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Barrett T, Haider MA. The Emerging Role of MRI in Prostate Cancer Active Surveillance and Ongoing Challenges. AJR Am J Roentgenol 2017; 208:131-139. [PMID: 27726415 DOI: 10.2214/ajr.16.16355] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Active surveillance (AS) has emerged as a management strategy for preventing overtreatment of indolent prostate cancer. Selection of patients for AS has traditionally proved challenging and resulted in 20-30% misclassification rates. MRI has potential to help overcome this limitation, broaden selection criteria to increase recruitment, and minimize the invasive nature of AS follow-up. CONCLUSION The main issues surrounding MRI and AS are the heterogeneity of inclusion criteria, the definition of significant disease, and agreement about what constitutes radiologic progression. Prospective cohorts with MRI at enrollment and long-term follow-up are required to further address these issues.
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Affiliation(s)
- Tristan Barrett
- 1 Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Masoom A Haider
- 2 Department of Medical Imaging, Sunnybrook Health Sciences Center and University of Toronto, Toronto, ON, Canada
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202
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Edmund L, Rotker KL, Lakis NS, Brito JM, Lepe M, Lombardo KA, Renzulli JF, Matoso A. Upgrading and upstaging at radical prostatectomy in the post–prostate-specific antigen screening era: an effect of delayed diagnosis or a shift in patient selection? Hum Pathol 2017; 59:87-93. [DOI: 10.1016/j.humpath.2016.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/29/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
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203
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Chen RC, Rumble RB, Jain S. Reply to J.J. Tosoian et al. J Clin Oncol 2016; 34:4453. [PMID: 27998225 DOI: 10.1200/jco.2016.70.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ronald C Chen
- Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; and Suneil Jain, Queen's University Belfast, Belfast, United Kingdom
| | - R Bryan Rumble
- Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; and Suneil Jain, Queen's University Belfast, Belfast, United Kingdom
| | - Suneil Jain
- Ronald C. Chen, University of North Carolina, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; and Suneil Jain, Queen's University Belfast, Belfast, United Kingdom
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204
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Simpkin AJ, Donovan JL, Tilling K, Athene Lane J, Martin RM, Albertsen PC, Bill-Axelson A, Ballentine Carter H, Bosch JLHR, Ferrucci L, Hamdy FC, Holmberg L, Jeffrey Metter E, Neal DE, Parker CC, Metcalfe C. Prostate-specific antigen patterns in US and European populations: comparison of six diverse cohorts. BJU Int 2016; 118:911-918. [PMID: 26799945 DOI: 10.1111/bju.13422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether there are differences in prostate-specific antigen (PSA) levels at diagnosis or changes in PSA levels between US and European populations of men with and without prostate cancer (PCa). SUBJECTS AND METHODS We analysed repeated measures of PSA from six clinically and geographically diverse cohorts of men: two cohorts with PSA-detected PCa, two cohorts with clinically detected PCa and two cohorts without PCa. Using multilevel models, average PSA at diagnosis and PSA change over time were compared among study populations. RESULTS The annual percentage PSA change of 4-5% was similar between men without cancer and men with PSA-detected cancer. PSA at diagnosis was 1.7 ng/mL lower in a US cohort of men with PSA-detected PCa (95% confidence interval 1.3-2.0 ng/mL), compared with a UK cohort of men with PSA-detected PCa, but there was no evidence of a different rate of PSA change between these populations. CONCLUSION We found that PSA changes over time are similar in UK and US men diagnosed through PSA testing and even in men without PCa. Further development of PSA models to monitor men on active surveillance should be undertaken in order to take advantage of these similarities. We found no evidence that guidelines for using PSA to monitor men cannot be passed between US and European studies.
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Affiliation(s)
- Andrew J Simpkin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK
| | - Peter C Albertsen
- Division of Urology, University of Connecticut Health Center, Farmington, CT, USA
| | - Anna Bill-Axelson
- Institution of Surgical Sciences, Department of Urology, Uppsala University, Uppsala, Sweden
| | | | - J L H Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, MA, USA
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lars Holmberg
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Regional Cancer Centre, Uppsala/Örebro Region, Uppsala, Sweden
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David E Neal
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Christopher C Parker
- Academic Urology Unit, Royal Marsden Hospital, Institute of Cancer Research, London, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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205
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Van Hemelrijck M, Garmo H, Lindhagen L, Bratt O, Stattin P, Adolfsson J. Quantifying the Transition from Active Surveillance to Watchful Waiting Among Men with Very Low-risk Prostate Cancer. Eur Urol 2016; 72:534-541. [PMID: 27816297 DOI: 10.1016/j.eururo.2016.10.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Active surveillance (AS) is commonly used for men with low-risk prostate cancer (PCa). When life expectancy becomes too short for curative treatment to be beneficial, a change from AS to watchful waiting (WW) follows. Little is known about this change since it is rarely documented in medical records. OBJECTIVE To model transition from AS to WW and how this is affected by age and comorbidity among men with very low-risk PCa. DESIGN, SETTING, AND PARTICIPANTS National population-based healthcare registers were used for analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Using data on PCa characteristics, age, and comorbidity, a state transition model was created to estimate the probability of changes between predefined treatments to estimate transition from AS to WW. RESULTS AND LIMITATIONS Our estimates indicate that 48% of men with very low-risk PCa starting AS eventually changed to WW over a life course. This proportion increased with age at time of AS initiation. Within 10 yr from start of AS, 10% of men aged 55 yr and 50% of men aged 70 yr with no comorbidity at initiation changed to WW. Our prevalence simulation suggests that the number of men on WW who were previously on AS will eventually stabilise after 30 yr. A limitation is the limited information from clinical follow-up visits (eg, repeat biopsies). CONCLUSIONS We estimated that changes from AS to WW become common among men with very low-risk PCa who are elderly. This potential change to WW should be discussed with men starting on AS. Moreover, our estimates may help in planning health care resources allocated to men on AS, as the transition to WW is associated with lower demands on outpatient resources. PATIENT SUMMARY Changes from active surveillance to watchful waiting will become more common among men with very low-risk prostate cancer. These observations suggest that patients need to be informed about this potential change before they start on active surveillance.
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Affiliation(s)
- Mieke Van Hemelrijck
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Hans Garmo
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK; Regional Cancer Centre Uppsala, Akademiska Sjukhuset, Uppsala, Sweden
| | | | - Ola Bratt
- Department of Translational Medicine Urology, Division of Urological Cancer, Lund University, Lund, Sweden; CamPARI Clinic, Department of Urology, Cambridge University Hospitals, Cambridge, UK
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Jan Adolfsson
- CLINTEC Department, Karolinska Institute, Stockholm, Sweden
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206
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Macleod LC, Ellis WJ, Newcomb LF, Zheng Y, Brooks JD, Carroll PR, Gleave ME, Lance RS, Nelson PS, Thompson IM, Wagner AA, Wei JT, Lin DW. Timing of Adverse Prostate Cancer Reclassification on First Surveillance Biopsy: Results from the Canary Prostate Cancer Active Surveillance Study. J Urol 2016; 197:1026-1033. [PMID: 27810448 DOI: 10.1016/j.juro.2016.10.090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE During active surveillance for localized prostate cancer, the timing of the first surveillance biopsy varies. We analyzed the Canary PASS (Prostate Cancer Active Surveillance Study) to determine biopsy timing influence on rates of prostate cancer adverse reclassification at the first active surveillance biopsy. MATERIALS AND METHODS Of 1,085 participants in PASS, 421 had fewer than 34% of cores involved with cancer and Gleason sum 6 or less, and thereafter underwent on-study active surveillance biopsy. Reclassification was defined as an increase in Gleason sum and/or 34% or more of cores with prostate cancer. First active surveillance biopsy reclassification rates were categorized as less than 8, 8 to 13 and greater than 13 months after diagnosis. Multivariable logistic regression determined association between reclassification and first biopsy timing. RESULTS Of 421 men, 89 (21.1%) experienced reclassification at the first active surveillance biopsy. Median time from prostate cancer diagnosis to first active surveillance biopsy was 11 months (IQR 7.8-13.8). Reclassification rates at less than 8, 8 to 13 and greater than 13 months were 24%, 19% and 22% (p = 0.65). On multivariable analysis, compared to men biopsied at less than 8 months the OR of reclassification at 8 to 13 and greater than 13 months were 0.88 (95% CI 0.5,1.6) and 0.95 (95% CI 0.5,1.9), respectively. Prostate specific antigen density 0.15 or greater (referent less than 0.15, OR 1.9, 95% CI 1.1, 4.1) and body mass index 35 kg/m2 or greater (referent less than 25 kg/m2, OR 2.4, 95% CI 1.1,5.7) were associated with increased odds of reclassification. CONCLUSIONS Timing of the first active surveillance biopsy was not associated with increased adverse reclassification but prostate specific antigen density and body mass index were. In low risk patients on active surveillance, it may be reasonable to perform the first active surveillance biopsy at a later time, reducing the overall cost and morbidity of active surveillance.
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Affiliation(s)
- Liam C Macleod
- University of Washington School of Medicine, Seattle, Washington.
| | - William J Ellis
- University of Washington School of Medicine, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lisa F Newcomb
- University of Washington School of Medicine, Seattle, Washington
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Peter R Carroll
- University of California-San Francisco School of Medicine, San Francisco, California
| | - Martin E Gleave
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Peter S Nelson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ian M Thompson
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | | | - John T Wei
- University of Michigan, Ann Arbor, Michigan
| | - Daniel W Lin
- University of Washington School of Medicine, Seattle, Washington; Seattle Puget Sound Health Care System, Veterans Affairs Hospital, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington.
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207
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Expectant Management for Prostate Cancer: Lessons from the Past, Challenges for the Future. Eur Urol 2016; 70:767-768. [DOI: 10.1016/j.eururo.2016.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 11/21/2022]
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208
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Yin Y, Zhang Q, Zhang H, He Y, Huang J. Molecular Signature to Risk-Stratify Prostate Cancer of Intermediate Risk. Clin Cancer Res 2016; 23:6-8. [PMID: 27803045 DOI: 10.1158/1078-0432.ccr-16-2400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022]
Abstract
A new 30-gene signature has been described that separates prostate cancers of Gleason score ≤6 from those of Gleason score ≥8. It provides independent prognostic information for prostate cancers of intermediate risk (Gleason score of 7), which has the potential to stratify these patients into different risk groups. Clin Cancer Res; 23(1); 6-8. ©2016 AACRSee related article by Sinnott et al., p. 81.
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Affiliation(s)
- Yu Yin
- Department of Pathology, Anhui Medical University, Hefei, China.,Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Qingfu Zhang
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina.,Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Hong Zhang
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Yiping He
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina.
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209
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Holtz JN, Tay KJ, Polascik TJ, Gupta RT. Integration of multiparametric MRI into active surveillance of prostate cancer. Future Oncol 2016; 12:2513-2529. [DOI: 10.2217/fon-2016-0142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Prostate cancer is the most common noncutaneous cancer in men though many men will not die of this disease and may not require definitive treatment. Active surveillance (AS) is an increasingly utilized potential solution to the issue of overtreatment of prostate cancer. Traditionally, prostate cancer patients have been stratified into risk groups based on clinical stage on digital rectal examination, prostate-specific antigen and biopsy Gleason score, though each of these variables has significant limitations. This review will discuss the potential role for prostate multiparametric MRI and targeted biopsy techniques incorporating MRI in the selection of candidates for AS, monitoring patients on AS and as triggers for definitive treatment.
