22). The interaction between biopsy scheme and prostate size was significant (P interaction = 0.01). CONCLUSIONS These data support the hypothesis that the risk of upgrading is a function of two opposing contributions: (i) a more aggressive phenotype in smaller prostates and thus increased risk of upgrading; and (ii) more thorough sampling in smaller prostates and thus decreased risk of upgrading. When sampled more thoroughly, the phenotype association dominates and smaller prostates are linked with an increased risk of upgrading. In less thoroughly sampled prostates, these opposing factors nullify, resulting in no association between prostate size and risk of upgrading. These findings help to explain previously published disparate results of the importance of prostate size as a predictor of Gleason upgrading.
Collapse
Affiliation(s)
- Ryan S Turley
- Division of Urological Surgery, Duke Prostate Center, Duke University School of Medicine, Durham, NC 27710, USA
| | | | | | | | | | | | | | | |
Collapse
|
53
|
Shariat SF, Karakiewicz PI, Suardi N, Kattan MW. Comparison of Nomograms With Other Methods for Predicting Outcomes in Prostate Cancer: A Critical Analysis of the Literature. Clin Cancer Res 2008; 14:4400-7. [PMID: 18628454 DOI: 10.1158/1078-0432.ccr-07-4713] [Citation(s) in RCA: 230] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shahrokh F Shariat
- Department of Urology, University of Texas Southwestern Medical Centre, Dallas, Texas, USA.
| | | | | | | |
Collapse
|
54
|
Sciarra A, Autran Gomez A, Salciccia S, Dattilo C, Ciccariello M, Gentile V, Di Silverio F. Biopsy-Derived Gleason Artifact and Prostate Volume: Experience Using Ten Samples in Larger Prostates. Urol Int 2008; 80:145-50. [DOI: 10.1159/000112604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 04/27/2007] [Indexed: 11/19/2022]
|
55
|
Turley RS, Hamilton RJ, Terris MK, Kane CJ, Aronson WJ, Presti JC, Amling CL, Freedland SJ. Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy: results from the SEARCH database. J Urol 2008; 179:523-7; discussion 527-8. [PMID: 18076952 DOI: 10.1016/j.juro.2007.09.078] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE Needle biopsy Gleason scores are often upgraded after pathological examination of the prostate following radical prostatectomy. It has been suggested that larger prostates would be associated with a greater risk of upgrading since a smaller percentage of the gland is sampled and, thus, the highest grade disease would more likely be missed, assuming an equal number of cores is taken from similar locations. We examined the likelihood of clinically relevant upgrading after radical prostatectomy as a function of transrectal ultrasound volume. MATERIALS AND METHODS We examined the association between transrectal ultrasound volume and upgrading (higher Gleason score category in the radical prostatectomy specimen than in the biopsy) in 586 men treated with radical prostatectomy between 1995 and 2006 in the SEARCH database who underwent at least a sextant biopsy using multivariate logistic regression. Transrectal ultrasound volume was categorized as 20 or less (in 71), 21 to 40 (in 334), 41 to 60 (in 123) and greater than 60 cm(3) (in 58). Gleason score was examined as a categorical variable of 2-6, 3 + 4 and 4 + 3 or greater. RESULTS Overall 138 cases (24%) were upgraded, 80 (14%) were downgraded, and 368 (62%) had identical biopsy and pathological Gleason sum groups. Larger transrectal ultrasound volume was significantly associated with decreased likelihood of upgrading (p trend <0.001). For transrectal ultrasound volumes greater than 60, 41 to 60, 21 to 40 and 20 cm(3) or less, the estimated multivariate adjusted probability of upgrading was 12.6%, 27.5%, 36.4% and 45.5% for Gleason 2-6 tumors, and 6.1%, 8.5%, 18.9% and 20.9% for Gleason 3 + 4 tumors, respectively. CONCLUSIONS Larger transrectal ultrasound volumes were at decreased risk for clinically significant upgrading after radical prostatectomy. This fact should be kept in mind when deciding on treatment decisions for men with apparently low grade prostate cancer on biopsy.
