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Mullane P, Williamson SR, Sangoi AR. Topline/Final Diagnostic Inclusion of Relevant Histologic Findings in Surgical Pathology Reporting of Carcinoma in Prostate Biopsies. Int J Surg Pathol 2024:10668969241231972. [PMID: 38504649 DOI: 10.1177/10668969241231972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
INTRODUCTION As the list of histologic parameters to include in surgical pathology reports of prostate cancer biopsies grows, some pathologists include this information in the microscopic description or summary sections of the report, whereas others include it in the "topline" or final diagnosis section. This prompted us to develop a multi-institutional survey to assess reporting trends among genitourinary (GU) pathologists. METHODS A survey instrument was shared among 110 GU pathologists via surveymonkey.com. Anonymized respondent data was analyzed. RESULTS Eighty-four (76%) participants completed the survey across four continents. Most participants report tumor volume quantitation (88%), number of cores involved (89%), and both Gleason grade and Grade group (93%) in their topline; 71% include percent of pattern 4, with another 16% including it depending on cancer grade; 58% include the presence of cribriform growth pattern 4, with another 11% including it depending on cancer grade. When present, most include extraprostatic extension (90%), prostatic intraductal carcinoma (77%), and perineural invasion (77%). Inclusion of atypical intraductal proliferation (AIP) in the topline diagnosis was cancer grade-dependent, with 74% including AIP in Grade group 1, 61% in Grade group 2, 45% in Grade group 3, 30% in Grade group 4, and 26% in Grade group 5 cancers. CONCLUSION Certain histologic features such as Gleason grade and tumor volume/cores involved are frequently included in the topline diagnosis, whereas the incorporation of other findings are more variably included. Prostate biopsy reporting remains a dynamic process with stylistic similarities and differences existing among GU pathologists.
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Affiliation(s)
- Patrick Mullane
- Department of Pathology, Stanford Medical Center, Stanford, CA, USA
| | | | - Ankur R Sangoi
- Department of Pathology, Stanford Medical Center, Stanford, CA, USA
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Zhuang H, Chatterjee A, Fan X, Qi S, Qian W, He D. A radiomics based method for prediction of prostate cancer Gleason score using enlarged region of interest. BMC Med Imaging 2023; 23:205. [PMID: 38066434 PMCID: PMC10709874 DOI: 10.1186/s12880-023-01167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is one of the most common cancers in men worldwide, and its timely diagnosis and treatment are becoming increasingly important. MRI is in increasing use to diagnose cancer and to distinguish between non-clinically significant and clinically significant PCa, leading to more precise diagnosis and treatment. The purpose of this study is to present a radiomics-based method for determining the Gleason score (GS) for PCa using tumour heterogeneity on multiparametric MRI (mp-MRI). METHODS Twenty-six patients with biopsy-proven PCa were included in this study. The quantitative T2 values, apparent diffusion coefficient (ADC) and signal enhancement rates (α) were calculated using multi-echo T2 images, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI), for the annotated region of interests (ROI). After texture feature analysis, ROI range expansion and feature filtering was performed. Then obtained data were put into support vector machine (SVM), K-Nearest Neighbor (KNN) and other classifiers for binary classification. RESULTS The highest classification accuracy was 73.96% for distinguishing between clinically significant (Gleason 3 + 4 and above) and non-significant cancers (Gleason 3 + 3) and 83.72% for distinguishing between Gleason 3 + 4 from Gleason 4 + 3 and above, which was achieved using initial ROIs drawn by the radiologists. The accuracy improved when using expanded ROIs to 80.67% using SVM and 88.42% using Bayesian classification for distinguishing between clinically significant and non-significant cancers and Gleason 3 + 4 from Gleason 4 + 3 and above, respectively. CONCLUSIONS Our results indicate the research significance and value of this study for determining the GS for prostate cancer using the expansion of the ROI region.
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Affiliation(s)
- Haoming Zhuang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Aritrick Chatterjee
- Department of Radiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Xiaobing Fan
- Department of Radiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Wei Qian
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Dianning He
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.