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Affiliation(s)
- Jamie N Holtz
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
| | - Kae Jack Tay
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
| | - Thomas J Polascik
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
| | - Rajan T Gupta
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
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210
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Stensland KD, Coutinho K, Hobbs AR, Haines L, Collingwood SA, Kwon YS, Hall SJ, Katsigeorgis M, Jazayeri SB, Samadi DB. Are magnetic resonance imaging undetectable prostate tumours clinically significant? Results of histopathological analyses. Arab J Urol 2016; 14:256-261. [PMID: 27900214 PMCID: PMC5122808 DOI: 10.1016/j.aju.2016.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/29/2016] [Accepted: 09/10/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate whether tumours at threshold values for detection on magnetic resonance imaging (MRI) represent clinically significant tumours or not, and therefore the utility of MRI in active surveillance (AS) protocols. PATIENTS AND METHODS A retrospective analysis of a single institution database was performed after Institutional Review Board approval. Between 2010 and 2013, 1633 patients underwent robot-assisted laparoscopic prostatectomy (RALP) at a single institution by a single surgeon. Of these, 1361 had complete clinical data and were included in analysis. Multivariate logistic regression was used to assess histopathological grade compared to tumour size whilst controlling for biopsy Gleason score, prostate-specific antigen level, body mass index, race, and age. RESULTS Of 120 tumours <5 mm in size, four were Gleason score 4 + 3. Of 276 tumours of 5-10 mm, 22 (8.1%) were Gleason score 4 + 3 and one (0.2%) was Gleason score 8. On multivariate regression analyses, tumours of <5 mm were much less likely to be high grade (Gleason score >3 + 4) at RALP compared to larger tumours (3.3% vs 25.1%, P < 0.001), or Gleason score ⩾8 (0.0% vs 7.6%, P < 0.001). Size was further shown to significantly correlate with grade on multivariate regression (P < 0.001). CONCLUSIONS Prostate tumours below the detection threshold for MRI (5 mm) most probably represent clinically insignificant tumours, which alone would not necessitate leaving AS in favour of more aggressive therapy. These findings point to a possible role of MRI in modern AS protocols.
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Affiliation(s)
| | - Karl Coutinho
- Department of Urology, Mount Sinai Medical Center, New York, NY, USA
| | - Adele R Hobbs
- Department of Urology, Mount Sinai Medical Center, New York, NY, USA
| | - Lindsay Haines
- Department of Urology, Mount Sinai Medical Center, New York, NY, USA
| | | | - Young Suk Kwon
- Department of Urology, Mount Sinai Medical Center, New York, NY, USA
| | - Simon J Hall
- Department of Urology, Mount Sinai Medical Center, New York, NY, USA
| | | | - Seyed Behzad Jazayeri
- Department of Urology, Lenox Hill Hospital, Hofstra Northwell School of Medicine, New York, NY, USA
| | - David B Samadi
- Department of Urology, Lenox Hill Hospital, Hofstra Northwell School of Medicine, New York, NY, USA
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211
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Park JJ, Park BK. Role of PI-RADSv2 with multiparametric MRI in determining who needs active surveillance or definitive treatment according to PRIAS. J Magn Reson Imaging 2016; 45:1753-1759. [PMID: 27783436 DOI: 10.1002/jmri.25534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/13/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the role of Prostate Imaging Reporting and Data System v. 2 (PI-RADSv2) in triaging patients with prostate cancer according to Prostate Cancer Research International: Active Surveillance (PRIAS). MATERIALS AND METHODS Between January 2012 and December 2014, 456 patients with biopsy-proven cancer underwent multiparametric 3T magnetic resonance imaging (MRI) using T2 -weighted, diffusion-weighted, and dynamic contrast-enhanced MRI sequences, and then radical prostatectomy. Two radiologists independently reviewed MR images using PI-RADSv2. For AS, PRIAS required clinical stage <T3, prostate-specific antigen (PSA) ≤10 ng/mL, PSA density <0.2 ng/mL2 , Gleason score (GS) ≤6, and the number of positive cores ≤2. For AS, PI-RADSv2 required an index lesion scored <4. Standard reference was prostatectomy, in which insignificant cancer was defined as a small (<0.5 cm3 ) organ-confined lesion with GS ≤6. Sensitivity and specificity for insignificant cancer were obtained with PRIAS, PI-RADSv2, and both. RESULTS The sensitivity and specificity with PRIAS were 82.9% (68/82) and 70.9% (265/374), respectively. PI-RADSv2 decreased the sensitivity to 61% (50/82) to 80.5% (66/82), but increased the specificity to 77.8% (291/374) to 90.8% (340/374). The combination of PRIAS and PI-RDASv2 increased significantly the specificity to 89.6% (335/374) to 92.8% (347/374) (P < 0.001). CONCLUSION PRIAS using multiparametric MRI can identify a greater number of insignificant cancers than PI-RADSv2. However, PI-RADSv2 helps detect many significant cancers that are misdiagnosed as insignificant cancer with PRIAS. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1753-1759.
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Affiliation(s)
- Jung Jae Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Kangwon National University School of Medicine, Chuncheon, Korea
| | - Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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212
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Mizuno K, Inoue T, Kinoshita H, Yano T, Kawanishi H, Kanda H, Terada N, Kobayashi T, Kamba T, Mikami Y, Shiraishi T, Uemura Y, Imai Y, Honjo G, Shirase T, Okumura K, Kawakita M, Ogura K, Sugimura Y, Matsuda T, Ogawa O. Evaluation of predictors of unfavorable pathological features in men eligible for active surveillance using radical prostatectomy specimens: a multi-institutional study. Jpn J Clin Oncol 2016; 46:1156-1161. [PMID: 27744325 DOI: 10.1093/jjco/hyw130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/04/2016] [Accepted: 08/18/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Active surveillance has emerged as an alternative to immediate treatment in men with favorable-risk prostate cancer; however, consensus about defining the appropriate candidates is still lacking. To examine the factors predicting unfavorable pathology among active surveillance candidates, we assessed low-risk radical prostatectomy specimens. METHODS This retrospective study included 1753 men who had undergone radical prostatectomy at six independent institutions in Japan from 2005 to 2011. Patients who met the active surveillance criteria were categorized depending on the pathological features of the radical prostatectomy specimens. 'Reclassification' was defined as upstaging (≥pT3) or upgrading (radical prostatectomy Gleason score ≥7), and 'adverse pathology' was defined as pathological stage ≥pT3 or radical prostatectomy Gleason score ≥4 + 3. Multivariate analysis was used to analyze the preoperative factors for reclassification and adverse pathology. The rates of reclassification and adverse pathology were evaluated by classifying patients according to biopsy core numbers. RESULTS The active surveillance criteria were met by 284 cases. Reclassification was identified in 154 (54.2%) cases, while adverse pathology in 60 (21.1%) cases. Prostate-specific antigen density and percentage of positive cores were independently associated with reclassification and adverse pathology. The rates of reclassification and adverse pathology were significantly higher among patients with <10 biopsy cores than among others. Thus, focusing on 149 patients with ≥10 biopsy cores, prostate-specific antigen density was the only independent predictor of unfavorable pathological features. The receiver operating characteristic curve analysis determines an optimal cut-off value of prostate-specific antigen density as 0.15 ng/ml2. CONCLUSIONS Prostate-specific antigen density is the most important predictor of unfavorable pathological features in active surveillance candidates.
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Affiliation(s)
- Kei Mizuno
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu
| | - Takahiro Inoue
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Hirakata
| | - Toshifumi Yano
- Department of Urology, Kobe City Medical Center General Hospital, Kobe
| | | | - Hideki Kanda
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu
| | - Naoki Terada
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto
| | - Tomomi Kamba
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto
| | - Taizo Shiraishi
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, Tsu
| | - Yoshiko Uemura
- Depatment of Clinical Pathology, Kansai Medical University, Hirakata
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe
| | - Gen Honjo
- Department of Pathology, Tenri Hospital, Tenri
| | - Tomoyuki Shirase
- Department of Pathology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | | | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe
| | - Keiji Ogura
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu
| | - Yoshiki Sugimura
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Hirakata
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto
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213
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Flood TA, Schieda N, Keefe DT, Morash C, Bateman J, Mai KT, Belanger EC, Robertson SJ, Breau RH. Perineural invasion on biopsy is associated with upstaging at radical prostatectomy in Gleason score 3 + 4 = 7 prostate cancer. Pathol Int 2016; 66:629-632. [PMID: 27709739 DOI: 10.1111/pin.12467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 01/22/2023]
Abstract
This study assesses if perineural invasion (PNI) detected on biopsy with Gleason score (GS) 3 + 4 = 7 prostate cancer (PCa) is associated with upstaging/upgrading of disease after radical prostatectomy (RP). 154 patients with GS 3 + 4 = 7 PCa diagnosed from biopsy who underwent RP were assessed for PNI. The percentage of biopsy sites with PNI (%PNI) was also calculated. Pattern 4 morphologies (ill-defined glands [IDG], fused, cribriform, and glomerulations) were also assessed. Clinical information, GS and stage after RP were retrieved from the medical records. 45 % (69/154) of patients were upstaged (≥pT3) and 29 % (44/154) were upgraded to GS >3 + 4 = 7 after RP. 37 % (57/154) of patients had PNI which was associated with upstaging (RR 1.4; P = 0.04) but not upgrading (RR 0.9; P = 0.7). There was higher %PNI in upstaged patients (12.1 % ± 1.8 vs. 7.1 % ± 1.5, P = 0.03) with a significant correlation between %PNI and ≥pT3 (r = 0.178, P = 0.027). After multivariate analysis, only cribriform formations were significantly associated with upstaging (P = 0.009). The presence of PNI in biopsies with GS 3 + 4 = 7 PCa is associated with upstaging at RP but is a weaker predictor of ≥pT3 disease than cribriform morphology.
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Affiliation(s)
- Trevor A Flood
- The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada.
| | - Nicola Schieda
- The Ottawa Hospital, Department of Medical Imaging, Ottawa, Canada
| | - Daniel T Keefe
- The Ottawa Hospital, Department of Urology, Ottawa, Canada
| | - Chris Morash
- The Ottawa Hospital, Department of Urology, Ottawa, Canada
| | - Justin Bateman
- The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada
| | - Kien T Mai
- The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada
| | - Eric C Belanger
- The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada
| | - Susan J Robertson
- The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Ottawa, Canada
| | - Rodney H Breau
- The Ottawa Hospital, Department of Urology, Ottawa, Canada
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214
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Kolb GF, Weißbach L. [Demographic change: Changes in society and medicine and developmental trends in geriatrics]. Urologe A 2016; 54:1701-9. [PMID: 26704273 DOI: 10.1007/s00120-015-4004-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Increasing life expectancy means growing numbers of elderly survive the critical age for cardiac and vascular diseases only to later experience cancer and dementia. OBJECTIVES Of the types of cancer affecting men, prostate cancer continues to be diagnosed early by prostate-specific antigen (PSA) screening. The clinical relevance and quality of life of those affected must be critically judged. Depending on life expectancy, active surveillance (AS) and watchful waiting (WW) will be increasingly used in geriatric patients. Risk stratification as guided by CGA facilitates the therapeutic decisions of urologists and spares metastatic castration-resistant prostate cancer patients from unnecessary and adverse overtreatment. By 2030, approximately 1.8 million people will have dementia. CONCLUSIONS Thus, in the future, the health care system will have to treat an aging population, which will require the creation of increasing numbers of geriatric hospital departments and cooperative models between geriatrics and other specialties. The future training of medical students and continuing medical education must also be further developed to include aspects on aging. Only in this manner will it be possible to effectively confront the challenges associated with demographic change in the specialty of geriatrics.