Collapse
Affiliation(s)
- Ryan S Turley
- Division of Urological Surgery, Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
56
|
Dong F, Jones JS, Stephenson AJ, Magi-Galluzzi C, Reuther AM, Klein EA. Prostate cancer volume at biopsy predicts clinically significant upgrading. J Urol 2008; 179:896-900; discussion 900. [PMID: 18207180 DOI: 10.1016/j.juro.2007.10.060] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE A significant proportion of patients with prostate cancer with Gleason score 6 disease at biopsy is upgraded to Gleason score 7 or higher after radical prostatectomy, increasing the risk of adverse outcome. We identified clinical and pathological parameters that predict pathological upgrading in this population. MATERIALS AND METHODS A total of 268 patients with biopsy Gleason score 6 prostate cancer who underwent biopsy and radical prostatectomy between October 1999 and January 2007 were included in the study. Pretreatment characteristics were used to identify predictors of pathological upgrading. Upgrading significance was established by comparing radical prostatectomy pathology between cases that were and were not upgraded. RESULTS A total of 134 patients (50%) were upgraded postoperatively to Gleason score 7 or higher. Preoperative prostate specific antigen greater than 5.0 ng/ml (p = 0.036), prostate weight 60 gm or less (p = 0.004) and more cancer volume at biopsy, defined by cancer involving greater than 5% of the biopsy tissue (p = 0.002), greater than 1 biopsy core (p <0.001) or greater than 10% of any core (p = 0.014), were associated with pathological upgrading. Upgraded patients were more likely to have extraprostatic extension and positive surgical margins at radical prostatectomy (p <0.001 and 0.001, respectively). CONCLUSIONS Prostate specific antigen, prostate volume and biopsy cancer volume predict clinically significant upgrading in patients diagnosed with Gleason score 6 disease. These parameters may be valuable in the pretreatment risk assessment of this patient population.
Collapse
Affiliation(s)
- Fei Dong
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | | | | | | | | |
Collapse
|
57
|
Prognostic significance of Gleason score discrepancies between needle biopsy and radical prostatectomy. Eur Urol 2007; 53:767-75; discussion 775-6. [PMID: 18060681 DOI: 10.1016/j.eururo.2007.11.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Discordance between the Gleason score (GS) on needle biopsy (NB) and the GS of the radical prostatectomy (RP) specimen is a common finding. The objective of this study was to evaluate the prognostic significance of these discrepancies with respect to outcomes following RP. METHODS In the study, 6625 men treated by RP were categorized as having NB=RP (68.8%), NB<RP (25.0%) or NB>RP (6.2%) GS, and stratified for analyses into RP GS groups. The Kaplan-Meier method was used to analyze differences in biochemical recurrence-free survival (BRFS), and multivariate Cox analyses were performed to estimate the independent relative risk of progression associated with GS discrepancies. RESULTS Across multiple RP GS strata (3+4, 7, 8, 8-10), patients with a lower NB GS experienced significantly better BRFS than patients with equal NB and RP GS (all p<0.05). NB<RP GS was independently associated with better (pooled HR, 0.76, p=0.001) BRFS, within and across RP GS strata. Similarly, patients with NB>RP GS had poorer BRFS than patients with NB=RP GS across multiple RP GS strata (< or =3+3, 3+4, 7; all p<0.05). NB>RP GS was independently associated with worse (pooled HR, 1.91, p<0.001) BRFS probabilities, within and across RP GS strata. CONCLUSIONS Our data suggest that the GS of the NB adds additional prognostic value to the RP GS in a consistent manner that may be applicable to strategies of risk stratification and patient counseling after surgery.