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Kamecki H, Mielczarek Ł, Szempliński S, Dębowska M, Rajwa P, Baboudjian M, Klemm J, Rivas JG, Modzelewska E, Tayara O, Malewski W, Szostek P, Poletajew S, Kryst P, Sosnowski R, Nyk Ł. Quantification of Gleason Pattern 4 at MRI-Guided Biopsy to Predict Adverse Pathology at Radical Prostatectomy in Intermediate-Risk Prostate Cancer Patients. Cancers (Basel) 2023; 15:5462. [PMID: 38001723 PMCID: PMC10670701 DOI: 10.3390/cancers15225462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/28/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Data on Gleason pattern 4 (GP4) amount in biopsy tissue is important for prostate cancer (PC) risk assessment. We aim to investigate which GP4 quantification method predicts adverse pathology (AP) at radical prostatectomy (RP) the best in men diagnosed with intermediate-risk (IR) PC at magnetic resonance imaging (MRI)-guided biopsy. METHODS We retrospectively included 123 patients diagnosed with IR PC (prostate-specific antigen <20 ng/mL, grade group (GG) 2 or 3, no iT3 on MRI) at MRI-guided biopsy, who underwent RP. Twelve GP4 amount-related parameters were developed, based on GP4 quantification method (absolute, relative to core, or cancer length) and site (overall, targeted, systematic biopsy, or worst specimen). Additionally, we calculated PV×GP4 (prostate volume × GP4 relative to core length in overall biopsy), aiming to represent the total GP4 volume in the prostate. The associations of GP4 with AP (GG ≥ 4, ≥pT3a, or pN1) were investigated. RESULTS AP was reported in 39 (31.7%) of patients. GP4 relative to cancer length was not associated with AP. Of the 12 parameters, the highest ROC AUC value was seen for GP4 relative to core length in overall biopsy (0.65). an even higher AUC value was noted for PV × GP4 (0.67), with a negative predictive value of 82.8% at the optimal threshold. CONCLUSIONS The lack of an association of GP4 relative to cancer length with AP, contrasted with the better performance of other parameters, indicates directions for future research on PC risk stratification to accurately identify patients who may not require immediate treatment. Incorporating formulas aimed at GP4 volume assessment may lead to obtaining models with the best discrimination ability.
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Affiliation(s)
- Hubert Kamecki
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Łukasz Mielczarek
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Stanisław Szempliński
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Małgorzata Dębowska
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109 Warsaw, Poland
| | - Paweł Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | | | - Jakob Klemm
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Juan Gómez Rivas
- Department of Urology, Hospital Clinico San Carlos, 28040 Madrid, Spain
| | - Elza Modzelewska
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Omar Tayara
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Wojciech Malewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Przemysław Szostek
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Roman Sosnowski
- Department of Urology and Oncological Urology, Warmian-Masurian Cancer Center, 10-228 Olsztyn, Poland
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
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Abstract
When multiple cores are biopsied from a single magnetic resonance imaging (MRI)-targeted lesion, Gleason grade may be assigned for each core separately or for all cores of the lesion in aggregate. Because of the potential for disparate grades, an optimal method for pathology reporting MRI lesion grade awaits validation. We examined our institutional experience on the concordance of biopsy grade with subsequent radical prostatectomy (RP) grade of targeted lesions when grade is determined on individual versus aggregate core basis. For 317 patients (with 367 lesions) who underwent MRI-targeted biopsy followed by RP, targeted lesion grade was assigned as (1) global Grade Group (GG), aggregated positive cores; (2) highest GG (highest grade in single biopsy core); and (3) largest volume GG (grade in the core with longest cancer linear length). The 3 biopsy grades were compared (equivalence, upgrade, or downgrade) with the final grade of the lesion in the RP, using κ and weighted κ coefficients. The biopsy global, highest, and largest GGs were the same as the final RP GG in 73%, 68%, 62% cases, respectively (weighted κ: 0.77, 0.79, and 0.71). For cases where the targeted lesion biopsy grade scores differed from each other when assigned by global, highest, and largest GG, the concordance with the targeted lesion RP GG was 69%, 52%, 31% for biopsy global, highest, and largest GGs tumors (weighted κ: 0.65, 0.68, 0.59). Overall, global, highest, and largest GG of the targeted biopsy show substantial agreement with RP-targeted lesion GG, however targeted global GG yields slightly better agreement than either targeted highest or largest GG. This becomes more apparent in nearly one third of cases when each of the 3 targeted lesion level biopsy scores differ. These results support the use of global (aggregate) GG for reporting of MRI lesion-targeted biopsies, while further validations are awaited.