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Affiliation(s)
- G F Kolb
- Medizinische Klinik, Abteilung für Innere Medizin, Fachbereich Geriatrie, Geriatrische Onkologie, Bonifatius-Hospital Lingen, Akademisches Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Wilhelmstraße 13, 49808, Lingen (Ems), Deutschland.
| | - L Weißbach
- Stiftung Männergesundheit, Berlin, Deutschland.
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215
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Luckenbaugh AN, Auffenberg GB, Hawken SR, Dhir A, Linsell S, Kaul S, Miller DC. Variation in Guideline Concordant Active Surveillance Followup in Diverse Urology Practices. J Urol 2016; 197:621-626. [PMID: 27663459 DOI: 10.1016/j.juro.2016.09.071] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE We examined the frequency of followup prostate specific antigen testing and prostate biopsy among men treated with active surveillance in the academic and community urology practices comprising MUSIC (Michigan Urological Surgery Improvement Collaborative). MATERIALS AND METHODS MUSIC is a consortium of 42 practices that maintains a prospective clinical registry with validated clinical data on all patients diagnosed with prostate cancer at participating sites. We identified all patients in MUSIC practices who entered active surveillance and had at least 2 years of continuous followup. After determining the frequency of repeat prostate specific antigen testing and prostate biopsy, we calculated rates of concordance with NCCN Guidelines® recommendations (ie at least 3 prostate specific antigen tests and 1 surveillance biopsy) collaborative-wide and across individual practices. RESULTS We identified 513 patients who entered active surveillance from January 2012 through September 2013 and had at least 2 years of followup. Among the 431 men (84%) who remained on active surveillance for 2 years 132 (30.6%) underwent followup surveillance testing at a frequency that was concordant with NCCN® (National Comprehensive Cancer Network®) recommendations. At the practice level, the median rate of guideline concordant followup was 26.5% (range 10% to 67.5%, p <0.001). Among patients with discordant followup, the absence of followup biopsy was common and not significantly different across practices (median rate 82.0%, p = 0.35). CONCLUSIONS Among diverse community and academic practices in Michigan, there is wide variation in the proportion of men on active surveillance who meet guideline recommendations for followup prostate specific antigen testing and repeat biopsy. These data highlight the need for standardized active surveillance pathways that emphasize the role of repeat surveillance biopsies.
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Affiliation(s)
- Amy N Luckenbaugh
- Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan
| | - Gregory B Auffenberg
- Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan
| | - Scott R Hawken
- Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan
| | - Apoorv Dhir
- Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan
| | - Susan Linsell
- Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan
| | - Sanjeev Kaul
- Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan.
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- Department of Urology, University of Michigan, Ann Arbor, Michigan; Comprehensive Urology, William Beaumont Hospital (SK), Royal Oak, Michigan
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216
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Pessoa RR, Viana PC, Mattedi RL, Guglielmetti GB, Cordeiro MD, Coelho RF, Nahas WC, Srougi M. Value of 3-Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance. BJU Int 2016; 119:535-542. [DOI: 10.1111/bju.13624] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Rodrigo R. Pessoa
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Publio C. Viana
- Department of Diagnostic and Interventional Radiology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Romulo L. Mattedi
- Department of Pathology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Giuliano B. Guglielmetti
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Mauricio D. Cordeiro
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Rafael F. Coelho
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - William C. Nahas
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
| | - Miguel Srougi
- Department of Urology; Instituto do Cancer; Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas; Sao Paulo SP Brazil
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217
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Ammani A, Janane A, Bouzide B, Dehayni Y, Lezrek M, Ghadouane M, Ameur A, Abbar M, Qarro A, Alami M. Accuracy of the contemporary Epstein criteria to predict insignificant prostate cancer in North African Man. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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218
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Cancer stem cell markers in prostate cancer: an immunohistochemical study of ALDH1, SOX2 and EZH2. Pathology 2016; 47:622-8. [PMID: 26517640 DOI: 10.1097/pat.0000000000000325] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aims of this study were to investigate the immunohistochemical expression and potential prognostic significance of putative cancer stems cell markers ALDH1, EZH2 and SOX2 in prostate cancer.A total of 142 consecutive radical prostatectomies submitted to one laboratory with a diagnosis of prostatic adenocarcinoma between 2008 and 2012 were retrieved and retrospectively studied. Immunohistochemistry for the three markers was performed in each case and both univariate and multivariate analyses were undertaken to evaluate the correlation between the staining patterns and known histopathological prognostic features.ALDH1 showed a statistically significant association with tumour stage p < 0.001), extraprostatic extension (p < 0.001) and lymphovascular invasion (p = 0.001). EZH2 correlated with Gleason score (p = 0.044) and lymph node metastases (p = 0.023). SOX2 showed a statistically significant correlation with lymphovascular invasion only (p = 0.018) in both univariate and multivariate analyses.Cancer stem cell markers are variably expressed in prostate adenocarcinoma and immunohistochemical staining for ALDH1 and EZH2 may have a role in predicting tumour aggressiveness before treatment of prostate cancer.
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219
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Coley RY, Fisher AJ, Mamawala M, Carter HB, Pienta KJ, Zeger SL. A Bayesian hierarchical model for prediction of latent health states from multiple data sources with application to active surveillance of prostate cancer. Biometrics 2016; 73:625-634. [DOI: 10.1111/biom.12577] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/01/2016] [Accepted: 07/01/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Rebecca Yates Coley
- Department of Biostatistics; Johns Hopkins University; Baltimore, Maryland 21205 U.S.A
| | - Aaron J. Fisher
- Department of Biostatistics; Johns Hopkins University; Baltimore, Maryland 21205 U.S.A
| | - Mufaddal Mamawala
- James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore, Maryland 21287 U.S.A
| | - Herbert Ballentine Carter
- James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore, Maryland 21287 U.S.A
- Department of Oncology; Johns Hopkins Medical Institutions; Baltimore, Maryland 21287 U.S.A
| | - Kenneth J. Pienta
- James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore, Maryland 21287 U.S.A
- Department of Oncology; Johns Hopkins Medical Institutions; Baltimore, Maryland 21287 U.S.A
- Department of Pharmacology; Johns Hopkins Medical Institutions; Baltimore, Maryland 21287
| | - Scott L. Zeger
- Department of Biostatistics; Johns Hopkins University; Baltimore, Maryland 21205 U.S.A
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220
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Shu X, Ye Y, Gu J, He Y, Davis JW, Thompson TC, Logothetis CJ, Kim J, Wu X. Genetic variants of the Wnt signaling pathway as predictors of aggressive disease and reclassification in men with early stage prostate cancer on active surveillance. Carcinogenesis 2016; 37:965-971. [PMID: 27515962 DOI: 10.1093/carcin/bgw082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/30/2016] [Indexed: 11/12/2022] Open
Abstract
Little is known about the genetic predictors of prostate cancer aggressiveness and reclassification in men with localized prostate cancer undergoing active surveillance. The Wnt signaling pathway is important for prostate cancer development and progression. Identifying genetic variants associated with prostate cancer aggressiveness and reclassification may have a potential role in the management of localized patients. In this study, we used a three-phase design. In phases I and II prostate cancer patient cohort, 578 single nucleotide polymorphisms (SNPs) from 45 genes of the Wnt signaling pathway were analyzed in 1762 localized prostate cancer patients. Twelve SNPs from four regions were significantly associated with aggressive disease, among which, three linked SNPs in CSNK1A1 at 5q32 (represented by rs752822) may differentiate GS 4+3 from GS 3+4 patients (OR = 1.44, 95% CI = 1.12-1.87, P = 4.76×10(-3)). In phase III active surveillance (AS) cohort, genotyping of rs752822 (candidate from phases I and II) and previously identified rs2735839 were determined in 494 GS ≤7 patients. We found a significant association between rs2735839 and prostate cancer reclassification in the AS cohort (AG + AA versus GG, HR = 1.59, 95% CI = 1.11-2.28, P = 0.012) and a suggestive association of rs752822. Jointly, rs752822 and rs2735839 showed good potentials in risk-stratifying GS 7 patients and predicting disease reclassification (OR = 2.71, 95% CI = 1.62-4.51, P = 1×10(-4) in phase II; HR = 1.89, 95% CI = 1.13-3.18, P = 0.016 in phase III). In summary, rs752822 and rs2735839 may assist in risk-stratifying GS 7 patients and predict prostate cancer reclassification. The significant associations were independent from GS, T stage and PSA levels at baseline.
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Affiliation(s)
- Xiang Shu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yuanqing Ye
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jian Gu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yonggang He
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | | | - Timothy C Thompson
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeri Kim
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xifeng Wu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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221
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Prediction of the Pathologic Gleason Score to Inform a Personalized Management Program for Prostate Cancer. Eur Urol 2016; 72:135-141. [PMID: 27523594 DOI: 10.1016/j.eururo.2016.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/03/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Active surveillance (AS) is an alternative to curative intervention, but overtreatment persists. Imperfect alignment of prostate biopsy and Gleason score after radical prostatectomy (RP) may be a contributing factor. OBJECTIVE To develop a statistical model that predicts the post-RP Gleason score (pathologic Gleason score [PGS]) using clinical observations made in the course of AS. DESIGN, SETTING, AND PARTICIPANTS Repeated prostate-specific antigen measurements and biopsy Gleason scores from 964 very low-risk patients in the Johns Hopkins Active Surveillance cohort were used in the analysis. PGS observations from 191 patients who underwent RP were also included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A Bayesian joint model based on accumulated clinical data was used to predict PGS in these categories: 6 (grade group 1), 3+4 (grade group 2), 4+3 (grade group 3), and 8-10 (grade groups 4 and 5). The area under the receiver operating characteristic curve (AUC) and calibration of predictions was assessed in patients with post-RP Gleason score observations. RESULTS AND LIMITATIONS The estimated probability of harboring a PGS >6 was <20% for most patients who had not experienced grade reclassification or elected surgery. Among patients with post-RP Gleason score observations, the AUC for predictions of PGS >6 was 0.74 (95% confidence interval, 0.66-0.81), and the mean absolute error was 0.022. CONCLUSIONS Although the model requires external validation prior to adoption, PGS predictions can be used in AS to inform decisions regarding follow-up biopsies and remaining on AS. Predictions can be updated as additional data are observed. The joint modeling framework also accommodates novel biomarkers as they are identified and measured on AS patients. PATIENT SUMMARY Measurements taken in the course of active surveillance can be used to accurately predict patients' underlying prostate cancer status. Predictions can be communicated to patients via a decision support tool and used to guide clinical decision making and reduce patient anxiety.