Collapse
|
58
|
Tumor necrosis factor-related apoptosis inducing ligand-R4 decoy receptor expression is correlated with high Gleason scores, prostate-specific antigen recurrence, and decreased survival in patients with prostate carcinoma. Urol Oncol 2007; 26:158-65. [PMID: 18312935 DOI: 10.1016/j.urolonc.2007.01.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 01/16/2007] [Accepted: 01/18/2007] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) has recently been investigated because of its ability to selectively kill cancer cells. Despite recent publications mainly focusing on TRAIL resistance in cancer cells, little is known about how TRAIL contributes to the carcinogenesis process. Because the expression patterns of TRAIL and its receptors in patients with prostate carcinoma have recently been reported, this study investigated the significance of TRAIL and TRAIL receptor expression in connection to serum prostate-specific antigen (PSA) and Gleason scoring. MATERIALS AND METHODS A total of 98 patients were included in the study. Gleason scores, PSA, TRAIL, and TRAIL receptor expressions were used for the comparison purposes. The Spearman rho correlation test was administered to reveal the correlations among the variants. The Kruskal Wallis-Mann Whitney U or Friedman-Wilcoxon signed ranks test determined the statistical significance between the pairs. Multinomial and/or multiple binary logistic regression analyses were deployed to test whether TRAIL markers were independent variables to predict the prognosis of prostate cancer. Kaplan-Meier and log-rank tests were used to determine the survival rates. RESULTS High-serum PSA levels were correlated with higher levels of TRAIL and TRAIL receptor expressions. Patients with high Gleason scores had higher levels of TRAIL-R4 decoy receptor expression but lower levels of TRAIL death ligand expression. CONCLUSIONS TRAIL-R4 decoy receptor expression is strongly correlated with PSA recurrence, which is suggestive of poor prognosis. High levels of TRAIL-R4 expression but low levels of TRAIL death ligand expression are connected to decreased survival.
Collapse
|
59
|
Kulkarni GS, Lockwood G, Evans A, Toi A, Trachtenberg J, Jewett MAS, Finelli A, Fleshner NE. Clinical predictors of gleason score upgrading. Cancer 2007; 109:2432-8. [PMID: 17497649 DOI: 10.1002/cncr.22712] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Brachytherapy, active surveillance, and watchful waiting are increasingly being offered to men with low-risk prostate cancer. However, many of these men harbor undetected high-grade disease (Gleason pattern > or =4). The ability to identify those individuals with occult high-grade disease may help guide treatment decisions in this patient cohort. METHODS The authors identified 175 cases of low-risk prostate cancer treated with radical prostatectomy. By using logistic regression analysis, 11 a priori-defined preoperative risk factors were evaluated for their ability to predict upgrading from Gleason 6 at biopsy to Gleason > or =7 at radical prostatectomy. An internally validated nomogram using all clinical variables was subsequently created to help physicians identify patients who had undetected high-grade disease. RESULTS A total of 60 (34%) patients were upgraded to high-grade disease. On multivariate analyses, both prostate-specific antigen (PSA) level (P = .02) and the level of pathologist expertise (P = .007) were predictive of upgrading. The predictive nomogram contained these variables plus age, digital rectal examination, transrectal ultrasound results, biopsy scheme applied (sextant vs extended), presence of prostatic intraepithelial neoplasia, prostate gland volume, and percentage of cancer in the biopsy. The nomogram provided acceptable discrimination (C statistic 0.71). CONCLUSIONS The authors identified significant predictors of upgrading for patients diagnosed with low-risk prostate cancer. A nomogram based on these study findings could help physicians further risk-stratify patients with low-risk prostate cancer before embarking on treatment. Caution should be exercised in recommending nonradical therapy to individuals with a high probability of undetected high-grade disease.
Collapse
Affiliation(s)
- Girish S Kulkarni
- Department of Surgery, Division of Urology, University Health Network, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | |
Collapse
|
60
|
Chun FKH, Karakiewicz PI, Briganti A, Walz J, Kattan MW, Huland H, Graefen M. A critical appraisal of logistic regression-based nomograms, artificial neural networks, classification and regression-tree models, look-up tables and risk-group stratification models for prostate cancer. BJU Int 2007; 99:794-800. [PMID: 17378842 DOI: 10.1111/j.1464-410x.2006.06694.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate several methods of predicting prostate cancer-related outcomes, i.e. nomograms, look-up tables, artificial neural networks (ANN), classification and regression tree (CART) analyses and risk-group stratification (RGS) models, all of which represent valid alternatives. METHODS We present four direct comparisons, where a nomogram was compared to either an ANN, a look-up table, a CART model or a RGS model. In all comparisons we assessed the predictive accuracy and performance characteristics of both models. RESULTS Nomograms have several advantages over ANN, look-up tables, CART and RGS models, the most fundamental being a higher predictive accuracy and better performance characteristics. CONCLUSION These results suggest that nomograms are more accurate and have better performance characteristics than their alternatives. However, ANN, look-up tables, CART analyses and RGS models all rely on methodologically sound and valid alternatives, which should not be abandoned.