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Diamand R, Ploussard G, Roumiguié M, Malavaud B, Oderda M, Gontero P, Fourcade A, Fournier G, Benamran D, Iselin C, Fiard G, Descotes JL, Peltier A, Simone G, Roche JB, Roumeguère T, Albisinni S. Stratifying patients with intermediate-risk prostate cancer: Validation of a new model based on MRI parameters and targeted biopsy and comparison with NCCN and AUA subclassifications. Urol Oncol 2020; 39:296.e1-296.e9. [PMID: 33041188 DOI: 10.1016/j.urolonc.2020.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/10/2020] [Accepted: 08/23/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Intermediate-risk prostate cancer regroups heterogeneous patients with different oncologic outcomes. Aim of the study is to validate a novel intermediate-risk subclassification ("magnetic resonance imaging [MRI] subclassification") that defines favorable and unfavorable diseases based on multiparametric MRI parameters and compare it to NCCN and AUA intermediate-risk subclassifications. METHODS A total of 429 patients treated with radical prostatectomy for NCCN intermediate-risk prostate cancer were identified. Using MRI subclassification, a favorable disease was defined as an organ-confined disease on MRI and international society of urological pathology Grade Group 1 to 2 on targeted biopsy. Remaining was classified as unfavorable. Univariable and multivariable analysis tested MRI subclassification in predicting overall unfavorable disease (OUD: pT3-4 and/or pN1 and/or International Society of Urological Pathology Grade Group ≥ 3), the need for adjuvant therapy and early biochemical recurrence (eBCR). Performance of NCCN, AUA, and MRI models was compared in term of OUD proportion and eBCR prediction using Harrell's c-index, calibrations plots, and decision curve analysis. RESULTS Median (interquartile range) follow-up was 12 months (4-28). In multivariable analysis, MRI subclassification was an independent factor for OUD (odds ratio [OR]: 4.54 [2.85-7.22], P < 0.001), the need for adjuvant therapy (OR: 3.42 [1.36-8.57], P = 0.009), and eBCR (HR: 2.62 [1.18-5.83], P = 0.018). Using this model, the proportion of unfavorable disease decreased from 73.7% and 63.9% to 35.9% (P < 0.001) associated to an increasing proportion of OUD when compared to NCCN and AUA models (63.9% and 67.1%-77.9% respectively, P < 0.001). Performance of the 3 models for eBCR prediction tended to be similar with a poor accuracy ranged from 58.7% to 66.7% (P > 0.05), permanent miscalibration and a net benefit at decision curve analysis. CONCLUSIONS We validated an intermediate-risk subclassification based on MRI and targeted biopsy that potentially improves patient selection by reducing the number of patients considered at unfavorable risk while increasing proportion of patients harboring poor oncologic outcomes. Its performance for eBCR detection was comparable to NCCN and AUA models.
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Affiliation(s)
- Romain Diamand
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Brussels, Belgium.