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222
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Prostate cancer outcomes of men with biopsy Gleason score 6 and 7 without cribriform or intraductal carcinoma. Eur J Cancer 2016; 66:26-33. [PMID: 27522247 DOI: 10.1016/j.ejca.2016.07.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/28/2016] [Accepted: 07/10/2016] [Indexed: 11/21/2022]
Abstract
AIM OF THE STUDY Gleason score (GS) 3 + 4 = 7 prostate cancer patients with presence of cribriform or intraductal carcinoma (7(+)) have a worse disease-specific survival than those without. The aim of this study was to compare the clinicopathologic characteristics and patient outcomes of men with biopsy GS 3 + 4 = 7 without cribriform or intraductal carcinoma (7(-)) to those with GS 3 + 3 = 6. MATERIALS AND METHODS We included all patients from the first screening round of the European Randomized Study of Screening for Prostate Cancer (1993-2000) with a revised GS ≤ 3 + 4 = 7 (n = 796) following the 2014 International Society of Urological Pathology criteria. Relations with biochemical recurrence after radical prostatectomy or radiotherapy were analysed using log-rank testing and multivariable Cox regression analysis. RESULTS In total, 486 patients had GS 6 and 310 had GS 7, 54 of whom had GS 7(+) (17%). During a median follow-up of 15 years, biochemical recurrence was seen in 61 (20%) GS 6, 54 (21%) GS 7(-) and 22 (41%) GS 7(+) patients (41%). Both biopsy GS 7(-) and 7(+) patients had significantly higher prostate-specific antigen levels, mean tumour percentage, percentage of positive cores and ≥cT3 than those with GS 6 (all P < .001). GS 7(-) patients did not have a poorer biochemical recurrence-free survival (BCRFS) after radical prostatectomy than GS 6 patients (log-rank P = .13), whereas those with GS 7(+) had (log-rank P = .05). In multivariable analyses, biopsy GS 7(-) was not associated with poorer BCRFS after radical prostatectomy (hazard ratio [HR], 1.3; 95% confidence interval [CI]: 0.67-2.4; P = .47) or radiotherapy (HR, 0.88; 95% CI: 0.51-1.5; P = .63). GS 7(+) was independently associated with poorer BCRFS after radical prostatectomy (HR, 3.0; 95% CI: 1.1-7.8; P = .03), but not after radiotherapy (HR, 1.2; 95% CI: 0.58-2.3; P = .67). CONCLUSIONS Men with biopsy GS 7(-) prostate cancer have similar BCRFS after radical prostatectomy or radiotherapy to those with GS 6 and may be candidates for active surveillance as long as other inclusion criteria such as on PSA and tumour volume are met.
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223
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Knighton AJ, Belnap T, Brunisholz K, Huynh K, Bishoff JT. Using Electronic Health Record Data to Identify Prostate Cancer Patients That May Qualify for Active Surveillance. EGEMS (WASHINGTON, DC) 2016; 4:1220. [PMID: 27683663 PMCID: PMC5019322 DOI: 10.13063/2327-9214.1220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The introduction of the protein-specific antigen (PSA) test in care means that prostate cancer (PCa) is being detected earlier and more frequently. The result of increased screening using PSA, digital rectal examination and awareness of prostate was an increase in the number of men with low risk cancers. Active surveillance has become a viable alternative to immediate treatment with surgery, radiation and other forms of localized treatment. Evidence suggests that there is no significant difference in mortality rates between AS and surgery. In addition, patients may potentially delay other complications associated with surgery, radiation or deprivation therapy. METHODS This quality improvement study using a delivery system science framework describes the electronic identification of AS candidates given an evidence-based identification criteria based upon national guidelines and clinical judgement. The study population (n=649) was drawn from health records of all patients who received a prostate biopsy (n=1731) at Intermountain Healthcare from 1/1/2013 to 12/31/2014. Automated and manual abstraction was performed. Receiver operating characteristic (ROC) analysis was used to compare AS-eligible patients to the actual treatment received to identify potential care improvement opportunities. Among those with complete data, 24.7% of this population (n=160) met "AS-eligible" criteria. 39.1% of the population had not received surgery, radiation or androgen deprivation therapy and were considered as being treated using an AS approach. 9% of AS-eligible patients did not receive AS; 27% of patients who did not meet AS-eligible criteria received AS. Estimated guideline adherence measured using area under the curve was 0.70 (95% CI: 0.66-0.73). Modest variation in criteria parameters for identifying AS-eligible patients did not significantly change estimated adherence levels. CONCLUSION Implementation of evidence-based criteria for detection of AS candidates is feasible using electronic health record data and provides a reasonable basis for delivery system evaluation of practice patterns and for quality improvement.
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224
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Leyh-Bannurah SR, Abou-Haidar H, Dell'Oglio P, Schiffmann J, Tian Z, Heinzer H, Huland H, Graefen M, Budäus L, Karakiewicz PI. Primary Gleason pattern upgrading in contemporary patients with D'Amico low-risk prostate cancer: implications for future biomarkers and imaging modalities. BJU Int 2016; 119:692-699. [PMID: 27367469 DOI: 10.1111/bju.13570] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To retrospectively assess the rate of high-grade primary Gleason upgrading (HGPGU) to primary Gleason pattern 4 or 5 in a contemporary cohort of patients with D'Amico low-risk prostate cancer including those who fulfilled Prostate Cancer Research International Active Surveillance (PRIAS) criteria, and to develop a tool for HGPGU prediction. HGPGU is a contraindication in most active surveillance (AS) and focal therapy protocols. PATIENTS AND METHODS In all, 10 616 patients with localised prostate cancer were treated at a high-volume European tertiary care centre from 2010 to 2015 with radical prostatectomy. Analyses were restricted to 1 819 patients with D'Amico low-risk prostate cancer (17.1%) with prostate-specific antigen (PSA) levels of <10.0 ng/mL, cT1c-cT2a and Gleason score ≤6, and were repeated within 772 of the men (7.3%) who fulfilled the PRIAS criteria for AS (PSA level of ≤10 ng/mL, T1c-T2, Gleason score ≤6, PSA density (PSAD) of <0.2 ng/mL2 , ≤2 positive cores). Uni- and multivariable logistic regression models were fitted, testing predictors of HGPGU. The final logistic regression model was based on the most informative variables. RESULTS There was HGPGU in 88 (4.8%) patients with D'Amico low-risk prostate cancer and in 32 (4.1%) of the subgroup who were PRIAS eligible. Multivariable analysis predicting HGPGU for the patients with D'Amico low-risk yielded three independent predictors: age, PSAD, and clinical tumour stage (P = 0.008, P = 0.005 and P = 0.021, respectively). Within the same patients, the model using all vs the most informative variables resulted in area under the curves (AUCs) of 69.2% and 68.3%, respectively. Multivariable analysis of those who were PRIAS eligible, yielded age and number of positive cores as independent predictors of HGPGU (P = 0.002 and P = 0.049, respectively; AUC 64.9%). CONCLUSIONS The low accuracy (invariably <70%) for HGPGU prediction in both patients with D'Amico low-risk prostate cancer and PRIAS eligibility indicates that these variables have poor predictive ability in contemporary patients. Despite HGPGU being a rare phenomenon, it may have life threatening implications and consequently alternatives such as biomarkers, genetic markers, or imaging modalities at re-biopsy are needed.
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Affiliation(s)
- Sami-Ramzi Leyh-Bannurah
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hiba Abou-Haidar
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Department of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Paolo Dell'Oglio
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jonas Schiffmann
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Hans Heinzer
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Department of Urology, University of Montreal Health Center, Montreal, QC, Canada
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225
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Prognostic Significance of the Disparity Between Biopsy and Pathologic Gleason Score After Radical Prostatectomy in Clinical Candidates for Active Surveillance According to the Royal Marsden Criteria. Clin Genitourin Cancer 2016; 14:e329-33. [DOI: 10.1016/j.clgc.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/29/2015] [Accepted: 01/16/2016] [Indexed: 11/21/2022]
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226
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Gnanapragasam VJ, Lophatananon A, Wright KA, Muir KR, Gavin A, Greenberg DC. Improving Clinical Risk Stratification at Diagnosis in Primary Prostate Cancer: A Prognostic Modelling Study. PLoS Med 2016; 13:e1002063. [PMID: 27483464 PMCID: PMC4970710 DOI: 10.1371/journal.pmed.1002063] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/24/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Over 80% of the nearly 1 million men diagnosed with prostate cancer annually worldwide present with localised or locally advanced non-metastatic disease. Risk stratification is the cornerstone for clinical decision making and treatment selection for these men. The most widely applied stratification systems use presenting prostate-specific antigen (PSA) concentration, biopsy Gleason grade, and clinical stage to classify patients as low, intermediate, or high risk. There is, however, significant heterogeneity in outcomes within these standard groupings. The International Society of Urological Pathology (ISUP) has recently adopted a prognosis-based pathological classification that has yet to be included within a risk stratification system. Here we developed and tested a new stratification system based on the number of individual risk factors and incorporating the new ISUP prognostic score. METHODS AND FINDINGS Diagnostic clinicopathological data from 10,139 men with non-metastatic prostate cancer were available for this study from the Public Health England National Cancer Registration Service Eastern Office. This cohort was divided into a training set (n = 6,026; 1,557 total deaths, with 462 from prostate cancer) and a testing set (n = 4,113; 1,053 total deaths, with 327 from prostate cancer). The median follow-up was 6.9 y, and the primary outcome measure was prostate-cancer-specific mortality (PCSM). An external validation cohort (n = 1,706) was also used. Patients were first categorised as low, intermediate, or high risk using the current three-stratum stratification system endorsed by the National Institute for Health and Care Excellence (NICE) guidelines. The variables used to define the groups (PSA concentration, Gleason grading, and clinical stage) were then used to sub-stratify within each risk category by testing the individual and then combined number of risk factors. In addition, we incorporated the new ISUP prognostic score as a discriminator. Using this approach, a new five-stratum risk stratification system was produced, and its prognostic power was compared against the current system, with PCSM as the outcome. The results were analysed using a Cox hazards model, the log-rank test, Kaplan-Meier curves, competing-risks regression, and concordance indices. In the training set, the new risk stratification system identified distinct subgroups with different risks of PCSM in pair-wise comparison (p < 0.0001). Specifically, the new classification identified a very low-risk group (Group 1), a subgroup of intermediate-risk cancers with a low PCSM risk (Group 2, hazard ratio [HR] 1.62 [95% CI 0.96-2.75]), and a subgroup of intermediate-risk cancers with an increased PCSM risk (Group 3, HR 3.35 [95% CI 2.04-5.49]) (p < 0.0001). High-risk cancers were also sub-classified by the new system into subgroups with lower and higher PCSM risk: Group 4 (HR 5.03 [95% CI 3.25-7.80]) and Group 5 (HR 17.28 [95% CI 11.2-26.67]) (p < 0.0001), respectively. These results were recapitulated in the testing set and remained robust after inclusion of competing risks. In comparison to the current risk stratification system, the new system demonstrated improved prognostic performance, with a concordance index of 0.75 (95% CI 0.72-0.77) versus 0.69 (95% CI 0.66-0.71) (p < 0.0001). In an external cohort, the new system achieved a concordance index of 0.79 (95% CI 0.75-0.84) for predicting PCSM versus 0.66 (95% CI 0.63-0.69) (p < 0.0001) for the current NICE risk stratification system. The main limitations of the study were that it was registry based and that follow-up was relatively short. CONCLUSIONS A novel and simple five-stratum risk stratification system outperforms the standard three-stratum risk stratification system in predicting the risk of PCSM at diagnosis in men with primary non-metastatic prostate cancer, even when accounting for competing risks. This model also allows delineation of new clinically relevant subgroups of men who might potentially receive more appropriate therapy for their disease. Future research will seek to validate our results in external datasets and will explore the value of including additional variables in the system in order in improve prognostic performance.