Collapse
Affiliation(s)
- Felix K-H Chun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
| | | | | | | | | | | | | |
Collapse
|
61
|
Krejcarek SC, Chen MH, Renshaw AA, Loffredo M, Sussman B, D'Amico AV. Prediagnostic Prostate-Specific Antigen Velocity and Probability of Detecting High-Grade Prostate Cancer. Urology 2007; 69:515-9. [PMID: 17382156 DOI: 10.1016/j.urology.2006.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 09/11/2006] [Accepted: 11/16/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Men with high-grade prostate cancer experience a survival benefit when androgen suppression therapy is combined with radiotherapy (RT) compared with RT alone. We evaluated whether an association exists between the pretreatment prostate-specific antigen (PSA) velocity and high-grade prostate cancer at diagnosis, controlling for known predictors of high-grade disease. METHODS The study cohort consisted of 358 men with Stage T1c-T4 prostate cancer treated with external beam RT from 1989 to 2002. Univariate and multivariate logistic regression analyses were used to assess whether an association exists between the pretreatment PSA velocity, PSA level, age, clinical T stage, and Gleason score 4+3 or greater compared with Gleason score 3+4 or less prostate cancer. RESULTS Of the 358 men, 73 had a Gleason score of 4+3 or greater. The median PSA velocity was 2.71 ng/mL/yr (interquartile range 1.09 to 12.6) for men with a Gleason score of 4+3 or greater and 1.24 ng/mL/yr (interquartile range 0.71 to 3.37) for men with a Gleason score of 3+4 or less. All clinical covariates were significantly associated (P < or = 0.05) with a Gleason score of 4+3 or greater on univariate analysis. On multivariate analysis, the PSA velocity (odds ratio 1.06, 95% confidence interval 1.02 to 1.10, P = 0.004), age (odds ratio 1.07, 95% confidence interval 1.02 to 1.13, P = 0.008), and clinical T stage (odds ratio 2.17, 95% confidence interval 1.21 to 3.92, P = 0.01) were significantly associated with the detection of Gleason score 4+3 or greater prostate cancer. CONCLUSIONS The prediagnostic PSA velocity, patient age, and clinical T stage were significantly associated with high-grade prostate cancer at diagnosis. Because a biopsy Gleason score of 4+3 or greater is associated with a prostatectomy Gleason score of 7 or greater in the vast majority of cases, these parameters can identify men at high risk of harboring occult high-grade prostate cancer, permitting improved selection of RT fields and the use of androgen suppression therapy.