| | | | | | - Bernard Malavaud
- Urology Department, Institut Universitaire du Cancer Toulouse - Oncopôle, Toulouse, France
| | - Marco Oderda
- Urology Department, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Department, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Georges Fournier
- Urology Department, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Daniel Benamran
- Urology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Christophe Iselin
- Urology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Gaelle Fiard
- Urology Department, CHU de Grenoble, Grenoble, France; Grenoble Alpes University, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Jean-Luc Descotes
- Urology Department, CHU de Grenoble, Grenoble, France; Grenoble Alpes University, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Giuseppe Simone
- Urology Department, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Thierry Roumeguère
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Brussels, Belgium
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Cooperberg MR, Zheng Y, Faino AV, Newcomb LF, Zhu K, Cowan JE, Brooks JD, Dash A, Gleave ME, Martin F, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Carroll PR, Lin DW. Tailoring Intensity of Active Surveillance for Low-Risk Prostate Cancer Based on Individualized Prediction of Risk Stability. JAMA Oncol 2020; 6:e203187. [PMID: 32852532 PMCID: PMC7453344 DOI: 10.1001/jamaoncol.2020.3187] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Active surveillance is increasingly recognized as the preferred standard of care for men with low-risk prostate cancer. However, active surveillance requires repeated assessments, including prostate-specific antigen tests and biopsies that may increase anxiety, risk of complications, and cost. Objective To identify and validate clinical parameters that can identify men who can safely defer follow-up prostate cancer assessments. Design, Setting, and Participants The Canary Prostate Active Surveillance Study (PASS) is a multicenter, prospective active surveillance cohort study initiated in July 2008, with ongoing accrual and a median follow-up period of 4.1 years. Men with prostate cancer managed with active surveillance from 9 North American academic medical centers were enrolled. Blood tests and biopsies were conducted on a defined schedule for least 5 years after enrollment. Model validation was performed among men at the University of California, San Francisco (UCSF) who did not enroll in PASS. Men with Gleason grade group 1 prostate cancer diagnosed since 2003 and enrolled in PASS before 2017 with at least 1 confirmatory biopsy after diagnosis were included. A total of 850 men met these criteria and had adequate follow-up. For the UCSF validation study, 533 active surveillance patients meeting the same criteria were identified. Exclusion criteria were treatment within 6 months of diagnosis, diagnosis before 2003, Gleason grade score of at least 2 at diagnosis or first surveillance biopsy, no surveillance biopsy, or missing data. Exposures Active surveillance for prostate cancer. Main Outcomes and Measures Time from confirmatory biopsy to reclassification, defined as Gleason grade group 2 or higher on subsequent biopsy. Results A total of 850 men (median [interquartile range] age, 64 [58-68] years; 774 [91%] White) were included in the PASS cohort. A total of 533 men (median [interquartile range] age, 61 [57-65] years; 422 [79%] White) were included in the UCSF cohort. Parameters predictive of reclassification on multivariable analysis included maximum percent positive cores (hazard ratio [HR], 1.30 [95% CI, 1.09-1.56]; P = .004), history of any negative biopsy after diagnosis (1 vs 0: HR, 0.52 [95% CI, 0.38-0.71]; P < .001 and ≥2 vs 0: HR, 0.18 [95% CI, 0.08-0.4]; P < .001), time since diagnosis (HR, 1.62 [95% CI, 1.28-2.05]; P < .001), body mass index (HR, 1.08 [95% CI, 1.05-1.12]; P < .001), prostate size (HR, 0.40 [95% CI, 0.25-0.62]; P < .001), prostate-specific antigen at diagnosis (HR, 1.51 [95% CI, 1.15-1.98]; P = .003), and prostate-specific antigen kinetics (HR, 1.46 [95% CI, 1.23-1.73]; P < .001). For prediction of nonreclassification at 4 years, the area under the receiver operating curve was 0.70 for the PASS cohort and 0.70 for the UCSF validation cohort. This model achieved a negative predictive value of 0.88 (95% CI, 0.83-0.94) for those in the bottom 25th percentile of risk and of 0.95 (95% CI, 0.89-1.00) for those in the bottom 10th percentile. Conclusions and Relevance In this study, among men with low-risk prostate cancer, heterogeneity prevailed in risk of subsequent disease reclassification. These findings suggest that active surveillance intensity can be modulated based on an individual's risk parameters and that many men may be safely monitored with a substantially less intensive surveillance regimen.