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Affiliation(s)
- Vincent J. Gnanapragasam
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Artitaya Lophatananon
- Institute of Population Health, University of Manchester, Manchester, United Kingdom
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Karen A. Wright
- National Cancer Registration Service Eastern Office, Public Health England, Cambridge, United Kingdom
| | - Kenneth R. Muir
- Institute of Population Health, University of Manchester, Manchester, United Kingdom
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - David C. Greenberg
- National Cancer Registration Service Eastern Office, Public Health England, Cambridge, United Kingdom
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227
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Loeb S, Folkvaljon Y, Robinson D, Makarov DV, Bratt O, Garmo H, Stattin P. Immediate versus delayed prostatectomy: Nationwide population-based study (.). Scand J Urol 2016; 50:246-54. [PMID: 27067998 PMCID: PMC4979613 DOI: 10.3109/21681805.2016.1166153] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/11/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study was to compare the outcome of immediate versus delayed radical prostatectomy (RP) in men with low-grade prostate cancer. MATERIALS AND METHODS The study included a nationwide population-based cohort in the National Prostate Cancer Register of Sweden, of 7608 men with clinically localized, biopsy Gleason score 6 prostate cancer who underwent immediate or delayed RP in 1997-2007. Multivariable models compared RP pathology, use of salvage radiotherapy and prostate cancer mortality based on timing of RP (< 1, 1-2 or >2 years after diagnosis). Median follow-up was 8.1 years. RESULTS Men undergoing RP more than 2 years after diagnosis had a higher risk of Gleason upgrading [odds ratio 2.93, 95% confidence interval (CI) 2.34-3.68] and an increased risk of salvage radiotherapy [hazard ratio (HR) 1.90, 95% CI 1.41-2.55], but no significant increase in prostate cancer-specific mortality (HR 1.85, 95% CI 0.57-5.99). In competing risk analysis, 7 year prostate cancer-specific cumulative mortality was similar, at less than 1%, for immediate RP and active surveillance regardless of later intervention. Limitations of this study include the lack of data on follow-up biopsies and the limited follow-up time. CONCLUSION Men undergoing RP more than 2 years after diagnosis had more adverse pathological features and second line therapy, highlighting the trade-off in deferring immediate curative therapy. However, men with delayed RP constitute a minority with higher risk cancer among the much larger group of low-risk men initially surveilled, and the overall risk of prostate cancer mortality at 7 years was similarly low with immediate RP or active surveillance.
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Affiliation(s)
- Stacy Loeb
- a New York University and Manhattan Veterans Affairs Medical Center , New York , NY , USA
| | - Yasin Folkvaljon
- b Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital , Uppsala , Sweden
| | - David Robinson
- c Department of Surgery and Perioperative Sciences, Urology and Andrology , Umeå University Hospital , Umeå , Sweden
- d Department of Urology , Ryhov County Hospital , Jönköping , Sweden
| | - Danil V Makarov
- a New York University and Manhattan Veterans Affairs Medical Center , New York , NY , USA
| | - Ola Bratt
- e Department of Urology, CamPARI Clinic , Addenbrooke's Hospital , Cambridge , UK
- f Department of Translational Sciences , Lund University , Lund , Sweden
| | - Hans Garmo
- g Faculty of Life Sciences and Medicine, Division of Cancer Studies , King's College London , London , UK
| | - Pär Stattin
- c Department of Surgery and Perioperative Sciences, Urology and Andrology , Umeå University Hospital , Umeå , Sweden
- h Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
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228
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Analysis of active surveillance uptake for low-risk localized prostate cancer in Canada: a Canadian multi-institutional study. World J Urol 2016; 35:595-603. [PMID: 27447989 DOI: 10.1007/s00345-016-1897-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Although the uptake of active surveillance (AS) appears to be increasing in published series, the uptake in most geographic regions remains largely unknown. Our aim was to examine practice patterns around the use of AS in low-risk prostate cancer in Canada. In addition, we examined regional variations in AS uptake, predictors of AS uptake, and persistent use for 12 months. METHODS This is a retrospective multicentre review of low-risk patients who underwent a prostate biopsy in 2010 in six centres in four provinces (BC, QC, MB and ON). AS was identified based on chart review and required a minimum of 6 months of follow-up after diagnosis without any active treatment. RESULTS Of 986 patients, 781 patients (mean age 64 years) were incident cases and over three-quarters (77.3 %) chose AS at diagnosis. There were significant differences in uptake of AS by centre (range 65.0-98.0 %, p ≤ 0.05). Key multivariate predictors of pursuing AS included older age (OR 1.34, p = 0.044), centre (p = 0.021), lower number of cores (OR 1.09, p = 0.025), lower number of positive biopsy cores (OR 0.52, p < 0.001), and lower percent core involvement (OR 0.84, p < 0.001). In total, 516 (85.4 %) men remained on AS over 12 months. Maintenance with AS over 12 months differed by centre, ranging from 64.1 to 93.9 % (p = 0.001). Predictors of maintenance with AS over 12 months included older age, centre, and lower number of positive cores. CONCLUSIONS Active surveillance is widely practiced across Canada, but important regional differences were observed. Further analyses are required to understand the root causes of differences and to determine whether AS uptake is changing over time.
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229
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Flood TA, Schieda N, Keefe DT, Breau RH, Morash C, Hogan K, Belanger EC, Mai KT, Robertson SJ. Utility of Gleason pattern 4 morphologies detected on transrectal ultrasound (TRUS)-guided biopsies for prediction of upgrading or upstaging in Gleason score 3 + 4 = 7 prostate cancer. Virchows Arch 2016; 469:313-9. [PMID: 27394432 DOI: 10.1007/s00428-016-1981-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/16/2016] [Accepted: 06/27/2016] [Indexed: 01/22/2023]
Abstract
Selected patients with Gleason score (GS) 3 + 4 = 7 prostate cancer (PCa) detected on transrectal ultrasound (TRUS)-guided biopsies may be considered for active surveillance (AS); however, a proportion of these will harbor more aggressive disease. The purpose of this study was to determine if morphologies of Gleason pattern 4 PCa may predict upgrading and/or upstaging after radical prostatectomy (RP). A database search for men with GS 3 + 4 = 7 PCa diagnosed on TRUS-guided biopsy that underwent RP between January 2010 and October 2015 identified 152 patients. Two blinded genitourinary pathologists independently reviewed the biopsies and assessed ill-defined glands (IDG), fused glands, small or large cribriform patterns, and glomerulations. Patient age, serum prostate-specific antigen (PSA), percentage (%) of biopsy sites involved by 3 + 4 = 7 PCa, and overall extent of pattern 4 were also recorded. GS and stage (presence or absence of extraprostatic extension [EPE]) were retrieved from RP reports. Data were compared using independent t tests and chi-square. Inter-observer agreement was calculated using Cohen's Kappa statistic. Percent of biopsy sites and extent of pattern 4 were compared to statistically significant morphologies using the Spearman correlation. 28.3 % (43/152) of patients were upgraded to GS >3 + 4 = 7 at RP (GS 4 + 3 = 7 [N = 17], GS 4 + 3 = 7 with tertiary pattern 5 [N = 25], and GS 4 + 5 = 9 [N = 1]) and 44.1 % (67/152) showed EPE after RP. PSA was associated with both upgrading (8.5 ± 5.4 vs. 6.9 ± 3.2 ng/mL, [p = 0.04]) and EPE (8.2 ± 4.6 vs. 6.7 ± 3.2 ng/mL, [p = 0.03]). IDG, fused glands, and glomerulations were not associated with upgrading or EPE (p > 0.05) with moderate to strong inter-observer agreement (K = 0.76-0.88). There was strong inter-observer agreement for small and large cribriform formations (K = 0.93 and 0.94, respectively) and both patterns were strongly associated with upgrading (p < 0.001) and EPE (p = 0.02) on RP. Strong associations were observed between increasing number of morphologies and both upgrading (p = 0.0.25) and EPE (p < 0.001). Overall extent of pattern 4 was associated with upgrading (p = 0.009) and EPE (p = 0.019) while percent of sites involved by GS 3 + 4 = 7 was only associated with EPE (p = 0.023). Cribriform morphology correlated to percentage of sites with 3 + 4 and overall extent of pattern 4 (rho = 0.25, p = 0.002, rho = 0.20, p = 0.015, respectively). Presence of cribriform morphology on TRUS-guided biopsy is strongly associated with upgrading and upstaging at RP and shows near-perfect inter-observer agreement whereas IDG, fused glands, and glomerulations were not useful. Cribriform morphology may be of importance when considering treatment plans for patients with intermediate risk PCa.
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Affiliation(s)
- Trevor A Flood
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.
| | - Nicola Schieda
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada
| | - Daniel T Keefe
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.,Department of Urology, The Ottawa Hospital, Ottawa, Canada
| | - Rodney H Breau
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.,Department of Urology, The Ottawa Hospital, Ottawa, Canada
| | - Chris Morash
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.,Department of Urology, The Ottawa Hospital, Ottawa, Canada
| | - Kevin Hogan
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada
| | - Eric C Belanger
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada
| | - Kien T Mai
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada
| | - Susan J Robertson
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada
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230
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Langley SEM, Uribe J, Challacombe BJ, Bott SRJ. A practical approach to investigating a man with a raised prostate-specific antigen in the modern era. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816654596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Urologists in the UK are encouraged to follow the National Institute for Health and Care Excellence (NICE) guidelines for patient management. In 2014, members of the British Association of Urological Surgeons (BAUS) were asked in a survey what diagnostic pathway they would follow for themselves or their relatives if they had a raised prostate-specific antigen (PSA). It was found that only a quarter would follow NICE guidance. The current recommendations rely on pathological assessment of prostate tissue obtained at a transrectal ultrasound guided biopsy. Increasing evidence indicates that pre-biopsy multiparametric magnetic resonance imaging (mp-MRI) coupled with targeted biopsy approaches outperform random biopsies in the detection of clinically significant disease. Herein we discuss the role of magnetic resonance imaging and targeted biopsy approaches to diagnose prostate cancer in the modern era.
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Affiliation(s)
- SEM Langley
- St Luke’s Cancer Centre, The Royal Surrey County Hospital National Health Service (NHS) Foundation Trust, UK
| | - J Uribe
- St Luke’s Cancer Centre, The Royal Surrey County Hospital National Health Service (NHS) Foundation Trust, UK
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231
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de Carvalho TM, Heijnsdijk EAM, de Koning HJ. Estimating the risks and benefits of active surveillance protocols for prostate cancer: a microsimulation study. BJU Int 2016; 119:560-566. [PMID: 27222299 DOI: 10.1111/bju.13542] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To estimate the increase in prostate cancer mortality (PCM) and the reduction in overtreatment resulting from different active surveillance (AS) protocols, compared with treating men immediately. PATIENTS AND METHODS We used a microsimulation model (MISCAN-Prostate), with the natural history of prostate cancer based on European Randomized Study of Screening for Prostate Cancer data. We estimated the probabilities of referral to radical treatment while on AS, depending on disease stage, using data from the Johns Hopkins AS cohort. We sampled 10 million men, representative of the US population, and projected the effects of applying AS protocols that differed by time between biopsies and compared these with the effects of treating men immediately. RESULTS We found that AS with yearly follow-up biopsies for men with low-risk prostate cancer (≤ T2a stage and Gleason 6) increases the probability of PCM to 2.6% (1% increase) and reduces overtreatment from 2.5 to 2.1% (18.4% reduction). With biopsies every 3 years after the first year, PCM increases by 2.3% and overtreatment reduces from 2.5 to 1.9% (30.3% reduction). The inclusion of men in the intermediate-risk group (> T2a stage or Gleason 3+4) in AS protocols increases PCM by 2.7% and reduces overtreatment from 2.5 to 2.0% (23.1% reduction). These results may not apply to African-American men. CONCLUSIONS Offering AS to men with low-risk prostate cancer is relatively safe. Increasing the biopsy interval from yearly to up to every 3 years after the first year will significantly reduce overtreatment among men in the low-risk group, with limited PCM risk.
