51
|
Lee MH, Lee S, Hong SK, Byun SS, Lee SE. Subclassification of pathologically organ-confined (pT2) prostate cancer does not significantly predict postoperative outcomes in Korean males. Investig Clin Urol 2019; 61:35-41. [PMID: 31942461 PMCID: PMC6946825 DOI: 10.4111/icu.2020.61.1.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/02/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose We evaluated the prognostic association of pT2 subclassification with the oncological outcomes in patients with prostate cancer (PCa) who underwent radical prostatectomy (RP) in South Korea. Materials and Methods We retrospectively reviewed 3,529 patients who underwent RP for pathologically organ-confined PCa between 2003 and 2017 at Seoul National University Bundang Hospital. We analyzed the differences in the rates of biochemical recurrence (BCR), overall survival (OS), and cancer-specific survival (CSS) between pT2 substages. Results According to the 2002 TNM staging system, 362 (15.3%) and 2,000 patients (84.5%) had T2a (involving one-half or less of a unilateral lobe) and T2c (involving bilateral lobes) diseases. Four patients (0.2%) had T2b (involving more than one-half of a unilateral lobe) disease and none of them developed BCR. The mean follow-up period was 8.4±3.7 years and 175 patients (7.4%) had BCR. On multivariable analysis, pT2 subclassification (pT2a/b vs. pT2c) was not a significant predictor of BCR (p=0.224) or OS (p=0.311). Biochemical disease-free survival (p=0.091), OS (p=0.502), and CSS (p=0.063) showed no significant difference between pT2 substages. Conclusions Our study revealed that the pT2 subclassification of PCa in Korean males provided no value for predicting BCR, OS, and CSS after RP, which agrees with recently reported results based on the updated 8th version of the American Joint Committee on Cancer (AJCC) TNM staging system.
Collapse
Affiliation(s)
- Min Ho Lee
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
52
|
Kir G, Arikan EA, Seneldir H, Ankarali H, Oznergiz S, Olgun ZC, Yildirim A. Determining the cut-off values of tumor diameter, degree of extraprostatic extension, and extent of surgical margin positivity with regard to biochemical recurrence of prostate cancer after radical prostatectomy. Ann Diagn Pathol 2019; 44:151431. [PMID: 31837592 DOI: 10.1016/j.anndiagpath.2019.151431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/02/2019] [Accepted: 09/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The pre-biopsy (bx) prostate-specific antigen (PSA) level, tumor volume/diameter, degree of extraprostatic extension (EPE), and extent of surgical margin positivity have been shown to be significant prognostic parameters of biochemical recurrence (BCR) after radical prostatectomy. The present study assessed the cut-off values of the pre-bx PSA level, maximum tumor diameter, radial and circumferential distances of EPE, and circumferential length of surgical margin (SM) positivity with regard to BCR. MATERIAL AND METHODS The study included 445 radical prostatectomy specimens, and the cut-off values of all parameters were determined using receiver operating characteristic curve analysis. RESULTS An ISUP grade group ≥ 3, radial distance of EPE >1 mm, and circumferential length of SM positivity ≥2 mm were identified as independent predictors of BCR after radical prostatectomy. The parameters that showed statistical significance in univariate analysis, such as pre-bx PSA level ≥ 7.20 ng/mL, tumor diameter ≥ 19.5 mm, presence of seminal vesicle invasion, and circumferential distance of EPE >3 mm, did not have independent prognostic values for BCR. CONCLUSIONS An ISUP grade group ≥ 3, radial distance of EPE >1 mm, and circumferential length of SM positivity ≥2 mm are predictors of BCR. Our findings might have significance in risk classification and adjuvant therapy consideration among patients with localized prostate cancer.
Collapse
Affiliation(s)
- Gozde Kir
- Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Evsen Apaydin Arikan
- Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Hatice Seneldir
- Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Handan Ankarali
- Department of Biostatistics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Seca Oznergiz
- Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Cagla Olgun
- Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
53
|
Vau N, Henriques V, Cheng L, Blanca A, Fonseca J, Montironi R, Cimadamore A, Lopez-Beltran A. Predicting biochemical recurrence after radical prostatectomy: the role of prognostic grade group and index tumor nodule. Hum Pathol 2019; 93:6-15. [DOI: 10.1016/j.humpath.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
|
54
|
Cimadamore A, Scarpelli M, Raspollini MR, Doria A, Galosi AB, Massari F, Di Nunno V, Cheng L, Lopez-Beltran A, Montironi R. Prostate cancer pathology: What has changed in the last 5 years. Urologia 2019; 87:3-10. [PMID: 31545701 DOI: 10.1177/0391560319876821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Prostate cancer is the most frequent non-cutaneous malignancy in men in the United States. In the last few years, many recommendations have been made available from the 2014 International Society of Urologic Pathology consensus conference, 2016 World Health Organization blue book and 2018 8th edition of American Joint Committee on Cancer Staging System. Here, we focus on four topics which are considered relevant on the basis of their common appearance in routine practice, clinical importance and 'need to improve communication between pathology reports and clinicians': prostate cancer classification, prostate cancer grading, prostate cancer staging, and current definition of clinically significant prostate cancer. Tissue biomarkers that can predict significant disease and/or upgrading and tissue-based genomics for the purpose of diagnosis and prognosis are mentioned briefly.
Collapse
Affiliation(s)
- Alessia Cimadamore
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy
| | | | - Andrea Doria
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy
| | - Andrea Benedetto Galosi
- Institute of Urology, Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy
| | - Francesco Massari
- Division of Oncology, Policlinico Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Di Nunno
- Division of Oncology, Policlinico Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Antonio Lopez-Beltran
- Department of Pathology and Surgery, Faculty of Medicine, University of Cordoba, Cordoba, Spain
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy
| |
Collapse
|
55
|
Kandori S, Kojima T, Nishiyama H. The updated points of TNM classification of urological cancers in the 8th edition of AJCC and UICC. Jpn J Clin Oncol 2019; 49:421-425. [PMID: 30844068 DOI: 10.1093/jjco/hyz017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/16/2019] [Accepted: 01/24/2019] [Indexed: 12/16/2022] Open
Abstract
The Tumor-Node-Metastasis (TNM) staging system, jointly developed by the American Joint Commission on Cancer (AJCC) and the Union for International Cancer Control (UICC), is widely employed in clinical practice and research on patients with cancer. The definitions of TNM classification have recently been changed, improving patient stratification for management and prognosis. As the feature of new editions, biomarkers which are necessary for the stratification of patients are included to adapt for personalized medicine. Although it would be ideal for the AJCC and UICC have identical TNM staging systems, there are some differences between these two publications. In this review, we introduce the significant changes and differences in the eighth edition of the AJCC and UICC TNM staging systems for urologic cancers and summarize the evidence supporting these changes.
Collapse
Affiliation(s)
- Shuya Kandori
- Department of Urology, Faculty of Medicine and Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Kojima
- Department of Urology, Faculty of Medicine and Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine and Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
56
|
Billis A, Freitas LLL, Costa LBE, Barreto IS, Magna LA, Matheus WE, Ferreira U. The TNM 8th edition: Validation of the proposal for organ - confined (pT2) prostate cancer. Int Braz J Urol 2019; 45:229-236. [PMID: 30648826 PMCID: PMC6541125 DOI: 10.1590/s1677-5538.ibju.2018.0338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/19/2018] [Indexed: 05/14/2023] Open
Abstract
Purpose: The 8th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ - confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change. Materials and Methods: Prostates were step - sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan - Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model. Results: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery. Conclusions: Pathologic sub - staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.