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Affiliation(s)
- Matthew R. Cooperberg
- Helen Diller Family Comprehensive Cancer Center, Department of Urology, University of California, San Francisco,Department of Epidemiology & Biostatistics, University of California, San Francisco
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Biostatistics Program, Public Health Sciences, Seattle, Washington
| | - Anna V. Faino
- Fred Hutchinson Cancer Research Center, Biostatistics Program, Public Health Sciences, Seattle, Washington
| | - Lisa F. Newcomb
- Fred Hutchinson Cancer Research Center, Cancer Prevention Program, Public Health Sciences, Seattle, Washington,Department of Urology, University of Washington, Seattle
| | - Kehao Zhu
- Fred Hutchinson Cancer Research Center, Biostatistics Program, Public Health Sciences, Seattle, Washington
| | - Janet E. Cowan
- Helen Diller Family Comprehensive Cancer Center, Department of Urology, University of California, San Francisco
| | - James D. Brooks
- Department of Urology, Stanford University, Stanford, California
| | - Atreya Dash
- Department of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Martin E. Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Frances Martin
- Department of Urology, Eastern Virginia Medical School, Virginia Beach
| | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor
| | - Peter S. Nelson
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Andrew A. Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Peter R. Carroll
- Helen Diller Family Comprehensive Cancer Center, Department of Urology, University of California, San Francisco
| | - Daniel W. Lin
- Fred Hutchinson Cancer Research Center, Cancer Prevention Program, Public Health Sciences, Seattle, Washington,Department of Urology, University of Washington, Seattle
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Sheriffdeen A, Millar JL, Martin C, Evans M, Tikellis G, Evans SM. (Dis)concordance of comorbidity data and cancer status across administrative datasets, medical charts, and self-reports. BMC Health Serv Res 2020; 20:858. [PMID: 32917193 PMCID: PMC7488579 DOI: 10.1186/s12913-020-05713-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/03/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Benchmarking outcomes across settings commonly requires risk-adjustment for co-morbidities that must be derived from extant sources that were designed for other purposes. A question arises as to the extent to which differing available sources for health data will be concordant when inferring the type and severity of co-morbidities, how close are these to the "truth". We studied the level of concordance for same-patient comorbidity data extracted from administrative data (coded from International Classification of Diseases, Australian modification,10th edition [ICD-10 AM]), from the medical chart audit, and data self-reported by men with prostate cancer who had undergone a radical prostatectomy. METHODS We included six hospitals (5 public and 1 private) contributing to the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic) in the study. Eligible patients from the PCOR-Vic underwent a radical prostatectomy between January 2017 and April 2018.Health Information Manager's in each hospital, provided each patient's associated administrative ICD-10 AM comorbidity codes. Medical charts were reviewed to extract comorbidity data. The self-reported comorbidity questionnaire (SCQ) was distributed through PCOR-Vic to eligible men. RESULTS The percentage agreement between the administrative data, medical charts and self-reports ranged from 92 to 99% in the 122 patients from the 217 eligible participants who responded to the questionnaire. The presence of comorbidities showed a poor level of agreement between data sources. CONCLUSION Relying on a single data source to generate comorbidity indices for risk-modelling purposes may fail to capture the reality of a patient's disease profile. There does not appear to be a 'gold-standard' data source for the collection of data on comorbidities.
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Affiliation(s)
- A Sheriffdeen
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - J L Millar
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
- William Buckland Radiotherapy Centre, The Alfred, Melbourne, Australia
| | - C Martin
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - M Evans
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - G Tikellis
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - S M Evans
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
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Kim SH. Determination of Gleason score discrepancy for risk stratification in magnetic resonance-ultrasound fusion prostate biopsy. Acta Radiol 2020; 61:1134-1142. [PMID: 31825763 DOI: 10.1177/0284185119891695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-ultrasound (US) fusion biopsy remains challenging and highlights the need towards standardization. PURPOSE To characterize the clinical and MRI features of clinically significant prostate cancer (csPCa) with discrepant Gleason score (GS) in MRI-US fusion biopsy. MATERIAL AND METHODS A total of 400 consecutive patients with suspected cancer lesions who underwent MRI-US fusion biopsy and subsequent prostatectomy were included. In the comparison of biopsy GS with pathology GS, matched lesions were defined as a GS, and discrepant lesions were defined as an upgrade of the GS. Descriptive statistics were used to define clinical characteristics, including age, prostate-specific antigen (PSA), PSA density, and maximal cancer core length (MCCL). Differences between lesions with matched and discrepant GS were determined considering the location and PI-RADS v2 score. A paired comparison of the volumes between the two groups was performed. RESULTS There were 130 lesions with discrepant GS in 124 patients. There was no significant difference in the age, PSA, and PSA density between the two groups, except for the MCCL (P = 0.028). The lesions were distributed in the peripheral (n = 88) and transition (n = 42) zones; 33, 50, and 47 lesions were at the apex, mid-gland, and base levels, respectively. PI-RADS scores were as follows: 2 (n = 5), 3 (n = 8), 4 (n = 68), and 5 (n = 39). In comparison with matched lesions, discrepant lesions had significantly smaller multiparametric MRI-measured cancer volumes (P < 0.05). CONCLUSION Knowledge of discrepant GS in MRI-US fusion biopsy is important, and a careful approach is needed to reduce this discrepancy.