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Affiliation(s)
- Tiago M de Carvalho
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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232
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Winters BR, Wright JL, Holt SK, Lin DW, Ellis WJ, Dalkin BL, Schade GR. Extreme Gleason Upgrading From Biopsy to Radical Prostatectomy: A Population-based Analysis. Urology 2016; 96:148-155. [PMID: 27313123 DOI: 10.1016/j.urology.2016.04.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/14/2016] [Accepted: 04/28/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the risk factors associated with the odds of extreme Gleason upgrading at radical prostatectomy (RP) (defined as a Gleason prognostic group score increase of ≥2), we utilized a large, population-based cancer registry. MATERIALS AND METHODS The Surveillance, Epidemiologic, and End Results database was queried (2010-2011) for all patients diagnosed with Gleason 3 + 3 or 3 + 4 on prostate needle biopsy. Available clinicopathologic factors and the odds of upgrading and extreme upgrading at RP were evaluated using multivariate logistic regression. RESULTS A total of 12,459 patients were identified, with a median age of 61 (interquartile range: 56-65) and a diagnostic prostate-specific antigen (PSA) of 5.5 ng/mL (interquartile range: 4.3-7.5). Upgrading was observed in 34% of men, including 44% of 7402 patients with Gleason 3 + 3 and 19% of 5057 patients with Gleason 3 + 4 disease. Age, clinical stage, diagnostic PSA, and % prostate needle biopsy cores positive were independently associated with odds of any upgrading at RP. In baseline Gleason 3 + 3 disease, extreme upgrading was observed in 6%, with increasing age, diagnostic PSA, and >50% core positivity associated with increased odds. In baseline Gleason 3 + 4 disease, extreme upgrading was observed in 4%, with diagnostic PSA and palpable disease remaining predictive. Positive surgical margins were significantly higher in patients with extreme upgrading at RP (P < .001). CONCLUSION Gleason upgrading at RP is common in this large population-based cohort, including extreme upgrading in a clinically significant portion.
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Affiliation(s)
- Brian R Winters
- Department of Urology, University of Washington School of Medicine, Seattle, WA.
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - William J Ellis
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Bruce L Dalkin
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - George R Schade
- Department of Urology, University of Washington School of Medicine, Seattle, WA
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233
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Fernandez Ots A, Bucci J, Chin YS, Malouf D, Howie A, Enari KE. Hemiablative Focal Low Dose Rate Brachytherapy: A Phase II Trial Protocol. JMIR Res Protoc 2016; 5:e98. [PMID: 27296781 PMCID: PMC4923592 DOI: 10.2196/resprot.5433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The objective of focal brachytherapy (BT) is to provide effective prostate cancer control for low-risk disease but with reduced genitourinary, gastrointestinal and sexual side effects in a cost-effective way. OBJECTIVE The aim of this study is to describe a phase II study examining technical and dosimetric feasibility and toxicity, quality of life changes, and local control with post-treatment biopsy outcomes in men with early stage low volume prostate cancer treated with focal iodine-125 seed BT. METHODS The study design is a prospective, multicenter trial with a planned sample size of 20 patients including men with a minimum age of 60 years, a life expectancy estimated to be greater than 10 years, with low or low-tier intermediate risk prostate cancer, unilateral disease on the biopsy, and a Gleason score of ≤3+4 and <25% cores involved. The investigations specific for the study are multi-parametric magnetic resonance imaging (Mp-MRI) baseline, at 20 and 36 months to rule out high grade disease and a transperineal mapping biopsy (baseline and at 36 months) for more accurate patient selection. The hemigland region will receive 144 Gy. Standard normal tissue constraints will be considered as for a whole gland (WG) implant. Dosimetric parameters will be evaluated at day 30 after the implant. Toxicity and quality of life will be evaluated with international validated questionnaires focusing on urinary, rectal, sexual domain, and general health-related quality of life. The patients will complete this assessment at baseline and then approximately every 6 months after the implant up to 10 years. RESULTS To date, one patient is involved in the trial. He underwent the pre-implant investigations which found bilateral disease. Therefore, a standard seed implant was performed. If the results from this trial provide evidence that the treatment is safe, feasible, and improves toxicity, funding will be sought to conduct a large, multicenter, randomized controlled trial (RCT). CONCLUSIONS This protocol is designed to show feasibility in delivering hemigland focal therapy with seed BT. It may answer crucial questions and obtain data which will enable downstream decisions on focal low dose rate (LDR) prostate BT. CLINICALTRIAL Clinicaltrial.gov NCT02643511; https://www.clinicaltrials.gov/ct2/show/NCT02643511 (Archived by Webcite at http://www.webcitation.org/6ghLCzIhY).
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Affiliation(s)
- Ana Fernandez Ots
- Cancer Care Centre, Radiation Oncology, St George Hospital, Sydney, Australia.
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Taylor KL, Hoffman RM, Davis KM, Luta G, Leimpeter A, Lobo T, Kelly SP, Shan J, Aaronson D, Tomko CA, Starosta AJ, Hagerman CJ, Van Den Eeden SK. Treatment Preferences for Active Surveillance versus Active Treatment among Men with Low-Risk Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2016; 25:1240-50. [PMID: 27257092 DOI: 10.1158/1055-9965.epi-15-1079] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/25/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Due to the concerns about the overtreatment of low-risk prostate cancer, active surveillance (AS) is now a recommended alternative to the active treatments (AT) of surgery and radiotherapy. However, AS is not widely utilized, partially due to psychological and decision-making factors associated with treatment preferences. METHODS In a longitudinal cohort study, we conducted pretreatment telephone interviews (N = 1,140, 69.3% participation) with newly diagnosed, low-risk prostate cancer patients (PSA ≤ 10, Gleason ≤ 6) from Kaiser Permanente Northern California. We assessed psychological and decision-making variables, and treatment preference [AS, AT, and No Preference (NP)]. RESULTS Men were 61.5 (SD, 7.3) years old, 24 days (median) after diagnosis, and 81.1% white. Treatment preferences were: 39.3% AS, 30.9% AT, and 29.7% NP. Multinomial logistic regression revealed that men preferring AS (vs. AT) were older (OR, 1.64; CI, 1.07-2.51), more educated (OR, 2.05; CI, 1.12-3.74), had greater prostate cancer knowledge (OR, 1.77; CI, 1.43-2.18) and greater awareness of having low-risk cancer (OR, 3.97; CI, 1.96-8.06), but also were less certain about their treatment preference (OR, 0.57; CI, 0.41-0.8), had greater prostate cancer anxiety (OR, 1.22; CI, 1.003-1.48), and preferred a shared treatment decision (OR, 2.34; CI, 1.37-3.99). Similarly, men preferring NP (vs. AT) were less certain about treatment preference, preferred a shared decision, and had greater knowledge. CONCLUSIONS Although a substantial proportion of men preferred AS, this was associated with anxiety and uncertainty, suggesting that this may be a difficult choice. IMPACT Increasing the appropriate use of AS for low-risk prostate cancer will require additional reassurance and information, and reaching men almost immediately after diagnosis while the decision-making is ongoing. Cancer Epidemiol Biomarkers Prev; 25(8); 1240-50. ©2016 AACR.
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Affiliation(s)
- Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
| | - Richard M Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine/Iowa City VA Medical Center, Iowa
| | - Kimberly M Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | | | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Scott P Kelly
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Jun Shan
- Division of Research, Kaiser Permanente Northern California
| | - David Aaronson
- Department of Urology, Kaiser Permanente East Bay, Oakland, California
| | - Catherine A Tomko
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Amy J Starosta
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Charlotte J Hagerman
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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Abstract
Prostate cancer is the most common noncutaneous cancer affecting men today. It largely affects men in the fifth and sixth decade of life. Screening for prostate cancer, though controversial, is still the only way to detect early prostate cancer. Multiple newer options such as blood tests and genetic markers are being used in the clinical domain today to improve cancer detection and avoid unnecessary biopsies. To date, biopsy of the prostate remains the only modality to stratify the grade of cancer. Significant improvements in the imaging technology have improved localizing and detecting the disease. Treatment of prostate cancer is stratified on the basis of the grade and volume of the disease. There are multiple treatment options involved in the management of prostate cancer. Treatment of localized prostate cancer still continues to have very high cure rates and long-term cancer-specific survival rates.
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Affiliation(s)
- Nilesh Patil
- Division of Urology, University of Cincinnati, Cincinnati, Ohio
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More Favorable Pathological Outcomes in Men with Low Risk Prostate Cancer Diagnosed on Repeat versus Initial Transrectal Ultrasound Guided Prostate Biopsy. J Urol 2016; 195:1767-72. [DOI: 10.1016/j.juro.2015.12.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/17/2022]
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237
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Kweldam CF, Nieboer D, Algaba F, Amin MB, Berney DM, Billis A, Bostwick DG, Bubendorf L, Cheng L, Compérat E, Delahunt B, Egevad L, Evans AJ, Hansel DE, Humphrey PA, Kristiansen G, van der Kwast TH, Magi-Galluzzi C, Montironi R, Netto GJ, Samaratunga H, Srigley JR, Tan PH, Varma M, Zhou M, van Leenders GJLH. Gleason grade 4 prostate adenocarcinoma patterns: an interobserver agreement study among genitourinary pathologists. Histopathology 2016; 69:441-9. [PMID: 27028587 DOI: 10.1111/his.12976] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/27/2016] [Indexed: 01/02/2023]
Abstract
AIMS To assess the interobserver reproducibility of individual Gleason grade 4 growth patterns. METHODS AND RESULTS Twenty-three genitourinary pathologists participated in the evaluation of 60 selected high-magnification photographs. The selection included 10 cases of Gleason grade 3, 40 of Gleason grade 4 (10 per growth pattern), and 10 of Gleason grade 5. Participants were asked to select a single predominant Gleason grade per case (3, 4, or 5), and to indicate the predominant Gleason grade 4 growth pattern, if present. 'Consensus' was defined as at least 80% agreement, and 'favoured' as 60-80% agreement. Consensus on Gleason grading was reached in 47 of 60 (78%) cases, 35 of which were assigned to grade 4. In the 13 non-consensus cases, ill-formed (6/13, 46%) and fused (7/13, 54%) patterns were involved in the disagreement. Among the 20 cases where at least one pathologist assigned the ill-formed growth pattern, none (0%, 0/20) reached consensus. Consensus for fused, cribriform and glomeruloid glands was reached in 2%, 23% and 38% of cases, respectively. In nine of 35 (26%) consensus Gleason grade 4 cases, participants disagreed on the growth pattern. Six of these were characterized by large epithelial proliferations with delicate intervening fibrovascular cores, which were alternatively given the designation fused or cribriform growth pattern ('complex fused'). CONCLUSIONS Consensus on Gleason grade 4 growth pattern was predominantly reached on cribriform and glomeruloid patterns, but rarely on ill-formed and fused glands. The complex fused glands seem to constitute a borderline pattern of unknown prognostic significance on which a consensus could not be reached.