Collapse
Affiliation(s)
- Athanase Billis
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Leandro L L Freitas
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Larissa B E Costa
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Icleia S Barreto
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Luis A Magna
- Departamento de Genética Médica / Bioestatística da Faculdade de Ciências Médicas (Unicamp), Campinas, SP, Brasil
| | - Wagner E Matheus
- Departmento de Urologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Ubirajara Ferreira
- Departmento de Urologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| |
Collapse
|
57
|
Srigley JR, Delahunt B, Samaratunga H, Billis A, Cheng L, Clouston D, Evans A, Furusato B, Kench J, Leite K, MacLennan G, Moch H, Pan CC, Rioux-Leclercq N, Ro J, Shanks J, Shen S, Tsuzuki T, Varma M, Wheeler T, Yaxley J, Egevad L. Controversial issues in Gleason and International Society of Urological Pathology (ISUP) prostate cancer grading: proposed recommendations for international implementation. Pathology 2019; 51:463-473. [PMID: 31279442 DOI: 10.1016/j.pathol.2019.05.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/17/2022]
Abstract
The Gleason Grading system has been used for over 50 years to prognosticate and guide the treatment for patients with prostate cancer. At consensus conferences in 2005 and 2014 under the guidance of the International Society of Urological Pathology (ISUP), the system has undergone major modifications to reflect modern diagnostic and therapeutic practices. The 2014 consensus conference yielded recommendations regarding cribriform, mucinous, glomeruloid and intraductal patterns, the most significant of which was the removal of any cribriform pattern from Gleason grade 3. Furthermore, a Gleason score grouping system was endorsed which consisted of five grades where Gleason score 6 (3+3) was classified as grade 1 which better reflected the mostly indolent behaviour of these tumours. Another issue discussed at the meeting and subsequently endorsed was that in Gleason score 7 cases, the percentage pattern 4 should be recorded. This is especially important in situations where modern active surveillance protocols expand to include men with low volume pattern 4. While major progress was made at the conference, several issues were either not resolved or not discussed at all. Most of these items relate to details of assignment of Gleason score and ISUP grade in specific specimen types and grading scenarios. This detailed review looks at the 2014 ISUP conference results and subsequent literature from an international perspective and proposes several recommendations. The specific issues addressed are percentage pattern 4 in Gleason score 7 tumours, percentage patterns 4 and 5 or 4/5 in Gleason score 8-10 disease, minor (≤5%) high grade patterns when either 2 or 3 patterns are present, level of reporting (core, specimen, case), dealing with grade diversity among site (highest and composite scores) and reporting scores in radical prostatectomy specimens with multifocal disease. It is recognised that for many of these issues, a strong evidence base does not exist, and further research studies are required. The proposed recommendations mostly reflect consolidated expert opinion and they are classified as established if there was prior agreement by consensus and provisional if there was no previous agreement or if the item was not discussed at prior consensus conferences. For some items there are reporting options that reflect the local requirements and diverse practice models of the international urological pathology community. The proposed recommendations provide a framework for discussion at future consensus meetings.
Collapse
Affiliation(s)
- John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | | | - Athanase Billis
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (Unicamp) Campinas, SP, Brazil
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Andrew Evans
- University Health Network, Laboratory Medicine Program, Toronto General Hospital, Toronto, ON, Canada
| | - Bungo Furusato
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences and Cancer Genomics Unit, Clinical Genomics Center, Nagasaki University Hospital, Sakamoto, Nagasaki, Japan
| | - James Kench
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Katia Leite
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gregory MacLennan
- Department of Pathology and Urology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Holger Moch
- University and University Hospital Zurich, Department of Pathology and Molecular Pathology, Zurich, Switzerland
| | - Chin-Chen Pan
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Jae Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Jonathan Shanks
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Steven Shen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, School of Medicine, Nagakute, Japan
| | - Murali Varma
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - Thomas Wheeler
- Department of Pathology and Laboratory Medicine, Baylor St. Luke's Medical Center and Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - John Yaxley
- Department of Medicine, University of Queensland, Wesley Urology Clinic, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Lars Egevad
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
58
|
[Prostate pathology recommendations from the Uropathology working group of the Spanish Society of Pathology]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 52:167-177. [PMID: 31213258 DOI: 10.1016/j.patol.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/24/2022]
Abstract
These guidelines from the uropathology working group of the Spanish Society of Pathology (SEAP) are based on the European and ISUP 2015 recommendations and those of the College of American Pathologists, as well as the latest WHO 2016, TNM (AJCC) 2017 classifications. They include recommendations for specimen sampling, macro- and microscopic examination and immunohistochemistry. Gleason patterns are specified: Gleason pattern 3 includes hyperplastic, atrophic and microcystic glands, while pattern 4 includes all cribriform or glomeruloid glands. The Gleason score in prostatectomy specimens may change; if a tertiary pattern occurs in more than 5% of the tumour, it becomes a secondary pattern. In both biopsies and prostatectomy specimens, if the Gleason score is 7, the percentage of pattern 4 should be stated. Gleason scoring in tumor variants and special situations should also be specified. These recommendations should be adapted according to the resources available.
Collapse
|
59
|
PTEN Expression in Prostate Cancer: Relationship With Clinicopathologic Features and Multiparametric MRI Findings. AJR Am J Roentgenol 2019; 212:1206-1214. [PMID: 30888866 DOI: 10.2214/ajr.18.20743] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE. The objective of our study was to investigate whether phosphatase and tensin homolog (PTEN) expression is associated with clinicopathologic features and multiparametric MRI findings in prostate cancer. MATERIALS AND METHODS. Forty-three patients with prostate cancer who underwent radical prostatectomy were included. Index tumor was identified on pretreatment MRI and delineated in the area that correlated best with histopathology results. The apparent diffusion coefficient (ADC) from DWI and pharmacokinetic parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) using the extended Tofts model (Ktrans, kep, ve, and vp) within the tumor were estimated. The following clinicopathologic parameters were assessed: pretreatment serum levels of prostate-specific antigen, disseminated tumor cell status, age, Gleason score, tumor size, extraprostatic extension (EPE), tumor location, and lymph node metastases. Gene expression profiles were acquired in biopsies from the tumor using bead arrays, and validated using reverse transcription quantitative polymerase chain reaction (RT-qPCR) on a different part of the biopsy. RESULTS. Based on bead arrays (p = 0.006) and RT-qPCR (p = 0.03) data, a significantly lower ADC was found in tumors with low PTEN expression. Moreover, PTEN expression was negatively associated with lymph node metastases (bead arrays, p = 0.008; RT-qPCR, p < 0.001). A weak but significant association between PTEN expression, EPE (p = 0.048), and Gleason score (p = 0.028) was revealed on bead arrays. ADC was negatively correlated with Gleason score (p = 0.001) and tumor size (p = 0.023). No association among DCE parameters, PTEN expression, and clinicopathologic features was found. CONCLUSION. ADC derived from DWI may be useful in selecting patients with potentially aggressive tumor caused by PTEN deficiency.
Collapse
|
60
|
Dataset for the reporting of prostate carcinoma in radical prostatectomy specimens: updated recommendations from the International Collaboration on Cancer Reporting. Virchows Arch 2019; 475:263-277. [DOI: 10.1007/s00428-019-02574-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 01/08/2023]
|
61
|
Casale P, Saita A, Lazzeri M, Lughezzani G, Hurle R, Fasulo V, Mondellini GM, Paciotti M, Domanico L, Lista G, Maffei D, Monari M, Motta L, Bini V, Ceriotti F, Guazzoni G, Buffi NM. p2PSA for predicting biochemical recurrence of prostate cancer earlier than total prostate-specific antigen after radical prostatectomy: an observational prospective cohort study. MINERVA UROL NEFROL 2019; 71:273-279. [DOI: 10.23736/s0393-2249.19.03279-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
62
|
Ito Y, Udo K, Vertosick EA, Sjoberg DD, Vickers AJ, Al-Ahmadie HA, Chen YB, Gopalan A, Sirintrapun SJ, Tickoo SK, Scardino PT, Eastham JA, Reuter VE, Fine SW. Clinical Usefulness of Prostate and Tumor Volume Related Parameters following Radical Prostatectomy for Localized Prostate Cancer. J Urol 2019; 201:535-540. [PMID: 30300632 DOI: 10.1016/j.juro.2018.09.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE We evaluated whether the prediction of biochemical recurrence after radical prostatectomy is enhanced by any of 6 parameters, including prostate volume, total tumor volume, high grade total tumor volume, the ratio of high grade total tumor volume to total tumor volume, the ratio of total tumor volume to prostate volume and/or the ratio of high grade total tumor volume to prostate volume. MATERIALS AND METHODS A total of 1,261 patients who underwent radical prostatectomy during a 3-year period had tumor maps constructed with the Gleason pattern denoted as low-3 or high-4 or 5 and volumetric data generated using commercially available software. Univariate Cox regression models were used to assess whether each volume related parameter was associated with biochemical recurrence after radical prostatectomy. A multivariable Cox regression base model (age, prostate specific antigen, Gleason score/grade group, pathological stage and margin status) was compared with 6 additional models (base model plus each volume related parameter) to evaluate enhancement in predictive accuracy. Decision curve analysis was performed to determine the clinical utility of parameters that enhanced predictive accuracy. RESULTS On univariate analysis each parameter was significantly associated with biochemical recurrence except prostate volume. Predictive accuracy of the multivariable base model was high (c-index = 0.861). Adding volume related parameters marginally enhanced discrimination. Decision curve analysis failed to show added benefit even for high grade total tumor volume/total tumor volume, which was the parameter with the highest discriminative improvement. CONCLUSIONS Tumor volume related parameters are significantly associated with radical prostatectomy but do not add important discrimination to standard clinicopathological variables for radical prostatectomy prediction or provide benefit across a range of clinically relevant decision thresholds. Volume related measurement is not warranted in routine pathological evaluation and reporting.