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Affiliation(s)
- See Hyung Kim
- Departmet of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
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10
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De Luca S, Fiori C, Bollito E, Garrou D, Aimar R, Cattaneo G, De Cillis S, Manfredi M, Tota D, Federica M, Passera R, Porpiglia F. Risk of Gleason Score 3+4=7 prostate cancer upgrading at radical prostatectomy is significantly reduced by targeted versus standard biopsy. MINERVA UROL NEFROL 2019; 72:360-368. [PMID: 31619029 DOI: 10.23736/s0393-2249.19.03367-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study is to evaluate if multiparametric magnetic resonance (mpMRI)-transrectal ultrasound (TRUS) fusion targeted biopsy (TBx) versus untargeted standard biopsy (SBx) may decrease the rate of pathological upgrading of Gleason Score (GS) 3+4 prostate cancer (PCa) at radical prostatectomy (RP). We also evaluated the impact of percent pattern 4 and cribriform glands at biopsy in the risk of GS 3+4=7 upgrading. METHODS A total of 301 patients with GS 3+4 PCa on biopsy (159 SBx and 142 TBx) who underwent laparoscopic robot-assisted RP were sequentially enrolled. Histological data from RP sections were used as reference standard. The concordance of biopsy with pathological GS, as well as the GS 3+4 upgrading at RP were evaluated in different univariate and multivariate binary logistic regression models, testing age, PSA, fPSA%, tumor volume, PI-RADS, clinical stage, percentage of Gleason pattern 4 (GP) and/or presence of cribriform sub-type at biopsy. RESULTS Of the 301 biopsies, the median of GP 4 was 16% of the tissue. Minimal GP 4 (≤16%) cancers had a significant lower median volume (1.7 mL) than those with GP4 >16% (2.9 mL), (P<0.001). Pathological GS 3+4 was confirmed for 58.8% and 82.2% for SBx and TBx patients, respectively. The rate of upgraded and downgraded GS on SBx versus TBx was 38.8% vis. 16.7% and 1.8% and 2.1%, respectively. The rate of upgrading was significantly associated with the presence of GP4 >16% versus ≤16% (OR 4.4, 95% CI 1.4-12.0; P=0.021) and with the presence of cribriform sub-type at biopsy specimens (OR 6.2, 95% CI 2.2-18.7; P<0.001). CONCLUSIONS We demonstrated that TBx technique significantly reduced the risk of GS 3+4 upgrading at RP, compared to SBx one. The rate of upgrading was significantly associated with GP4>16%, mostly when cribriform sub-type was present at biopsy specimens.