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Affiliation(s)
| | - Daan Nieboer
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Ferran Algaba
- Department of Pathology, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Mahul B Amin
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dan M Berney
- Department of Cellular Pathology, The Royal London Hospital, London, UK
| | - Athanase Billis
- Department of Anatomical Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | | | - Lukas Bubendorf
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
| | - Liang Cheng
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eva Compérat
- Service d'Anatomie & Cytologie Pathologiques du Pr Capron, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - 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 University Hospital, Stockholm, Sweden
| | - Andrew J Evans
- Department of Pathology & Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Donna E Hansel
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Theodorus H van der Kwast
- Department of Pathology & Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Cristina Magi-Galluzzi
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, Polytechnic University of the Marche Region (Ancona), Ancona, Italy
| | - George J Netto
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - John R Srigley
- Trillium Health Partners, Mississauga and McMaster University, Hamilton, ON, Canada
| | - Puay H Tan
- Department of Pathology, Singapore General Hospital, Singapore
| | - Murali Varma
- Department of Medical Genetics, Haematology and Pathology, Cardiff University, Cardiff, UK
| | - Ming Zhou
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
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Chong JJ, Van Hemelrijck M, Cahill D, Kinsella J. Serial transperineal sector prostate biopsies: impact on long-term erectile dysfunction. Ecancermedicalscience 2016; 10:643. [PMID: 27350788 PMCID: PMC4898939 DOI: 10.3332/ecancer.2016.643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 11/24/2022] Open
Abstract
We wanted to determine whether serial transperineal sector prostate biopsies have a long-term effect on erectile dysfunction (ED). A total of 64 men with prostate cancer entered our active surveillance (AS) programme after a transrectal prostate biopsy as well as a confirmatory initial transperineal sector prostate biopsy (TPSBx). A repeat TPSBx was performed 24 months later as part of our active surveillance protocol. The International Index of Erectile Function-5 (IIEF-5) questionnaire assessed ED at baseline prior to each TPSBx, and at one, three, and six months after first and second TPSBx. There was a significant short-term deterioration in erectile function on mean IIEF-5 score between baseline (19.5), when compared to one month (10.5) (P <0.001) and three months (18.7) (P = 0.001) following first TPSBx. This resolved at six month follow-up (19.6) (P = 0.681). Following second TPSBx, there was a deterioration in erectile function between baseline (16.6), compared to one month (7.3), three months (13.8), and six months (15.9) (P <0.05) following second TPSBx. Initial TPSBx caused significant short-term ED, which resolved by six months. Serial TPSBx appears to have an adverse impact on erectile function in men monitored on AS, increasing the risk of long-term ED. This risk should be highlighted and discussed during the consent process.
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Affiliation(s)
- James Jy Chong
- Faculty of Life Sciences and Medicine, King's College London, London SE1 1UL, UK
| | - Mieke Van Hemelrijck
- Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, King's College London, London SE1 9RT, UK
| | - Declan Cahill
- Department of Urology, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Janette Kinsella
- Department of Urology, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
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Hurwitz LM, Cullen J, Elsamanoudi S, Kim DJ, Hudak J, Colston M, Travis J, Kuo HC, Porter CR, Rosner IL. A prospective cohort study of treatment decision-making for prostate cancer following participation in a multidisciplinary clinic. Urol Oncol 2016; 34:233.e17-25. [DOI: 10.1016/j.urolonc.2015.11.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/25/2015] [Accepted: 11/14/2015] [Indexed: 01/22/2023]
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Kim EH, Andriole GL. Editorial Comment. Urology 2016; 91:17. [DOI: 10.1016/j.urology.2015.12.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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242
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Kendel F, Helbig L, Neumann K, Herden J, Stephan C, Schrader M, Gaissmaier W. Patients' perceptions of mortality risk for localized prostate cancer vary markedly depending on their treatment strategy. Int J Cancer 2016; 139:749-53. [PMID: 27038059 DOI: 10.1002/ijc.30123] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/18/2016] [Accepted: 03/14/2016] [Indexed: 12/11/2022]
Abstract
Treatment choice for localized prostate cancer (PCa) is a controversial issue, and mortality risk is probably the most decisive factor in this regard. The study aimed to compare prostate-cancer-specific mortality risk estimates for different treatment options assigned by patients managed with active surveillance (AS), radical prostatectomy (RP) and patients who had discontinued AS (DAS). Patients initially managed with AS or RP (N = 370) were matched according to length of therapy. All patients completed mailed questionnaires assessing their mortality risk estimates (in %) and prostate-cancer-specific anxiety. Differences in risk estimates among the three treatment groups were analyzed using ANOVA, relationships of clinical and psychosocial variables with risk estimates using standard multiple regression. In all treatment groups, the prostate- cancer-specific mortality risk was overestimated. This applied whether it was the patient's own treatment or the alternative treatment option. RP patients assigned a mortality risk to AS that was almost three times higher than that assigned to RP (50.9 ± 25.0 vs. 17.8 ± 19.7, d = 1.48; p < 0.001). Anxiety was significantly associated with risk estimates for AS (p = 0.008) and RP (p = 0.001). Compared with clinical data that suggest that the prostate-cancer-specific mortality risk for AS is low and does not significantly differ from that for RP, patients strongly overestimated the mortality risk. This was most markedly so in RP patients, who drastically overestimated the benefits of RP compared to the risk of AS. This overestimation could increase overtreatment and should therefore be corrected by better patient education.
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Affiliation(s)
- Friederike Kendel
- Institute of Medical Psychology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Lukas Helbig
- Institute of Medical Psychology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Konrad Neumann
- Institute of Medical Biometrics and Clinical Epidemiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Jan Herden
- Department of Urology, University of Cologne, Köln, Germany
| | - Carsten Stephan
- Department of Urology, Charité - Universitaetsmedizin Berlin and Berlin Institute for Urologic Research, Berlin, Germany
| | - Mark Schrader
- Department of Urology, HELIOS Clinic Berlin-Buch, Berlin, Germany
| | - Wolfgang Gaissmaier
- Department of Social Psychology and Decision Sciences, University of Konstanz, Konstanz, Germany
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243
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Bosco C, Cozzi G, Kinsella J, Bianchi R, Acher P, Challacombe B, Popert R, Brown C, George G, Van Hemelrijck M, Cahill D. Confirmatory biopsy for the assessment of prostate cancer in men considering active surveillance: reference centre experience. Ecancermedicalscience 2016; 10:633. [PMID: 27170833 PMCID: PMC4854226 DOI: 10.3332/ecancer.2016.633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To evaluate how accurate a 12-core transrectal biopsy derived low-risk prostate cancer diagnosis is for an active surveillance programme by comparing the histological outcome with that from confirmatory transperineal sector biopsy. SUBJECTS AND METHODS The cohort included 166 men diagnosed with low volume Gleason score 3+3 prostate cancer on initial transrectal biopsy who also underwent a confirmatory biopsy. Both biopsy techniques were performed according to standard protocols and samples were taken for histopathology analysis. Subgroup analysis was performed according to disease severity at baseline to determine possible disease parameters of upgrading at confirmatory biopsy. RESULTS After confirmatory biopsy, 34% demonstrated Gleason score upgrade, out of which 25% were Gleason score 3+4 and 8.5% primary Gleason pattern 4. Results remained consistent for the subgroup analysis and a weak positive association, but not statistically significant, between prostate specific antigen (PSA), age, and percentage of positive cores, and PCa upgrading at confirmatory biopsy was found. CONCLUSION In our single centre study, we found that one-third of patients had higher Gleason score at confirmatory biopsy. Furthermore 8.5% of these upgraders had a primary Gleason pattern 4. Our results together with previously published evidence highlight the need for the revision of current guidelines in prostate cancer diagnosis for the selection of men for active surveillance.
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Affiliation(s)
- Cecilia Bosco
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK
| | - Gabriele Cozzi
- European Institute of Urology, Division of Urology, Milan, Italy
| | - Janette Kinsella
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, London SE1 9RT, UK
| | - Roberto Bianchi
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, London SE1 9RT, UK
| | - Peter Acher
- Southend University Hospital NHS Foundation Trust, Southend SS0 0RY, UK
| | | | - Rick Popert
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, London SE1 9RT, UK
| | - Christian Brown
- King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Gincy George
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, London SE1 9RT, UK
| | - Mieke Van Hemelrijck
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK
| | - Declan Cahill
- Guy’s and St Thomas’ Hospital NHS Foundation Trust, London SE1 9RT, UK
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Kelly SP, Van Den Eeden SK, Hoffman RM, Aaronson DS, Lobo T, Luta G, Leimpter AD, Shan J, Potosky AL, Taylor KL. Sociodemographic and Clinical Predictors of Switching to Active Treatment among a Large, Ethnically Diverse Cohort of Men with Low Risk Prostate Cancer on Observational Management. J Urol 2016; 196:734-40. [PMID: 27091570 DOI: 10.1016/j.juro.2016.04.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE We determined the clinical and sociodemographic predictors of beginning active treatment in an ethnically diverse population of men with low risk prostate cancer initially on observational treatment. MATERIALS AND METHODS We retrospectively studied men diagnosed with low risk prostate cancer between 2004 and 2012 at Kaiser Permanente Northern California who did not receive any treatment within the first year of diagnosis and had at least 2 years of followup. We used Cox proportional hazards regression models to determine factors associated with time from diagnosis to active treatment. RESULTS We identified 2,228 eligible men who were initially on observation, of whom 27% began active treatment during followup at a median of 2.9 years. NonHispanic black men were marginally more likely to begin active treatment than nonHispanic white men independent of baseline and followup clinical measures (HR 1.3, 95% CI 1.0-1.7). Among men who remained on observation nonHispanic black men were rebiopsied within 24 months of diagnosis at a slightly lower rate than nonHispanic white men (HR 0.70, 95% CI 0.6-1.0). Gleason grade progression (HR 3.3, 95% CI 2.7-4.1) and PSA doubling time less than 48 months (HR 2.9, 95% CI 2.3-3.7) were associated with initiation of active treatment independent of race. CONCLUSIONS Sociodemographic factors such as ethnicity and education may independently influence the patient decision to pursue active treatment and serial biopsies during active surveillance. These factors are important for further studies of prostate cancer treatment decision making.