Collapse
Affiliation(s)
- Stephanie C Krejcarek
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | |
Collapse
|
62
|
Yu JH, Lee JW, Chang IH, Han JH, Han BK, Jeong SJ, Hong SK, Byun SS, Choe G, Lee SE. The Relationship of Prostate Volume and the Grade of Prostate Cancer. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.10.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ji Hyeong Yu
- Department of Urology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jeong Woo Lee
- Department of Urology, Seoul National University Hospital, Korea
| | - In Ho Chang
- KEPCO Medical Foundation Hanil General Hospital, Seoul, Korea
| | - Jun Hyun Han
- KEPCO Medical Foundation Hanil General Hospital, Seoul, Korea
| | - Byoung Kyu Han
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong-Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
63
|
Chun FKH, Briganti A, Shariat SF, Graefen M, Montorsi F, Erbersdobler A, Steuber T, Salonia A, Currlin E, Scattoni V, Friedrich MG, Schlomm T, Haese A, Michl U, Colombo R, Heinzer H, Valiquette L, Rigatti P, Roehrborn CG, Huland H, Karakiewicz PI. Significant upgrading affects a third of men diagnosed with prostate cancer: predictive nomogram and internal validation. BJU Int 2006; 98:329-34. [PMID: 16879673 DOI: 10.1111/j.1464-410x.2006.06262.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the rate of significant upgrading from biopsy to radical prostatectomy (RP) specimens in a contemporary cohort, and to develop a prognostic model capable of predicting the probability of significant upgrading, as previous reports indicate that up to 43% of men with low-grade prostate cancer at biopsy will be diagnosed with high-grade cancer at RP. PATIENTS AND METHODS The study cohort comprised 4789 men (median age 63 years, range 39-82) treated with RP, with available clinical stage, prostate-specific antigen levels, biopsy and RP Gleason sum values. These variables were used as predictors in multivariate logistic regression models (LRMs) addressing the rate of significant Gleason sum upgrading, defined as a Gleason sum increase either from < or = 6 to > or = 7 or from 7 to > or = 8 between the biopsy and RP specimens. Regression coefficients were used to develop and validate (200 bootstrap re-samples) a nomogram predicting significant biopsy Gleason sum upgrading. RESULTS Significant biopsy Gleason sum upgrading was recorded in 1349 (28.2%) patients. In multivariate LRMs, all predictors were highly significant (all P < 0.001). The bootstrap-corrected accuracy of the nomogram predicting the probability of significant Gleason sum upgrading between biopsy and RP specimens was 75.7%. CONCLUSION Our nomogram might prove highly useful when the possibility of a more aggressive Gleason variant could change the treatment options.
Collapse
Affiliation(s)
- Felix K-H Chun
- Department of Urology, University of Hamburg, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
64
|
Kulkarni GS, Al-Azab R, Lockwood G, Toi A, Evans A, Trachtenberg J, Jewett MAS, Finelli A, Fleshner NE. Evidence for a biopsy derived grade artifact among larger prostate glands. J Urol 2006; 175:505-9. [PMID: 16406982 DOI: 10.1016/s0022-5347(05)00236-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Indexed: 02/08/2023]
Abstract
PURPOSE The PCPT has demonstrated a higher incidence of high grade (Gleason pattern 4 or greater) prostate cancers among men randomized to finasteride. One plausible explanation for this finding is that tumor grade as assigned by TRUS guided biopsy is artifactually associated with prostate volume. MATERIALS AND METHODS We evaluated our institutional data set of TRUS guided biopsies in the last 3 years and identified 369 cases of prostate cancer that fit the criteria of PSA less than 10 ng/ml, biopsy at our center and RP at our center. We identified risk factors for Gleason pattern 4 or greater on biopsy and then on RP specimens from the same patients using univariate and multiple logistic regression analyses. Assessed covariates included patient age, PSA and TRUS volume. RESULTS Risk factors for Gleason pattern 4 or greater in the biopsy specimens included age (p = 0.01), hypoechoic lesions on TRUS (p <0.001) and TRUS volume (p = 0.008). However, among RP specimens TRUS volume (p = 0.60) became nonsignificant of Gleason pattern 4 or greater on multivariable analysis. Although prostate volume was a predictor for biopsy derived high grade disease it was not predictive of true histological grade. CONCLUSIONS These data suggest that simply having a larger prostate results in fewer high grade cancers diagnosed at biopsy. Prostatectomy results in the same men suggest sampling artifact, as the distribution of cancer grade is not associated with prostate volume. These findings provide evidence that the increase in higher grade tumors among men in the finasteride arm of PCPT may simply result from prostate volume reduction.