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Affiliation(s)
- Stefano De Luca
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Bollito
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Diletta Garrou
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberta Aimar
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giovanni Cattaneo
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Tota
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Massa Federica
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberto Passera
- Department of Nuclear Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
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Decipher identifies men with otherwise clinically favorable-intermediate risk disease who may not be good candidates for active surveillance. Prostate Cancer Prostatic Dis 2019; 23:136-143. [PMID: 31455846 PMCID: PMC8076042 DOI: 10.1038/s41391-019-0167-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/17/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND We aimed to validate Decipher to predict adverse pathology (AP) at radical prostatectomy (RP) in men with National Comprehensive Cancer Network (NCCN) favorable-intermediate risk (F-IR) prostate cancer (PCa), and to better select F-IR candidates for active surveillance (AS). METHODS In all, 647 patients diagnosed with NCCN very low/low risk (VL/LR) or F-IR prostate cancer were identified from a multi-institutional PCa biopsy database; all underwent RP with complete postoperative clinicopathological information and Decipher genomic risk scores. The performance of all risk assessment tools was evaluated using logistic regression model for the endpoint of AP, defined as grade group 3-5, pT3b or higher, or lymph node invasion. RESULTS The median age was 61 years (interquartile range 56-66) for 220 patients with NCCN F-IR disease, 53% classified as low-risk by Cancer of the Prostate Risk Assessment (CAPRA 0-2) and 47% as intermediate-risk (CAPRA 3-5). Decipher classified 79%, 13% and 8% of men as low-, intermediate- and high-risk with 13%, 10%, and 41% rate of AP, respectively. Decipher was an independent predictor of AP with an odds ratio of 1.34 per 0.1 unit increased (p value = 0.002) and remained significant when adjusting by CAPRA. Notably, F-IR with Decipher low or intermediate score did not associate with significantly higher odds of AP compared to VL/LR. CONCLUSIONS NCCN risk groups, including F-IR, are highly heterogeneous and should be replaced with multivariable risk-stratification. In particular, incorporating Decipher may be useful for safely expanding the use of AS in this patient population.
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Abstract
PURPOSE OF REVIEW Active surveillance is becoming more widely accepted as an initial management option for carefully selected men with favorable intermediate-risk prostate cancer (PCa). As prospective active surveillance cohorts mature sufficiently to begin evaluating longer-term outcomes, consensus on more precise evidence-based guidelines is needed to identify the patient cohorts who may be safely managed with active surveillance and what the ideal surveillance protocol entails. RECENT FINDINGS Long-term outcomes updates have suggested a trend toward worse 15-year survival outcomes for intermediate-risk patients on active surveillance compared with definitive treatment, but 'intermediate-risk' is a broad category and there is a subset of favorable intermediate-risk patients for whom survival outcomes remain equivalent. Promising updates to current risk stratification include consideration of genomic classifiers, advanced imaging and more nuanced interpretation of biopsy results. SUMMARY Despite widespread acknowledgement of the pitfalls of overtreatment in clinically localized PCa, utilization of active surveillance in the intermediate-risk population remains marginal, in part due to the absence of easily interpretable consensus recommendations. As more long-term outcomes data become available for this subgroup, the field is now poised to refine the definition of favorable intermediate-risk patients for whom active surveillance is a safe, evidence-based first-line management option.
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13
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Effects of Initial Gleason Grade on Outcomes during Active Surveillance for Prostate Cancer. Eur Urol Oncol 2018; 1:386-394. [DOI: 10.1016/j.euo.2018.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/06/2018] [Accepted: 04/27/2018] [Indexed: 11/18/2022]
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Sharma M, Miyamoto H. Percent Gleason pattern 4 in stratifying the prognosis of patients with intermediate-risk prostate cancer. Transl Androl Urol 2018; 7:S484-S489. [PMID: 30363387 PMCID: PMC6178316 DOI: 10.21037/tau.2018.03.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Gleason score remains the most reliable prognosticator in men with prostate cancer. One of the recent important modifications in the Gleason grading system recommended from the International Society of Urological Pathology consensus conference is recording the percentage of Gleason pattern 4 in the pathology reports of prostate needle biopsy and radical prostatectomy cases with Gleason score 7 prostatic adenocarcinoma. Limited data have indeed suggested that the percent Gleason pattern 4 contributes to stratifying the prognosis of patients who undergo radical prostatectomy. An additional obvious benefit of reporting percent pattern 4 includes providing critical information for treatment decisions. This review summarizes and discusses available studies assessing the utility of the percentage of Gleason pattern 4 in the management of prostate cancer patients.