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Affiliation(s)
- Scott P Kelly
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C..
| | - Stephen K Van Den Eeden
- Department of Urology, Kaiser Oakland Medical Center, Northern California, Oakland, California
| | - Richard M Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - David S Aaronson
- Department of Urology, Kaiser Oakland Medical Center, Northern California, Oakland, California
| | - Tania Lobo
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
| | - Amethyst D Leimpter
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jun Shan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Arnold L Potosky
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
| | - Kathryn L Taylor
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
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Salido-Guadarrama AI, Morales-Montor JG, Rangel-Escareño C, Langley E, Peralta-Zaragoza O, Cruz Colin JL, Rodriguez-Dorantes M. Urinary microRNA-based signature improves accuracy of detection of clinically relevant prostate cancer within the prostate-specific antigen grey zone. Mol Med Rep 2016; 13:4549-60. [PMID: 27081843 PMCID: PMC4878542 DOI: 10.3892/mmr.2016.5095] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/15/2016] [Indexed: 12/19/2022] Open
Abstract
At present, prostate-specific antigen (PSA) is used as a clinical biomarker for prostate cancer (PCa) diagnosis; however, a large number of patients with benign prostate hyperplasia (BPH) with PSA levels in the ʻgray areaʼ (4–10 ng/ml) are currently subjected to unnecessary biopsy due to overdiagnosis. Certain microRNAs (miRs) have been proven to be useful biomarkers, several of which are detectable in bodily fluids. The present study identified and validated a urinary miR-based signature to enhance the specificity of PCa diagnosis and to reduce the number of patients with benign conditions undergoing biopsy. Seventy-three urine samples from Mexican patients with diagnosis of PCa with a Gleason score ≥7 and 70 patients diagnosed with BPH were collected after digital rectal examination (DRE) of the prostate. miR expression profiles were determined using TaqMan Low Density Array experiments, and normalized Ct values for the miRs were compared between PCa and BPH groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate whether miR detection in urine is suitable for distinguishing patients with PCa from those with BPH. The identified miR-100/200b signature was significantly correlated with PCa. Using a multivariable logistic regression approach, a base model including the clinical variables age, prostate-specific antigen (PSA), the percentage of free PSA and DRE was generated, and a second base model additionally contained the miR-100/200b signature. ROC analysis demonstrated that the combined model significantly outperformed the capacity of PSA (P<0.001) and the base model (P=0.01) to discriminate between PCa and BPH patients. In terms of evaluation of the sub-group of patients in the gray zone of PSA levels, the performance of the combined model for predicting PCa cases was significantly superior to PSA level determination (P<0.001) and the base model (P=0.009). In addition, decision curve analysis demonstrated that the use of the combined model increased the clinical benefit for patients and produced a substantial reduction in unnecessary biopsies across a range of reasonable threshold probabilities (10–50%). Detection of the urinary miR signature identified in the present study as part of clinical diagnostic procedures will enhance the accuracy of PCa diagnosis and provide a clinical benefit for patients with BPH by sparing them from undergoing invasive biopsy. To the best of our knowledge, the present study was the first to describe the profiling of urinary miR100 and miR-200b levels for the clinical diagnosis of PCa.
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Affiliation(s)
| | | | - Claudia Rangel-Escareño
- Computational Genomics, The National Institute of Genomic Medicine, Mexico City 14610, Mexico
| | - Elizabeth Langley
- Department of Basic Research, National Institute of Cancerology, Mexico City 14080, Mexico
| | - Oscar Peralta-Zaragoza
- Division of Chronic Infections and Cancer, Research Center in Infection Diseases, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Jose Luis Cruz Colin
- Oncogenomics Laboratory, The National Institute of Genomic Medicine, Mexico City 14610, Mexico
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Almeida GL, Petralia G, Ferro M, Ribas CAPM, Detti S, Jereczek-Fossa BA, Matei DV, Coman I, De Cobelli O, Tagliabue E. Role of Multi-Parametric Magnetic Resonance Image and PIRADS Score in Patients with Prostate Cancer Eligible for Active Surveillance According PRIAS Criteria. Urol Int 2016; 96:459-69. [PMID: 27045167 DOI: 10.1159/000444197] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/21/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the prognostic role of multiparametric-MRI (mp-MRI) in patients with clinically localized prostate cancer (PCa) eligible for active surveillance (AS) according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. PATIENTS AND METHODS We analyzed prospectively 73 patients with PCa and PRIAS criteria for low-risk disease. All patients fitted criteria for AS but optioned surgery treatment. The mp-MRI was performed to define the likelihood of malignancy according to the Prostate Imaging Reporting and Data System (PIRADS) score (1-5). Patients were divided in 2 groups: non-visible cancer lesion on MRI (PIRADS 2-3) and visible cancer (PIRADS 4-5). Preoperative clinical data (age, body mass index, prostate specific antigen (PSA) level, positive core biopsy, PSA density (PSAD)) and definitive pathological findings (staging, upgrading, unfavorable disease) were compared between groups. PIRADS score was correlated with pathological data to evaluate the prognostic role of mp-MRI; and preoperative variables and definitive pathology (upgrading, upstaging and unfavorable disease) were also assessed. RESULTS PSAD (p = 0.04) and pathological stage (p = 0.03) were significantly associated with the presence of visible disease. Visible disease was significantly associated with upstaging (p = 0.03). Correlation between PIRADS 5 and unfavorable disease was statistically significant (p = 0.02). The mp-MRI had adequate sensibility in detecting upstaging (92%), intermediate for upgrading (76%) and unfavorable disease (76%). Negative predictive value was higher for upstaging than for upgrading or unfavorable disease (96 vs. 68% and 64%). Multivariate logistic regression revealed that PIRADS 5 was a significant predictor of upstaging (p = 0.05, OR 16.12) and unfavorable disease (p = 0.01, OR 6.53). CONCLUSION A visible lesion on mp-MRI strongly predicts significant PCa in patients eligible for AS according to PRIAS criteria, based on upstaging and unfavorable disease. We believe that mp-MRI is an important tool and should be added to clinical selection criteria for AS.
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247
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Ramsay CR, Adewuyi TE, Gray J, Hislop J, Shirley MDF, Jayakody S, MacLennan G, Fraser C, MacLennan S, Brazzelli M, N'Dow J, Pickard R, Robertson C, Rothnie K, Rushton SP, Vale L, Lam TB. Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-490. [PMID: 26140518 DOI: 10.3310/hta19490] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND For people with localised prostate cancer, active treatments are effective but have significant side effects. Minimally invasive treatments that destroy (or ablate) either the entire gland or the part of the prostate with cancer may be as effective and cause less side effects at an acceptable cost. Such therapies include cryotherapy, high-intensity focused ultrasound (HIFU) and brachytherapy, among others. OBJECTIVES This study aimed to determine the relative clinical effectiveness and cost-effectiveness of ablative therapies compared with radical prostatectomy (RP), external beam radiotherapy (EBRT) and active surveillance (AS) for primary treatment of localised prostate cancer, and compared with RP for salvage treatment of localised prostate cancer which has recurred after initial treatment with EBRT. DATA SOURCES MEDLINE (1946 to March week 3, 2013), MEDLINE In-Process & Other Non-Indexed Citations (29 March 2013), EMBASE (1974 to week 13, 2013), Bioscience Information Service (BIOSIS) (1956 to 1 April 2013), Science Citation Index (1970 to 1 April 2013), Cochrane Central Register of Controlled Trials (CENTRAL) (issue 3, 2013), Cochrane Database of Systematic Reviews (CDSR) (issue 3, 2013), Database of Abstracts of Reviews of Effects (DARE) (inception to March 2013) and Health Technology Assessment (HTA) (inception to March 2013) databases were searched. Costs were obtained from NHS sources. REVIEW METHODS Evidence was drawn from randomised controlled trials (RCTs) and non-RCTs, and from case series for the ablative procedures only, in people with localised prostate cancer. For primary therapy, the ablative therapies were cryotherapy, HIFU, brachytherapy and other ablative therapies. The comparators were AS, RP and EBRT. For salvage therapy, the ablative therapies were cryotherapy and HIFU. The comparator was RP. Outcomes were cancer related, adverse effects (functional and procedural) and quality of life. Two reviewers extracted data and carried out quality assessment. Meta-analysis used a Bayesian indirect mixed-treatment comparison. Data were incorporated into an individual simulation Markov model to estimate cost-effectiveness. RESULTS The searches identified 121 studies for inclusion in the review of patients undergoing primary treatment and nine studies for the review of salvage treatment. Cryotherapy [3995 patients; 14 case series, 1 RCT and 4 non-randomised comparative studies (NRCSs)], HIFU (4000 patients; 20 case series, 1 NRCS) and brachytherapy (26,129 patients; 2 RCTs, 38 NRCSs) studies provided limited data for meta-analyses. All studies were considered at high risk of bias. There was no robust evidence that mortality (4-year survival 93% for cryotherapy, 99% for HIFU, 91% for EBRT) or other cancer-specific outcomes differed between treatments. For functional and quality-of-life outcomes, the paucity of data prevented any definitive conclusions from being made, although data on incontinence rates and erectile dysfunction for all ablative procedures were generally numerically lower than for non-ablative procedures. The safety profiles were comparable with existing treatments. Studies reporting the use of focal cryotherapy suggested that incontinence rates may be better than for whole-gland treatment. Data on AS, salvage treatment and other ablative therapies were too limited. The cost-effectiveness analysis confirmed the uncertainty from the clinical review and that there is no technology which appears superior, on the basis of current evidence, in terms of average cost-effectiveness. The probabilistic sensitivity analyses suggest that a number of ablative techniques are worthy of further research. LIMITATIONS The main limitations were the quantity and quality of the data available on cancer-related outcomes and dysfunction. CONCLUSIONS The findings indicate that there is insufficient evidence to form any clear recommendations on the use of ablative therapies in order to influence current clinical practice. Research efforts in the use of ablative therapies in the management of prostate cancer should now be concentrated on the performance of RCTs and the generation of standardised outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002461. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Joanne Gray
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Jenni Hislop
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark D F Shirley
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | | | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sara MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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Tosoian JJ, Sundi D, Trock BJ, Landis P, Epstein JI, Schaeffer EM, Carter HB, Mamawala M. Pathologic Outcomes in Favorable-risk Prostate Cancer: Comparative Analysis of Men Electing Active Surveillance and Immediate Surgery. Eur Urol 2016; 69:576-581. [DOI: 10.1016/j.eururo.2015.09.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022]
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Abusamra A, Murshid E, Kushi H, Alkhateeb S, Al-Mansour M, Saadeddin A, Rabah D, Bazarbashi S, Alotaibi M, Alghamdi A, Alghamdi K, Alsharm A, Ahmad I. Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer. Urol Ann 2016; 8:123-30. [PMID: 27141178 PMCID: PMC4839225 DOI: 10.4103/0974-7796.176872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/15/2015] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7(th) edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.
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Affiliation(s)
- Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Hussain Kushi
- Department of Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmad Saadeddin
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Oncology, Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Medical Military Center, Riyadh, Saudi Arabia
| | - Khalid Alghamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Scarpato KR, Barocas DA. Use of mpMRI in active surveillance for localized prostate cancer. Urol Oncol 2016; 34:320-5. [PMID: 27036218 DOI: 10.1016/j.urolonc.2016.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/21/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In an effort to limit prostate cancer (PCa) overdiagnosis and overtreatment, which have occurred in response to widespread prostate specific antigen testing, numerous strategies aimed at improved risk stratification of patients with PCa have evolved. Multiparametric magnetic resonance imaging (MRI) is being used in concert with prostate specific antigen testing and prostate biopsies to improve sensitivity and specificity of these tests. There are limited data on how multiparametric MRI can be incorporated into active surveillance (AS) protocols. EVIDENCE ACQUISITION A PubMed literature search of available English language publications on PCa, AS, and MRI was conducted. Appropriate articles were selected and included for review. Bibliographies were also used to expand our search. EVIDENCE SYNTHESIS Data from 41 studies were reviewed. AS inclusion criteria and protocols varied among studies, as did indications for use of MRI. Technological improvements are briefly highlighted. Studies are broadly categorized and discussed according to the role of MRI in patient selection, disease staging, and monitoring in AS protocols. CONCLUSIONS Although improvements in MRI technology have been useful for biopsy guidance and in the diagnosis and staging of PCa, this literature search demonstrates that more prospective research is needed, specifically regarding how this promising technology can be incorporated into AS protocols.
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Affiliation(s)
- Kristen R Scarpato
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville TN 37232.
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville TN 37232
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