Collapse
Affiliation(s)
- Girish S Kulkarni
- Division of Urology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
65
|
Chun FKH, Steuber T, Erbersdobler A, Currlin E, Walz J, Schlomm T, Haese A, Heinzer H, McCormack M, Huland H, Graefen M, Karakiewicz PI. Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol 2005; 49:820-6. [PMID: 16439050 DOI: 10.1016/j.eururo.2005.11.007] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 11/10/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Previous reports indicate that as many as 43% of men with low grade PCa at biopsy will be diagnosed with high-grade PCa at RP. We explored the rate of upgrading from biopsy to RP specimen in our contemporary cohort, and developed a model capable of predicting the probability of biopsy Gleason sum upgrading. MATERIALS AND METHODS The study cohort consisted of 2982 men treated with RP, with available clinical stage, serum prostate specific antigen and biopsy Gleason scores. These clinical data were used as predictors in multivariate logistic regression models (LRM) addressing the rate of Gleason sum upgrading between biopsy and RP pathology. LRM regression coefficients were used to develop a nomogram predicting the probability of Gleason sum upgrading and was subjected to 200 bootstrap resamples for internal validation and to reduce overfit bias. RESULTS Overall, 875 patients were upgraded (29.3%). In multivariate LRMs, all predictors were highly significant (all p values <0.0001). Bootstrap-corrected predictive accuracy of the nomogram predicting the probability of Gleason sum upgrading between biopsy and RP was 0.804. CONCLUSION We developed a highly accurate clinical aid for treatment decision-making. It may prove useful when the possibility of a more aggressive Gleason variant may change the treatment options.
Collapse
Affiliation(s)
- Felix K-H Chun
- Department of Urology, University of Hamburg, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
66
|
Ferrer González F, Casas Duran F, Biete Solà A. Impacto de la edad y de la comorbilidad en la supervivencia y toxicidad del paciente con cáncer de próstata irradiado. Med Clin (Barc) 2005; 125:121-6. [PMID: 15989851 DOI: 10.1157/13076949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE We intended to assess the impact of age on radiation outcome in patients treated for prostate cancer with 2D planning radiation therapy in clinical practice at the Hospital Clínic of Barcelona Radiation Oncology Department. PATIENTS AND METHOD One hundred eighty three patients, treated from November 1993 to April 1999, were included. Median follow-up was 41.8 months and median age was 70 years old. Median dose to prostate was 70 Gy. Univariate (Kaplan-Meier with log rank test comparison) and multivariate analysis (Cox's regression models) were done to assess the effect of age on toxicity and to study prognostic factors for disease control, survival and radiation treatment toxicity. RESULTS Five years disease free survival probability was 61.94%, with an overall survival probability of 82.83%. Although comorbidity increased significantly with age, reduced overall survival by a factor of 0.4, from 94.85% to 78.55% at 5 years. No differences were seen with regard to age in acute or late toxicity. Five years toxicity free probability was 66.46%. CONCLUSIONS Comorbidities decrease life expectancy in prostate cancer patients treated with radiation. Age does not necessarily suppose an increased risk of late toxicity for selected patients.
Collapse
Affiliation(s)
- Ferran Ferrer González
- Institut d'Oncologia Radioteràpica, IMAS, Avda. Sant Josep de la Muntanya 12, 08024 Barcelona, Spain.
| | | | | |
Collapse
|
67
|
FitzGerald TJ, Simon E, Meyer J. Prostate carcinoma: opportunities for translational research. J Cell Biochem 2004; 91:433-42. [PMID: 14755675 DOI: 10.1002/jcb.10693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adenocarcinoma of the prostate continues to be a major health concern. Although modern screening techniques have increased the number of men presenting with early stage disease, a significant population of men will present with intermediate or advanced pathological risk factors for recurrence. There are defined limitations in outcome with traditional therapies including surgery, radiation therapy, and hormone manipulation. Patients with intermediate and high-risk factors for treatment failure are candidates for protocols using translational research strategies incorporated into studies currently in development. These strategies may be able to selectively treat expression products of tumor and thus be more selective in the target for treatment. Carefully designed studies using these translational strategies have great potential in improving clinical outcome, tumor kill, and normal tissue tolerance in the care of these patients.