Collapse
Affiliation(s)
- Yujiro Ito
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kazuma Udo
- Urology Service, Department of Surgery, 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
| | - 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
| | - Hikmat A Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ying-Bei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anuradha Gopalan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - S Joseph Sirintrapun
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Satish K Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter T Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
63
|
Compérat E, Varinot J, Eymerit C, Paner GP, Hansel DE, Amin MB, Moroch J. Comparaison des classifications TNM des 8es éditions de l’UICC et de l’AJCC en uropathologie. Ann Pathol 2019; 39:158-166. [DOI: 10.1016/j.annpat.2018.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 11/27/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022]
|
64
|
Paner GP, Gandhi J, Choy B, Amin MB. Essential Updates in Grading, Morphotyping, Reporting, and Staging of Prostate Carcinoma for General Surgical Pathologists. Arch Pathol Lab Med 2019; 143:550-564. [PMID: 30865487 DOI: 10.5858/arpa.2018-0334-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Within this decade, several important updates in prostate cancer have been presented through expert international consensus conferences and influential publications of tumor classification and staging. OBJECTIVE.— To present key updates in prostate carcinoma. DATA SOURCES.— The study comprised a review of literature and our experience from routine and consultation practices. CONCLUSIONS.— Grade groups, a compression of the Gleason system into clinically meaningful groups relevant in this era of active surveillance and multidisciplinary care management for prostate cancer, have been introduced. Refinements in the Gleason patterns notably result in the contemporarily defined Gleason score 6 cancers having a virtually indolent behavior. Grading of tertiary and minor higher-grade patterns in radical prostatectomy has been clarified. A new classification for prostatic neuroendocrine tumors has been promulgated, and intraductal, microcystic, and pleomorphic giant cell carcinomas have been officially recognized. Reporting the percentage of Gleason pattern 4 in Gleason score 7 cancers has been recommended, and data on the enhanced risk for worse prognosis of cribriform pattern are emerging. In reporting biopsies for active surveillance criteria-based protocols, we outline approaches in special situations, including variances in sampling or submission. The 8th American Joint Commission on Cancer TNM staging for prostate cancer has eliminated pT2 subcategorization and stresses the importance of nonanatomic factors in stage groupings and outcome prediction. As the clinical and pathology practices for prostate cancer continue to evolve, it is of utmost importance that surgical pathologists become fully aware of the new changes and challenges that impact their evaluation of prostatic specimens.
Collapse
Affiliation(s)
| | | | | | - Mahul B Amin
- From the Departments of Pathology (Drs Paner and Choy) and Surgery (Urology) (Dr Paner), University of Chicago, Chicago, Illinois; and the Departments of Pathology and Laboratory Medicine (Drs Gandhi and Amin) and Urology (Dr Amin), University of Tennessee Health Science Center, Memphis
| |
Collapse
|
65
|
Simopoulos DN, Sisk AE, Priester A, Felker ER, Kwan L, Delfin MK, Reiter RE, Marks LS. Cancer core length from targeted biopsy: an index of prostate cancer volume and pathological stage. BJU Int 2019; 124:275-281. [PMID: 30694605 DOI: 10.1111/bju.14691] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To study the relationship of maximum cancer core length (MCCL), on targeted biopsy (TB) of magnetic resonance imaging (MRI)-visible index lesions, to volume of that tumour found at radical prostatectomy (RP). PATIENTS AND METHODS In all, 205 men undergoing fusion biopsy and RP were divided into two groups: 136 in whom the MCCL came from an index MRI-visible lesion (TB) and 69 in whom MCCL came from a non-targeted lesion (non-targeted biopsy [NTB]). MRI was 3-T multi-parametric and biopsy was via MRI-ultrasonography fusion. RESULTS In the TB group, MCCL correlated with volume of clinically significant index tumours (ρ = 0.44-0.60, P < 0.01). The correlation was similar for first and repeat biopsy and for transition and peripheral zone lesions (ρ = 0.42-0.49, P < 0.01). No correlations were found in the NTB group. TB MCCL (6-10 and >10 mm) and MRI lesion diameter (>20 mm) were independently associated with tumour volume. TB MCCLs >10 mm and Gleason scores >7 were each associated with pathological T3 disease (odds ratios 5.73 and 5.04, respectively), but MRI lesion diameter lesion was not. CONCLUSIONS MCCL on a TB from an MRI-visible lesion is an independent predictor of both cancer volume and pathological stage. This relationship does not exist for MCCL from a NTB core. Quantifying CCL on MRI-TBs may have a value, not previously described, to risk-stratify patients with prostate cancer before treatment.
Collapse
Affiliation(s)
- Demetrios N Simopoulos
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Anthony E Sisk
- Department of Pathology, David Geffen School of Medicine, UCLA, Los Angeles, CA,, USA
| | - Alan Priester
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Ely R Felker
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Merdie K Delfin
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| |
Collapse
|
66
|
Giannarini G, Girometti R, Crestani A, Rossanese M, Calandriello M, Cereser L, Bednarova S, Battistella C, Sioletic S, Zuiani C, Valotto C, Ficarra V. A Prospective Accuracy Study of Prostate Imaging Reporting and Data System Version 2 on Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer With Whole-mount Pathology. Urology 2019; 123:191-197. [DOI: 10.1016/j.urology.2018.07.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 11/28/2022]
|
67
|
Rozet F, Hennequin C, Beauval JB, Beuzeboc P, Cormier L, Fromont-Hankard G, Mongiat-Artus P, Ploussard G, Mathieu R, Brureau L, Ouzzane A, Azria D, Brenot-Rossi I, Cancel-Tassin G, Cussenot O, Rebillard X, Lebret T, Soulié M, Penna RR, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : cancer de la prostate French ccAFU guidelines – Update 2018–2020: Prostate cancer. Prog Urol 2018; 28:S79-S130. [PMID: 30392712 DOI: 10.1016/j.purol.2018.08.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 12/31/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.007.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the DOI:10.1016/j.purol.2019.01.007.
That newer version of the text should be used when citing the article.
Collapse
Affiliation(s)
- F Rozet
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, institut mutualiste Montsouris, université René-Descartes, 42, boulevard Jourdan, 75674, Paris, France.
| | - C Hennequin
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de radiothérapie, Saint-Louis Hospital, AP-HP, 75010, Paris, France
| | - J-B Beauval
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, oncologie médicale, institut universitaire du cancer Toulouse-Oncopole, CHU Rangueil, 31100, Toulouse, France
| | - P Beuzeboc
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Foch, 92150, Suresnes, France
| | - L Cormier
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU François-Mitterrand, 21000, Dijon, France
| | - G Fromont-Hankard
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; CHU de Tours, 2, boulevard Tonnellé, 37000, Tours, France
| | - P Mongiat-Artus
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, Paris cedex 10, France
| | - G Ploussard
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, clinique La Croix du Sud-Saint-Jean Languedoc, institut universitaire du cancer, 31100, Toulouse, France
| | - R Mathieu
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital de Rennes, 2, rue Henri-le-Guilloux, 35033, Rennes cedex 9, France
| | - L Brureau
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Inserm, U1085, IRSET, 97145 Pointe-à-Pitre, Guadeloupe
| | - A Ouzzane
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000, Lille, France
| | - D Azria
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Inserm U1194, ICM, université de Montpellier, 34298, Montpellier, France
| | - I Brenot-Rossi
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - G Cancel-Tassin
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; GRC no 5 ONCOTYPE-URO, institut universitaire de cancérologie, Sorbonne université, 75020, Paris, France
| | - O Cussenot
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Tenon, AP-HP, Sorbonne université, 75020, Paris, France
| | - X Rebillard
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, clinique mutualiste Beau-Soleil, 119, avenue de Lodève, 34070, Montpellier, France
| | - T Lebret
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Foch, 92150, Suresnes, France
| | - M Soulié
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre hospitalier universitaire Rangueil, 31059, Toulouse, France
| | - R Renard Penna
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; GRC no 5 ONCOTYPE-URO, institut universitaire de cancérologie, Sorbonne université, 75020, Paris, France; Service de radiologie, hôpital Tenon, AP-HP, 75020, Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique des hôpitaux de Paris (AP-HP), 75015, Paris, France
| |
Collapse
|
68
|
Rozet F, Hennequin C, Beauval JB, Beuzeboc P, Cormier L, Fromont-Hankard G, Mongiat-Artus P, Ploussard G, Mathieu R, Brureau L, Ouzzane A, Azria D, Brenot-Rossi I, Cancel-Tassin G, Cussenot O, Rebillard X, Lebret T, Soulié M, Renard Penna R, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : cancer de la prostate. Prog Urol 2018; 28 Suppl 1:R81-R132. [DOI: 10.1016/j.purol.2019.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 01/02/2023]
|
69
|
Donato P, Roberts MJ, Morton A, Kyle S, Coughlin G, Esler R, Dunglison N, Gardiner RA, Yaxley J. Improved specificity with 68Ga PSMA PET/CT to detect clinically significant lesions “invisible” on multiparametric MRI of the prostate: a single institution comparative analysis with radical prostatectomy histology. Eur J Nucl Med Mol Imaging 2018; 46:20-30. [DOI: 10.1007/s00259-018-4160-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/05/2018] [Indexed: 01/10/2023]
|
70
|
Evolution in Prostate Cancer Staging: Pathology Updates From AJCC 8th Edition and Opportunities That Remain. Adv Anat Pathol 2018; 25:327-332. [PMID: 29870405 DOI: 10.1097/pap.0000000000000200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The Tumor-Nodes-Metastasis system at the core of prognostic staging has been recently updated in the American Joint Committee on Cancer (AJCC) 8th edition, published in 2016. For prostate cancer, significant changes in staging of organ-confined disease, inclusion of a new grade grouping, and provision of levels of evidence for these modifications are part of what differentiates the 8th edition AJCC from prior iterations. Herein, the rationale underlying these changes is detailed. In addition, data elements not well represented in the present system are highlighted as opportunities for fresh study that may impact future AJCC classifications.