Collapse
Affiliation(s)
- T J FitzGerald
- Department of Radiation Oncology, Worcester, Massachusetts 016555, USA.
| | | | | |
Collapse
|
68
|
Rogers CG, Khan MA, Craig Miller M, Veltri RW, Partin AW. Natural history of disease progression in patients who fail to achieve an undetectable prostate-specific antigen level after undergoing radical prostatectomy. Cancer 2004; 101:2549-56. [PMID: 15470681 DOI: 10.1002/cncr.20637] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To the authors' knowledge, the natural history of disease progression to distant metastasis is unknown in men who fail to achieve an undetectable prostate-specific antigen (PSA) level after radical retropubic prostatectomy (RRP),. The authors assessed the clinical outcome of men with a persistently detectable PSA level after RRP for clinically localized prostate carcinoma. METHODS Between 1989 and 2002, 160 men failed to achieve an undetectable PSA level (>/= 0.1 ng/mL) after undergoing RRP for clinically localized prostate carcinoma. No patient received adjuvant therapy before documented metastasis. The Kaplan-Meier method was used to estimate distant metastasis-free survival. Univariate and multivariate Cox proportional hazards regression was used to assess the ability of clinical and pathologic variables to predict distant metastasis-free survival. RESULTS The probability of distant metastasis-free survival at 3 years, 5 years, and 10 years was reported to be 68%, 49%, and 22%, respectively. Seventy-five men (47%) developed distant metastases after RRP (median time to metastases of 5.0 years; range, 0.5-13 years). The combination of RRP Gleason score, seminal vesicle status, and lymph node status resulted in 3 risk groups for the prediction of distant metastasis-free survival (hazards ratio [HR] = 1.6; P < 0.01). The slope of PSA changes approximately 3-12 months after RRP at a cutoff value >/= 0.05 was found to be even more predictive of distant metastasis-free survival (HR = 2.9; P < 0.01). CONCLUSIONS Many patients remained free of metastatic disease for an extended period despite failing to achieve an undetectable PSA level after undergoing RRP for clinically localized prostate carcinoma. However, other patients experienced rapid disease progression to distant metastasis. The authors defined clinical (PSA slope) and pathologic (Gleason score) prognostic variables to help identify those patients with a higher risk of developing distant metastasis after undergoing RRP.
Collapse
Affiliation(s)
- Craig G Rogers
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | | | | | | |
Collapse
|
69
|
Khan MA, Partin AW, Mangold LA, Epstein JI, Walsh PC. Probability of biochemical recurrence by analysis of pathologic stage, Gleason score, and margin status for localized prostate cancer. Urology 2003; 62:866-71. [PMID: 14624910 DOI: 10.1016/s0090-4295(03)00674-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Partin tables provide pretreatment information regarding the probability of various pathologic stages (eg, organ confined, extraprostatic extension, and seminal vesicle or lymph node involvement). Although the pathologic stage serves as an excellent surrogate for outcome after radical prostatectomy (RRP), many patients and physicians want to know how the predictions made from the Partin tables can be translated into long-term biochemical recurrence-free survival. In this work, we go beyond the pathologic outcomes predicted by the Partin nomograms to provide long-term biochemical recurrence-free estimates on the basis of the pathologic data obtained at RRP to help counsel patients after surgery for prostate cancer. METHODS The study group comprised 1955 men treated by one surgeon with RRP and pelvic lymph node dissection for clinically localized disease (1989 to 2001). The patients were followed up for at least 1 year postoperatively, and the disease-free survival rates were determined using Kaplan-Meier analysis. RESULTS The pathologic stages were as follows: organ confined in 57%, extraprostatic extension in 35%, seminal vesicle involvement in 4%, and lymph node involvement in 4%. The prostatectomy Gleason score distribution was as follows: 2 to 4 in 1%, 5 to 6 in 63%, 7 in 30%, and 8 to 10 in 6%. Overall, a positive surgical margin was present in 9.8%. On the basis of the prostatectomy Gleason score, pathologic stage, and surgical margin status, the probability of long-term biochemical recurrence-free survival was divided into four groups: excellent, good, moderate, and low. CONCLUSIONS These simple to use and explain risk groups can be used to predict long-term biochemical recurrence-free survival from pathologic stage data obtained at surgery or predicted from the Partin tables, along with surgical margin status and Gleason score information obtained at RRP.