Collapse
|
71
|
Hompland T, Hole KH, Ragnum HB, Aarnes EK, Vlatkovic L, Lie AK, Patzke S, Brennhovd B, Seierstad T, Lyng H. Combined MR Imaging of Oxygen Consumption and Supply Reveals Tumor Hypoxia and Aggressiveness in Prostate Cancer Patients. Cancer Res 2018; 78:4774-4785. [DOI: 10.1158/0008-5472.can-17-3806] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/14/2018] [Accepted: 06/20/2018] [Indexed: 11/16/2022]
|
72
|
Martin-Malburet A, Marcq G, Leroy X, Guiffart P, Fantoni JC, Flamand V, Villers A, Puech P, Ouzzane A. [Pathology findings after radical prostatectomy for prostate cancer in patients eligible for active surveillance: Contribution of multiparametric MRI to treatment decision]. Prog Urol 2018; 28:425-433. [PMID: 29789235 DOI: 10.1016/j.purol.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 02/21/2018] [Accepted: 03/28/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To analyze, in patients with prostate cancer (PC) potentially eligible for active surveillance (AS), whether multiparametric-MRI (mp-MRI) predicts presence of clinically significant cancer on radical prostatectomy (RP) specimen. METHODS We identified 77 men with PC eligible for AS (PSA≤15ng/mL, stage≤T2a, Gleason score≤6, up to 3 positive cores, maximal cancer core length≤5mm) who underwent RP between 01/2008 and 08/2015. All patients had prebiopsy mp-MRI followed by systematic±targeted biopsies. For each patient, the likelihood of the presence of cancer on mp-MRI was assigned using Likert scale (1 to 5). The predictive factors for the presence of significant cancer on RP specimen (Gleason score≥7 and/or tumoral maximal diameter>10mm) were evaluated using logistic regression. RESULTS Median age was 61 and median PSA was 6.7ng/mL. Overall, 49 (64%) patients had a positive mp-MRI (score≥3). Clinically significant cancer on RP specimen was found in 45 (58%) patients (69% in MRI-positive patients vs 39% in MRI-negative patients). In multivariate analysis, a positive MRI was a predictive factor for the presence of significant cancer on the surgical specimen (OR=3.0; CI95% [1.01-8.88]; P=0.04), as was age (OR=1.17; CI95% [1.05-1.31]; P=0.004) and PSAD (OR=1.10; CI95% [1.01-1.20]; P=0.02). CONCLUSION Mp-MRI is a useful exam for selecting patients eligible for AS even if the situation remains unclear after prostate biopsies including targeted biopsies. Upon confirmation by further studies, mp-MRI should be considered as an independent criterion before entering an AS program. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- A Martin-Malburet
- Service d'urologie, hôpital Claude Huriez, CHRU Lille, rue Michel Polonovski, 59000 Lille, France.
| | - G Marcq
- Service d'urologie, hôpital Claude Huriez, CHRU Lille, rue Michel Polonovski, 59000 Lille, France
| | - X Leroy
- Service d'anatomopathologie, CHRU Lille, 59800 Lille, France
| | - P Guiffart
- Service d'urologie, hôpital Claude Huriez, CHRU Lille, rue Michel Polonovski, 59000 Lille, France
| | - J-C Fantoni
- Service d'urologie, hôpital Claude Huriez, CHRU Lille, rue Michel Polonovski, 59000 Lille, France
| | - V Flamand
- Service d'urologie, hôpital Claude Huriez, CHRU Lille, rue Michel Polonovski, 59000 Lille, France
| | - A Villers
- Service d'urologie, hôpital Claude Huriez, CHRU Lille, rue Michel Polonovski, 59000 Lille, France
| | - P Puech
- Service d'uro-radiologie, hôpital Claude Huriez, CHRU Lille, 59800 Lille, France
| | - A Ouzzane
- Service d'urologie, hôpital Claude Huriez, CHRU Lille, rue Michel Polonovski, 59000 Lille, France
| |
Collapse
|
73
|
Paner GP, Stadler WM, Hansel DE, Montironi R, Lin DW, Amin MB. Updates in the Eighth Edition of the Tumor-Node-Metastasis Staging Classification for Urologic Cancers. Eur Urol 2018; 73:560-569. [DOI: 10.1016/j.eururo.2017.12.018] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/14/2017] [Indexed: 12/23/2022]
|
74
|
Xiao WJ, Zhu Y, Zhu Y, Dai B, Ye DW. Evaluation of clinical staging of the American Joint Committee on Cancer (eighth edition) for prostate cancer. World J Urol 2018; 36:769-774. [PMID: 29372356 DOI: 10.1007/s00345-018-2183-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the eighth edition of the American Joint Committee on Cancer (AJCC) for clinical staging of prostate cancer based upon Surveillance, Epidemiology and, End Results (SEER) database. MATERIALS AND METHODS Patients diagnosed as prostate adenocarcinoma during 2004-2009 without any surgical treatment to the primary site were selected from the SEER registry. Excluded were cases with incomplete or unavailable staging, PSA and Gleason score information. RESULTS A total of 144,443 cases were identified. The median follow-up time was 84 months. The median age at diagnosis was 69 years, and median PSA was 7 ng/ml. CSS at 10th years was 96.2% for cT2a and 86.2% for cT2b/2c, respectively. The survival differences between clinical stage cT2a and cT2b/2c still had statistical significance (P < 0.001). For patients with grade group 1, there was no statistically significant difference for CCS between the cT2a and cT1 (P = 0.310), and between the subgroup of cT1/cT2a with 10 ng/ml ≤ PSA < 20 ng/ml and the subgroup of cT2b/2c with PSA < 20 ng/ml (P = 0.126), respectively. The CSS of IIIA (T1/2 with PSA ≥ 20 ng/ml) was less than IIC (P < 0.001), which has worst prognosis within stage I/II. The prognosis of T1/2 stage with Gleason score grade group 5 and PSA < 20 ng/ml was not only worse than AJCC IIC (P < 0.001) but also worse than AJCC IIIB (P < 0.001). CONCLUSION It is necessary to maintain a three-tier system to subdivide T2 disease clinically. For patients with grade group 1, cT2a and cT1 could merge into one group. Organ-confined disease with PSA ≥ 20 ng/ml or grade group 5 should be separated from stage II.