Collapse
Affiliation(s)
- Masood A Khan
- Department of Urology, James Buchanan Brady Urological Institute and Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287-2101, USA
| | | | | | | | | |
Collapse
|
70
|
Abstract
Prostate cancer that extends beyond the confines of the prostatic gland on clinical and/or radiographic assessment, without evidence of lymph node or distant metastases, is regarded as locally advanced. The locally advanced prostate cancer patient population consists of a heterogeneous group of men, some of whom have tumors that may be amenable to primary curative intent with local definitive therapy associated with acceptable long-term cancer control rates. In order to optimally manage this group of patients, it is important to be able to recognize who is at a high risk of tumor recurrence after primary local therapy. In this brief review, we discuss the factors that contribute to the prediction of high risk in populations with locally advanced disease and the treatment options available.
Collapse
Affiliation(s)
- Masood A Khan
- James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | | |
Collapse
|
71
|
Lee AK, Schultz D, Renshaw AA, Richie JP, D'Amico AV. Optimizing patient selection for prostate monotherapy. Int J Radiat Oncol Biol Phys 2001; 49:673-7. [PMID: 11172948 DOI: 10.1016/s0360-3016(00)01421-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Patients at low risk for prostate-specific antigen (PSA) failure following definitive local therapy are those with PSA of 10 or less, biopsy Gleason Score of 6 or less, and 1992 American Joint Committee on Cancer (AJCC) clinical Stage T1c or T2a. However, low-risk patients managed with radical prostatectomy and found to have prostatectomy Gleason score > or = 3+4 have a less favorable PSA outcome when compared to patients with prostatectomy Gleason score < or = 3+3. This study was performed to determine whether the percentage of positive prostate biopsy cores could predict upgrading from a biopsy Gleason score of 6 or less to a prostatectomy Gleason score > or = 3+4 in low-risk patients to optimize selection for prostate only radiation therapy. METHODS AND MATERIALS Concordance testing of the biopsy Gleason score and the primary and secondary prostatectomy Gleason grades was performed in 427 prostate cancer patients treated with radical prostatectomy and at low risk for PSA failure. Logistic regression multivariable analysis was performed to test the ability of the established prognostic factors and the percentage of positive prostate biopsies (<34%, 34-50%, >50%) to predict for upgrading from biopsy Gleason score of 6 or less prostatectomy Gleason score > or = 3+4. PSA failure-free survival was reported using the actuarial method of Kaplan and Meier and comparisons were made using a log-rank test. RESULTS Twenty-nine percent of the 427 study patients were upgraded from a biopsy Gleason score of 6 or less to a prostatectomy Gleason score > or = 3+4. The presence of greater than 50% positive biopsies was the only significant factor for predicting the upgrading from biopsy Gleason score of 6 or less to prostatectomy Gleason score > or = 3+4 on logistic regression multivariable analysis with the variables treated as continuous and categorical. Specifically, upgrading occurred in 26% vs. 59% of patients with 50% or less vs. greater than 50% positive biopsies, respectively. This translated into a 5-year PSA failure-free survival which was significantly higher (92% vs. 62%, p = 0.00001) for men with 50% or less vs. greater than 50% positive prostate biopsies, respectively. CONCLUSION The presence of greater than 50% positive biopsies was associated with higher rates of pathologic upgrading which translated into lower 5-year PSA failure-free survival following radical prostatectomy (RP). Therefore, the percentage of positive biopsies may be useful in optimizing the selection of low-risk patients for prostate only radiation therapy such as external beam radiation or implant monotherapy.
Collapse
Affiliation(s)
- A K Lee
- Joint Center for Radiation Therapy, Harvard Medical School, 330 Brookline Avenue, 5th Floor, Boston, MA 02215, USA.
| | | | | | | | | |
Collapse
|