Collapse
Affiliation(s)
- Wen-Jun Xiao
- Department of Urology, Fudan University Shanghai Cancer Centre, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
| | - Yu Zhu
- Department of Urology, Fudan University Shanghai Cancer Centre, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Centre, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Centre, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Centre, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.
| |
Collapse
|
75
|
Nguyen DP, Vertosick EA, Sharma V, Corradi RB, Vilaseca A, Takeda T, Sjoberg DD, Benfante N, Fine SW, Reuter VE, Scardino PT, Eastham JA, Karnes RJ, Touijer KA. Does Subclassification of Pathologically Organ Confined (pT2) Prostate Cancer Provide Prognostic Discrimination of Outcomes after Radical Prostatectomy? J Urol 2018; 199:1502-1509. [PMID: 29307681 DOI: 10.1016/j.juro.2017.12.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE We tested the latest update in the prostate cancer staging system by assessing the prognostic association of pT2 subclassification with the probability of survival related outcomes in patients who underwent radical prostatectomy. MATERIALS AND METHODS We retrospectively analyzed the records of a total of 15,305 patients who underwent radical prostatectomy at 2 referral centers between 1985 and 2016, and had pT2 disease at the final pathological evaluation. Descriptive statistics were used to compare baseline data stratified by pT2 substages (pT2a/b vs pT2c). Cox regression models were adjusted for institution analyzed differences in the rate of biochemical recurrence, metastasis, cancer specific death and overall mortality. Multivariable Cox regression models were used to evaluate the predictive value of pT2 subclassification for survival, including the linear predictor from the Stephenson nomogram. RESULTS Prostate specific antigen levels and Gleason score differed significantly between the pT2 substages (each p <0.0001). At a median followup of 6.0 years (IQR 3.3-10.1) 2,083 patients had biochemical recurrence, 161 had metastases, 43 had died of prostate cancer and 1,032 had died of another cause. On univariate analysis the pT2 subclassification was significantly associated with biochemical recurrence (p = 0.001) and distant metastasis (p = 0.033) but not with cancer specific death (p = 0.6) or overall mortality (p = 0.3). Multivariable analysis showed no evidence of a significant association between the pT2 subclassification and biochemical recurrence (p = 0.4) or distant metastasis (p = 0.6). Multivariable analysis of cancer specific death and overall mortality was omitted due to lack of significance on univariate analysis. CONCLUSIONS Subclassification of pT2 prostate cancer is not a prognostic indicator of survival related outcomes after radical prostatectomy. Our results validate the elimination of pT2 substages in the updated staging system.
Collapse
Affiliation(s)
- Daniel P Nguyen
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, University of Bern, Bern, Switzerland
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Renato B Corradi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Mario Penna Cancer Institute, Belo Horizonte, Brazil
| | - Antoni Vilaseca
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Urology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Toshikazu Takeda
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Keio University School of Medicine, Tokyo, Japan
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Peter T Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | | | - Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| |
Collapse
|
76
|
Grignon DJ. Prostate cancer reporting and staging: needle biopsy and radical prostatectomy specimens. Mod Pathol 2018; 31:S96-109. [PMID: 29297497 DOI: 10.1038/modpathol.2017.167] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/10/2017] [Accepted: 10/14/2017] [Indexed: 12/19/2022]
Abstract
Prostatic adenocarcinoma remains the most common cancer affecting men. A substantial majority of patients have the diagnosis made on thin needle biopsies, most often in the absence of a palpable abnormality. Treatment choices ranging from surveillance to radical prostatectomy or radiation therapy are largely driven by the pathologic findings in the biopsy specimen. The first part of this review focuses on important morphologic parameters in needle biopsy specimens that are not covered in the accompanying articles. This includes tumor quantification as well as other parameters such a extraprostatic extension, seminal vesicle invasion, perineural invasion, and lymphovascular invasion. For those men who undergo radical prostatectomy, pathologic stage and other parameters are critical in prognostication and in determining the appropriateness of adjuvant therapy. Staging parameters, including extraprostatic extension, seminal vesicle invasion, and lymph node status are discussed here. Surgical margin status is also an important parameter and definitions and reporting of this feature are detailed. Throughout the article the current reporting guidelines published by the College of American Pathologists and the International Collaboration on Cancer Reporting are highlighted.
Collapse
Affiliation(s)
- David J Grignon
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, IUH Pathology Laboratory, Indianapolis, IN, USA
| |
Collapse
|
77
|
Schoots IG, van der Kwast TH. MR Imaging in Prostate Tumor Volume Assessment: How Accurate? ACTIVE SURVEILLANCE FOR LOCALIZED PROSTATE CANCER 2018. [DOI: 10.1007/978-3-319-62710-6_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
78
|
Egevad L, Delahunt B, Kristiansen G, Samaratunga H, Varma M. Contemporary prognostic indicators for prostate cancer incorporating International Society of Urological Pathology recommendations. Pathology 2018; 50:60-73. [DOI: 10.1016/j.pathol.2017.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/28/2017] [Indexed: 12/21/2022]
|
79
|
Bertero L, Massa F, Metovic J, Zanetti R, Castellano I, Ricardi U, Papotti M, Cassoni P. Eighth Edition of the UICC Classification of Malignant Tumours: an overview of the changes in the pathological TNM classification criteria-What has changed and why? Virchows Arch 2017; 472:519-531. [PMID: 29209757 DOI: 10.1007/s00428-017-2276-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/02/2017] [Accepted: 11/21/2017] [Indexed: 02/07/2023]
Abstract
The TNM classification of malignant tumours is a mainstay tool in clinical practice and research for prognostic assessment of patients, treatment allocation and trial enrolment, as well as for epidemiological studies and data collection by cancer registries worldwide. Pathological TNM (pTNM) represents the pathological classification of a tumor, assigned after surgical resection or adequate sampling by biopsy, and periodical updates to the relative classification criteria are necessary to preserve its clinical relevance by integrating newly reported data. A structured approach has been put in place to fulfil this need and, based upon this process, the Eighth Edition of Union for International Cancer Control (UICC) TNM Classification of Malignant Tumours has been published, introducing many significant changes, including novel classification criteria for specific tumour types. In this review, we aim to describe the major changes introduced in the pTNM classification criteria and to summarize the evidence supporting these changes.
Collapse
Affiliation(s)
- Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza Hospital, Via Santena 7, 10126, Turin, Italy.
| | - Federica Massa
- Pathology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Santena 7, 10126, Turin, Italy
| | - Jasna Metovic
- Pathology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Santena 7, 10126, Turin, Italy
| | - Roberto Zanetti
- Piedmont Cancer Registry, CPO - Centre for Cancer Prevention, Via San Massimo 24, 10123, Turin, Italy
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza Hospital, Via Santena 7, 10126, Turin, Italy
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Genova 3, 10126, Turin, Italy.,Italian National Committee, Union for International Cancer Control (UICC) - TNM, Turin, Italy
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Santena 7, 10126, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza Hospital, Via Santena 7, 10126, Turin, Italy.,Italian National Committee, Union for International Cancer Control (UICC) - TNM, Turin, Italy
| |
Collapse
|
80
|
Bhindi B, Karnes RJ, Rangel LJ, Mason RJ, Gettman MT, Frank I, Tollefson MK, Lin DW, Thompson RH, Boorjian SA. Independent Validation of the American Joint Committee on Cancer 8th Edition Prostate Cancer Staging Classification. J Urol 2017; 198:1286-1294. [DOI: 10.1016/j.juro.2017.06.085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Bimal Bhindi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Ross J. Mason
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel W. Lin
- Department of Urology, University of Washington, Seattle, Washington
| | | | | |
Collapse
|
81
|
Billis A, Freitas LLL, Costa LBE, Angelis CM, Carvalho KR, Magna LA, Ferreira U. Does index tumor predominant location influence prognostic factors in radical prostatectomies? Int Braz J Urol 2017; 43:686-697. [PMID: 28379672 PMCID: PMC5557445 DOI: 10.1590/s1677-5538.ibju.2016.0335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/01/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To find any influence on prognostic factors of index tumor according to predominant location. MATERIALS AND METHODS Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (anterolateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model. RESULTS Index tumors with predominant posterior location were significantly associated with higher total tumor extent, needle and radical prostatectomy Gleason score, positive lymph nodes and preoperative prostate-specific antigen. Index tumors with predominant basal location were significantly associated with higher preoperative prostate-specific antigen, pathological stage higher than pT2, extra-prostatic extension, and seminal vesicle invasion. Index tumors with predominant basal location were significantly associated with time to biochemical recurrence in Kaplan-Meier estimates and significantly predicted shorter time to biochemical recurrence on univariate analysis but not on multivariate analysis. CONCLUSIONS The study suggests that index tumor predominant location is associated with prognosis in radical prostatectomies, however, in multivariate analysis do not offer advantage over other well-established prognostic factors.
Collapse
Affiliation(s)
- Athanase Billis
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Leandro L L Freitas
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Larissa B E Costa
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Camila M Angelis
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Kelson R Carvalho
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Luis A Magna
- Departamento de Genética Médica/Bioestatística, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Ubirajara Ferreira
- Departamento Urologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| |
Collapse
|
82
|
Focal Ablation of Early-Stage Prostate Cancer: Candidate Selection, Treatment Guidance, and Assessment of Outcome. Urol Clin North Am 2017; 44:575-585. [PMID: 29107274 DOI: 10.1016/j.ucl.2017.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prostate cancer lesions smaller than 0.5 m3, or Gleason pattern 3, are likely clinically insignificant. Clinically significant disease is often limited to a single index lesion. Focal ablation targets this index lesion, maintains oncological control, and minimizes complications by preserving healthy prostate tissue. Template mapping biopsy or multiparametric MRI-targeted biopsies are used to identify appropriate index lesions. Multiple energy modalities have been tested, including high-intensity frequency ultrasound, cryoablation, laser ablation, photodynamic therapy, focal brachytherapy, radiofrequency ablation, irreversible electroporation. Outcome is assessed by biopsy of the target area, triggered by prostate-specific antigen measurements or MRI imaging, or performed per protocol at 12 months.
Collapse
|
83
|
Xiao WJ, Zhu Y, Dai B, Ye DW. Evaluation of the major changes in eighth edition of the American Joint Committee on Cancer pathological staging for prostate cancer treated with prostatectomy. PLoS One 2017; 12:e0187887. [PMID: 29121104 PMCID: PMC5679543 DOI: 10.1371/journal.pone.0187887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/27/2017] [Indexed: 11/18/2022] Open
Abstract
This study aimed to evaluate the major changes of the eighth edition of the American Joint Committee on Cancer (AJCC) pathologic staging for prostate cancer treated with radical prostatectomy. A total of 138,176 patients diagnosed with prostate adenocarcinoma undergoing radical prostatectomy were selected from the Surveillance, Epidemiology and End Results (SEER) database during 2004–2014 period. Excluded were cases with incomplete or unavailable staging, PSA and Gleason score information. Two subgroups were established: group a, T2 stage with PSA≥20ng/ml; group b, T2 stage with Gleason score grade group 5 and PSA<20ng/ml. The median follow-up time was 58 months. The median age at diagnosis for the overall group was 61 years, and the median PSA was 5.7ng/ml. Cancer-specific survival (CSS) at tenth years was 99.3% for T2a/T2b, 99.2% for T2c, respectively. The survival differences between T2a/T2b and T2c did not have statistical significance (P = .323). It was necessary for the current eighth edition to define a single pathologic T2 category, eliminating the subcategories, for all organ-confined disease.CSS at the tenth years was 98.4% for group a, 92.6% for group b, respectively. The prognosis of group a was worse than AJCC II (P = .002). The prognosis of group b was not only worse than AJCC II (P < .001), but also worse than AJCC IIIB. There was necessity to separate the disease with PSA≥20ng/ml or Gleason score grade group 5 from other organ-confined disease. The present study supported the scientificity of the eighth edition of AJCC pathologic staging for prostate cancer.
Collapse
Affiliation(s)
- Wen-jun Xiao
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
- * E-mail: (YZ); (DWY)
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Ding-wei Ye
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
- * E-mail: (YZ); (DWY)
| |
Collapse
|
84
|
Epstein JI. Central pathology review of radical prostatectomy specimens does make a difference not only with grade. BJU Int 2017; 120:E5-E6. [PMID: 29105993 DOI: 10.1111/bju.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan I Epstein
- Departments of Pathology, Urology, Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| |
Collapse
|
85
|
van der Kwast T. Re: Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient-specific Molds to Correlate Images with Whole-mount Pathology. Eur Urol 2017; 73:139. [PMID: 29042126 DOI: 10.1016/j.eururo.2017.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
|
86
|
Ferro M, Lucarelli G, Bruzzese D, Di Lorenzo G, Perdonà S, Autorino R, Cantiello F, La Rocca R, Busetto GM, Cimmino A, Buonerba C, Battaglia M, Damiano R, De Cobelli O, Mirone V, Terracciano D. Low serum total testosterone level as a predictor of upstaging and upgrading in low-risk prostate cancer patients meeting the inclusion criteria for active surveillance. Oncotarget 2017; 8:18424-18434. [PMID: 27793023 PMCID: PMC5392340 DOI: 10.18632/oncotarget.12906] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022] Open
Abstract
Active surveillance (AS) is currently a widely accepted treatment option for men with clinically localized prostate cancer (PCa). Several reports have highlighted the association of low serum testosterone levels with high-grade, high-stage PCa. However, the impact of serum testosterone as a predictor of progression in men with low-risk PCa has been little assessed. In this study, we evaluated the association of circulating testosterone concentrations with a staging/grading reclassification in a cohort of low-risk PCa patients meeting the inclusion criteria for the AS protocol but opting for radical prostatectomy. Radical prostatectomy (RP) was performed in 338 patients, eligible for AS according to the following criteria: clinical stage T2a or less, PSA<10ng/ml, two or fewer cancer cores, Gleason score (GS)=6 and PSA density<0.2 ng/mL/cc. Reclassification was defined as upstaging (stage>pT2) and upgrading (GS=7; primary Gleason pattern 4) disease. Unfavorable disease was defined as the occurrence of pathological stage>pT2 and predominant Gleason score 4. Total testosterone was measured before surgery. Low serum testosterone levels (<300 ng/dL) were significantly associated with upgrading, upstaging, unfavorable disease and positive surgical margins. The addition of testosterone to a base model, including age, PSA, PSA density, clinical stage and positive cancer involvement in cores, showed a significant independent influence of this variable on upstaging, upgrading and unfavorable disease. In conclusion, our results support the idea that total testosterone should be a selection criterion for inclusion of low-risk PCa patients in AS programs and suggest that testosterone level less than 300 ng/dL should be considered a discouraging factor when a close AS program is considered as treatment option
Collapse
Affiliation(s)
- Matteo Ferro
- Department of Urology, European Institute of Oncology, Via Ripamonti, Milan, Italy
| | - Giuseppe Lucarelli
- Department of Emergency & Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples 'Federico II', Naples, Italy
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine, Medical Oncology Unit, University of Naples 'Federico II', Naples, Italy
| | - Sisto Perdonà
- Department of Urology, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
| | | | | | - Roberto La Rocca
- Department of Urology, University of Naples 'Federico II', Naples, Italy
| | | | - Amelia Cimmino
- Institute of Genetics and Biophysics "A. Buzzati Traverso", National Research Council, Naples, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine, Medical Oncology Unit, University of Naples 'Federico II', Naples, Italy
| | - Michele Battaglia
- Department of Emergency & Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Rocco Damiano
- Division of Urology, Magna Graecia University, Catanzaro, Italy
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, Via Ripamonti, Milan, Italy.,University of Milan, Milan, Italy.,University of Medicine Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Vincenzo Mirone
- Department of Urology, University of Naples 'Federico II', Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples 'Federico II', Naples, Italy
| |
Collapse
|
87
|
Re: Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient Specific Molds to Correlate Images with Whole Mount Pathology: A. Priester, S. Natarajan, P. Khoshnoodi, D. J. Margolis, S. S. Raman, R. E. Reiter, J. Huang, W. Grundfest and L. S. Marks J Urol 2017;197:320-326. J Urol 2017; 198:1436-1437. [PMID: 28888772 DOI: 10.1016/j.juro.2017.07.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 11/24/2022]
|
88
|
Incorporating Oxygen-Enhanced MRI into Multi-Parametric Assessment of Human Prostate Cancer. Diagnostics (Basel) 2017; 7:diagnostics7030048. [PMID: 28837092 PMCID: PMC5617948 DOI: 10.3390/diagnostics7030048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/13/2017] [Accepted: 08/21/2017] [Indexed: 12/18/2022] Open
Abstract
Hypoxia is associated with prostate tumor aggressiveness, local recurrence, and biochemical failure. Magnetic resonance imaging (MRI) offers insight into tumor pathophysiology and recent reports have related transverse relaxation rate (R2*) and longitudinal relaxation rate (R1) measurements to tumor hypoxia. We have investigated the inclusion of oxygen-enhanced MRI for multi-parametric evaluation of tumor malignancy. Multi-parametric MRI sequences at 3 Tesla were evaluated in 10 patients to investigate hypoxia in prostate cancer prior to radical prostatectomy. Blood oxygen level dependent (BOLD), tissue oxygen level dependent (TOLD), dynamic contrast enhanced (DCE), and diffusion weighted imaging MRI were intercorrelated and compared with the Gleason score. The apparent diffusion coefficient (ADC) was significantly lower in tumor than normal prostate. Baseline R2* (BOLD-contrast) was significantly higher in tumor than normal prostate. Upon the oxygen breathing challenge, R2* decreased significantly in the tumor tissue, suggesting improved vascular oxygenation, however changes in R1 were minimal. R2* of contralateral normal prostate decreased in most cases upon oxygen challenge, although the differences were not significant. Moderate correlation was found between ADC and Gleason score. ADC and R2* were correlated and trends were found between Gleason score and R2*, as well as maximum-intensity-projection and area-under-the-curve calculated from DCE. Tumor ADC and R2* have been associated with tumor hypoxia, and thus the correlations are of particular interest. A multi-parametric approach including oxygen-enhanced MRI is feasible and promises further insights into the pathophysiological information of tumor microenvironment.
Collapse
|
89
|
Diagnostic Accuracy of 64 Copper Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Primary Lymph Node Staging of Intermediate- to High-risk Prostate Cancer: Our Preliminary Experience. Urology 2017; 106:139-145. [DOI: 10.1016/j.urology.2017.04.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 11/22/2022]
|
90
|
Delahunt B, Egevad L, Samaratunga H, Varma M, Verrill C, Cheville J, Kristiansen G, Corbishley C, Berney DM. UICC drops the ball in the 8th edition TNM staging of urological cancers. Histopathology 2017; 71:5-11. [DOI: 10.1111/his.13200] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Brett Delahunt
- Department of Pathology and Molecular Medicine; Wellington School of Medicine and Health Sciences; University of Otago; Wellington New Zealand
| | - Lars Egevad
- Department of Oncology and Pathology; Karolinska Institutet; Stockholm Sweden
| | - Hemamali Samaratunga
- Aquesta Uropathology and University of Queensland; Brisbane Queensland Australia
| | - Murali Varma
- Department of Cellular Pathology; University Hospital of Wales; Cardiff UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
| | - John Cheville
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester MN USA
| | | | - Catherine Corbishley
- Department of Cellular Pathology; St George's Healthcare NHS Foundation Trust; London UK
| | - Daniel M Berney
- Department of Molecular Oncology; Barts Cancer Institute; St Bartholomew's Hospital; Queen Mary University of London; London UK
| |
Collapse
|
91
|
Heidkamp J, Hoogenboom M, Kovacs IE, Veltien A, Maat A, Sedelaar JPM, Hulsbergen-van de Kaa CA, Fütterer JJ. Ex vivo MRI evaluation of prostate cancer: Localization and margin status prediction of prostate cancer in fresh radical prostatectomy specimens. J Magn Reson Imaging 2017; 47:439-448. [PMID: 28580659 DOI: 10.1002/jmri.25785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/19/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate the ability of high field ex vivo magnetic resonance imaging (MRI) to localize prostate cancer (PCa) and to predict the margin status in fresh radical prostatectomy (RP) specimens using histology as the reference standard. MATERIALS AND METHODS This Institutional Review Board (IRB)-approved study had written informed consent. Patients with biopsy-proved PCa and a diagnostic multiparametric 3T MRI examination of the prostate prior to undergoing RP were prospectively included. A custom-made container provided reference between the 7T ex vivo MRI obtained from fresh RP specimens and histological slicing. On ex vivo MRI, PCa was localized and the presence of positive surgical margins was determined in a double-reading session. These findings were compared with histological findings obtained from completely cut, whole-mount embedded, prostate specimens. RESULTS In 12 RP specimens, histopathology revealed 36 PCa lesions, of which 17 (47%) and 20 (56%) were correlated with the ex vivo MRI in the first and second reading session, respectively. Nine of 12 (75%) index lesions were localized in the first session, in the second 10 of 12 (83%). Seven and 8 lesions of 11 lesions with Gleason score >6 and >0.5 cc were localized in the first and second session, respectively. In the first session none of the four histologically positive surgical margins (sensitivity 0%) and 9 of 13 negative margins (specificity 69%) were detected. In second session the sensitivity and specificity were 25% and 88%, respectively. CONCLUSION Ex vivo MRI enabled accurate localization of PCa in fresh RP specimens, and the technique provided information on the margin status with high specificity. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:439-448.
Collapse
Affiliation(s)
- Jan Heidkamp
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martijn Hoogenboom
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Iringo E Kovacs
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andor Veltien
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arie Maat
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
92
|
Abstract
OBJECTIVES The purpose of the guidelines national committee CCAFU was to propose updated french guidelines for localized and metastatic prostate cancer (PCa). METHODS A Medline search was achieved between 2013 and 2016, as regards diagnosis, options of treatment and follow-up of PCa, to evaluate different references with levels of evidence. RESULTS Epidemiology, classification, staging systems, diagnostic evaluation are reported. Disease management options are detailed. Recommandations are reported according to the different clinical situations. Active surveillance is a major option in low risk PCa. Radical prostatectomy remains a standard of care of localized PCa. The three-dimensional conformal radiotherapy is the technical standard. A dose of > 74Gy is recommended. Moderate hypofractionation provides short-term biochemical control comparable to conventional fractionation. In case of intermediate risk PCa, radiotherapy can be combined with short-term androgen deprivation therapy (ADT). In case of high risk disease, long-term ADT remains the standard of care. ADT is the backbone therapy of metastatic disease. In men with metastases at first presentation, upfront chemotherapy combined with ADT should be considered as a new standard. In case of metastatic castration-resistant PCa (mCRPC), new hormonal treatments and chemotherapy provide a better control of tumor progression and increase survival. CONCLUSIONS These updated french guidelines will contribute to increase the level of urological care for the diagnosis and treatment for prostate cancer. © 2016 Elsevier Masson SAS. All rights reserved.
Collapse
|
93
|
Buyyounouski MK, Choyke PL, McKenney JK, Sartor O, Sandler HM, Amin MB, Kattan MW, Lin DW. Prostate cancer - major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 2017; 67:245-253. [PMID: 28222223 PMCID: PMC6375094 DOI: 10.3322/caac.21391] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Answer questions and earn CME/CNE The eighth edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) Staging Manual has been updated and improved to ensure the highest degree of clinical relevance and to improve its utility for patient evaluation and clinical research. Major changes include: 1) pathologically organ-confined disease is now considered pT2 and is no longer subclassified by extent of involvement or laterality, 2) tumor grading now includes both the Gleason score (as in the seventh edition criteria) and the grade group (introduced in the eighth edition criteria), 3) prognostic stage group III includes select, organ-confined disease based on prostate-specific antigen and Gleason/grade group status, and 4) 2 statistical prediction models are included in the staging manual. The AJCC will continue to critically analyze emerging prostate cancer biomarkers and tools for their ability to prognosticate and guide treatment decision making with the highest level of accuracy and confidence for patients and physicians. CA Cancer J Clin 2017;67:245-253. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Mark K. Buyyounouski
- Associate Professor of Radiation Oncology, Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Peter L. Choyke
- Director, Molecular Imaging Program, National Cancer Institute, Rockville, MD
| | - Jesse K. McKenney
- Section Head, Surgical Pathology, Robert J. Tomisch Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Oliver Sartor
- Hematology/Oncology Section Chief and Professor of Radiation Oncology, Departments of Medicine and Urology, Tulane Medical School, New Orleans, LA
| | - Howard M. Sandler
- Chair, Department of Radiation Oncology, and Professor of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mahul B. Amin
- Chair, Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Michael W. Kattan
- Chair, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Daniel W. Lin
- Chief of Urologic Oncology, Department of Urology, University of Washington, and Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
94
|
Kesch C, Vinsensia M, Radtke JP, Schlemmer HP, Heller M, Ellert E, Holland-Letz T, Duensing S, Grabe N, Afshar-Oromieh A, Wieczorek K, Schäfer M, Neels OC, Cardinale J, Kratochwil C, Hohenfellner M, Kopka K, Haberkorn U, Hadaschik BA, Giesel FL. Intraindividual Comparison of 18F-PSMA-1007 PET/CT, Multiparametric MRI, and Radical Prostatectomy Specimens in Patients with Primary Prostate Cancer: A Retrospective, Proof-of-Concept Study. J Nucl Med 2017; 58:1805-1810. [DOI: 10.2967/jnumed.116.189233] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/19/2017] [Indexed: 11/16/2022] Open
|
95
|
Giesel FL, Hadaschik B, Cardinale J, Radtke J, Vinsensia M, Lehnert W, Kesch C, Tolstov Y, Singer S, Grabe N, Duensing S, Schäfer M, Neels OC, Mier W, Haberkorn U, Kopka K, Kratochwil C. F-18 labelled PSMA-1007: biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. Eur J Nucl Med Mol Imaging 2017; 44:678-688. [PMID: 27889802 PMCID: PMC5323462 DOI: 10.1007/s00259-016-3573-4] [Citation(s) in RCA: 374] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The prostate-specific membrane antigen (PSMA) targeted positron-emitting-tomography (PET) tracer 68Ga-PSMA-11 shows great promise in the detection of prostate cancer. However, 68Ga has several shortcomings as a radiolabel including short half-life and non-ideal energies, and this has motivated consideration of 18F-labelled analogs. 18F-PSMA-1007 was selected among several 18F-PSMA-ligand candidate compounds because it demonstrated high labelling yields, outstanding tumor uptake and fast, non-urinary background clearance. Here, we describe the properties of 18F-PSMA-1007 in human volunteers and patients. METHODS Radiation dosimetry of 18F-PSMA-1007 was determined in three healthy volunteers who underwent whole-body PET-scans and concomitant blood and urine sampling. Following this, ten patients with high-risk prostate cancer underwent 18F-PSMA-1007 PET/CT (1 h and 3 h p.i.) and normal organ biodistribution and tumor uptakes were examined. Eight patients underwent prostatectomy with extended pelvic lymphadenectomy. Uptake in intra-prostatic lesions and lymph node metastases were correlated with final histopathology, including PSMA immunostaining. RESULTS With an effective dose of approximately 4.4-5.5 mSv per 200-250 MBq examination, 18F-PSMA-1007 behaves similar to other PSMA-PET agents as well as to other 18F-labelled PET-tracers. In comparison to other PSMA-targeting PET-tracers, 18F-PSMA-1007 has reduced urinary clearance enabling excellent assessment of the prostate. Similar to 18F-DCFPyL and with slightly slower clearance kinetics than PSMA-11, favorable tumor-to-background ratios are observed 2-3 h after injection. In eight patients, diagnostic findings were successfully validated by histopathology. 18F-PSMA-1007 PET/CT detected 18 of 19 lymph node metastases in the pelvis, including nodes as small as 1 mm in diameter. CONCLUSION 18F-PSMA-1007 performs at least comparably to 68Ga-PSMA-11, but its longer half-life combined with its superior energy characteristics and non-urinary excretion overcomes some practical limitations of 68Ga-labelled PSMA-targeted tracers.
Collapse
Affiliation(s)
- Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany.
| | - B Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Cardinale
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - J Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Vinsensia
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | | | - C Kesch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Y Tolstov
- Section of Molecular Urooncology, Department of Urology, Medical Faculty Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - S Singer
- Section of Molecular Urooncology, Department of Urology, Medical Faculty Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - N Grabe
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
- Hamamatsu Tissue Imaging and Analysis Center, University of Heidelberg, Heidelberg, Germany
| | - S Duensing
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Section of Molecular Urooncology, Department of Urology, Medical Faculty Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - M Schäfer
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - O C Neels
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - W Mier
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - U Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - K Kopka
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - C Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| |
Collapse
|
96
|
Harvey H, Orton MR, Morgan VA, Parker C, Dearnaley D, Fisher C, deSouza NM. Volumetry of the dominant intraprostatic tumour lesion: intersequence and interobserver differences on multiparametric MRI. Br J Radiol 2017; 90:20160416. [PMID: 28055249 PMCID: PMC5601508 DOI: 10.1259/bjr.20160416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/10/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To establish the interobserver reproducibility of tumour volumetry on individual multiparametric (mp) prostate MRI sequences, validate measurements with histology and determine whether functional to morphological volume ratios reflect Gleason score. METHODS 41 males with prostate cancer treated with prostatectomy (Cohort 1) or radical radiotherapy (Cohort 2), who had pre-treatment mpMRI [T2 weighted (T2W) MRI, diffusion-weighted (DW)-MRI and dynamic contrast-enhanced (DCE)-MRI], were studied retrospectively. Dominant intraprostatic lesions (DIPLs) were manually delineated on each sequence and volumes were compared between observers (n = 40 analyzable) and with radical prostatectomy (n = 20). Volume ratios of DW-MRI and DCE-MRI to T2W MRI were documented and compared between Gleason grade 3 + 3, 3 + 4 and 4 + 3 or greater categories. RESULTS Limits of agreement of DIPL volumes between observers were: T2W MRI 0.9, -1.1 cm3, DW-MRI 1.3, -1.7 cm3 and DCE-MRI 0.74, -0.89 cm3. In Cohort 1, T2W volumes overestimated fixed specimen histological volumes (+33% Observer 1, +16% Observer 2); DW- and DCE-MRI underestimated histological volume, the latter markedly so (-32% Observer 1, -79% Observer 2). Differences between T2W, DW- and DCE-MRI volumes were significant (p < 10-8). The ratio of DW-MRI volume (73.9 ± 18.1% Observer 1, 72.5 ± 21.9% Observer 2) and DCE-MRI volume (42.6 ± 24.6% Observer 1, 34.3 ± 24.9% Observer 2) to T2W volume was significantly different (p < 10-8), but these volume ratios did not differ between the Gleason grades. CONCLUSION The low variability of the DIPL volume on T2W MRI between Observers and agreement with histology indicates its suitability for delineation of gross tumour volume for radiotherapy planning. The volume of cellular tumour represented by DW-MRI is greater than the vascular (DCE) abnormality; ratios of both to T2W volume are independent of Gleason score. Advances in knowledge: (1) Manual volume measurement of tumour is reproducible within 1 cm3 between observers on all sequences, confirming suitability across observers for radiotherapy planning. (2) Volumes derived on T2W MRI most accurately represent in vivo lesion volumes. (3) The proportion of cellular (DW-MRI) or vascular (DCE-MRI) volume to morphological (T2W MRI) volume is not affected by Gleason score.
Collapse
Affiliation(s)
- Hugh Harvey
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew R Orton
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Veronica A Morgan
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Chris Parker
- Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - David Dearnaley
- Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Cyril Fisher
- Department of Histopathology, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Nandita M deSouza
- Cancer Research UK Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| |
Collapse
|
97
|
[TNM-Classification of localized prostate cancer : The clinical T-category does not correspond to the required demands]. Urologe A 2016; 55:1564-1572. [PMID: 27830286 DOI: 10.1007/s00120-016-0264-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The TNM staging system for localized prostate cancer (PCa) divides tumors based on clinical parameters into a clinical (c)T category and, after radical prostatectomy (RP), a pathological (p)T category. OBJECTIVES This study examines the extent to which the cT and the pT category correspond to each other and whether the two categories differ in their prediction for organ-confined disease. PATIENTS AND METHODS Data of 687 RP patients were collected in a prospective, noninterventional, multicenter health service research study for the treatment of localized PCa (HAROW). Group comparisons were performed by analysis of variance and student t‑test as well as the chi-squared test or the Fisher exact test. RESULTS Clinical cT1 category (62.9%) and pathological pT2c category (56.6%) were diagnosed most frequently. The correspondence of cT and pT category was 15% for cT2a , 10.5% for cT2b, and 55% for cT2c. An extraprostatic extension (≥pT3) was observed for the categories cT1 and cT2 in 23.5% and 36.4% (p < 0.001), differences in the subcategories cT2a-c were not significant: cT2a = 28.8%, cT2b = 42.1%, and cT2c = 38.8% (p = 0.194). Tumors with a pathologically extraprostatic extension were not recognized clinically in >50%. CONCLUSIONS For localized PCa there is low agreement between clinical and pathologic T category, thus, often leading to understaging. An adaptation of the T classification of the TNM system with division into "not palpable" and "palpable" appears sufficient for a prognostic prediction.
Collapse
|
98
|
Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt CD, Kesch C, Popeneciu IV, Huettenbrink C, Gasch C, Klein T, Bonekamp D, Duensing S, Roth W, Schueler S, Stock C, Schlemmer HP, Roethke M, Hohenfellner M, Hadaschik BA. Multiparametric Magnetic Resonance Imaging (MRI) and MRI–Transrectal Ultrasound Fusion Biopsy for Index Tumor Detection: Correlation with Radical Prostatectomy Specimen. Eur Urol 2016; 70:846-853. [DOI: 10.1016/j.eururo.2015.12.052] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/29/2015] [Indexed: 11/26/2022]
|
99
|
Ettel M, Kong M, Lee P, Zhou M, Melamed J, Deng FM. Modification of the pT2 substage classification in prostate adenocarcinoma. Hum Pathol 2016; 56:57-63. [DOI: 10.1016/j.humpath.2016.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/08/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
|
100
|
Primary focal prostate radiotherapy: Do all patients really need whole-prostate irradiation? Crit Rev Oncol Hematol 2016; 105:100-11. [DOI: 10.1016/j.critrevonc.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/09/2016] [Accepted: 06/16/2016] [Indexed: 12/27/2022] Open
|