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Affiliation(s)
- Meenal Sharma
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hiroshi Miyamoto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Oncology, University of Rochester Medical Center, Rochester, NY, USA
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15
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Zhao Y, Deng FM, Huang H, Lee P, Lepor H, Rosenkrantz AB, Taneja S, Melamed J, Zhou M. Prostate Cancers Detected by Magnetic Resonance Imaging–Targeted Biopsies Have a Higher Percentage of Gleason Pattern 4 Component and Are Less Likely to Be Upgraded in Radical Prostatectomies. Arch Pathol Lab Med 2018; 143:86-91. [DOI: 10.5858/arpa.2017-0410-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
In Gleason score (GS) 7 prostate cancers, the quantity of Gleason pattern 4 (GP 4) is an important prognostic factor and influences treatment decisions. Magnetic resonance imaging (MRI)–targeted biopsy has been increasingly used in clinical practice.
Objective.—
To investigate whether MRI-targeted biopsy may detect GS 7 prostate cancer with greater GP 4 quantity, and whether it improves biopsy/radical prostatectomy GS concordance.
Design.—
A total of 243 patients with paired standard and MRI-targeted biopsies with cancer in either standard or targeted or both were studied, 65 of whom had subsequent radical prostatectomy. The biopsy findings, including GS and tumor volume, were correlated with the radical prostatectomy findings.
Results.—
More prostate cancers detected by MRI-targeted biopsy were GS 7 or higher. Mean GP 4 percentage in GS 7 cancers was 31.0% ± 29.3% by MRI-targeted biopsy versus 25.1% ± 29.5% by standard biopsy. A total of 122 of 218 (56.0%) and 96 of 217 (44.2%) prostate cancers diagnosed on targeted biopsy and standard biopsy, respectively, had a GP 4 of 10% or greater (P = .01). Gleason upgrading was seen in 12 of 59 cases (20.3%) from MRI-targeted biopsy and in 24 of 57 cases (42.1%) from standard biopsy (P = .01). Gleason upgrading correlated with the biopsy cancer volume inversely and GP 4 of 30% or less in standard biopsy. Such correlation was not found in MRI-targeted biopsy.
Conclusions.—
Magnetic resonance imaging–targeted biopsy may detect more aggressive prostate cancers and reduce the risk of Gleason upgrading in radical prostatectomy. This study supports a potential role for MRI-targeted biopsy in the workup of prostate cancer and inclusion of percentage of GP 4 in prostate biopsy reports.
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Affiliation(s)
- Yani Zhao
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Fang-Ming Deng
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Hongying Huang
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Peng Lee
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Hebert Lepor
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Andrew B. Rosenkrantz
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Samir Taneja
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Jonathan Melamed
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Ming Zhou
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
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Herlemann A, Washington SL, Eapen RS, Cooperberg MR. Whom to Treat: Postdiagnostic Risk Assessment with Gleason Score, Risk Models, and Genomic Classifier. Urol Clin North Am 2017; 44:547-555. [PMID: 29107271 DOI: 10.1016/j.ucl.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Management of prostate cancer presents unique challenges because of the disease's variable natural history. Accurate risk stratification at the time of diagnosis in clinically localized disease is crucial in providing optimal counseling about management options. To accurately distinguish pathologically indolent tumors from aggressive disease, risk groups are no longer sufficient. Rather, multivariable prognostic models reflecting the complete information known at time of diagnosis offer improved accuracy and interpretability. After diagnosis, further testing with genomic assays or other biomarkers improves risk classification. These postdiagnostic risk assessment tools should not supplant shared decision making, but rather facilitate risk classification and enable more individualized care.
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Affiliation(s)
- Annika Herlemann
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA; Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Samuel L Washington
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA
| | - Renu S Eapen
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Box 0981, San Francisco, CA 94143-0981, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, 550 16th Street, San Francisco, CA 94143, USA.
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17
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Savdie R, Aning J, So AI, Black PC, Gleave ME, Goldenberg SL. Identifying intermediate-risk candidates for active surveillance of prostate cancer. Urol Oncol 2017; 35:605.e1-605.e8. [DOI: 10.1016/j.urolonc.2017.06.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/13/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022]
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18
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Kane CJ, Eggener SE, Shindel AW, Andriole GL. Variability in Outcomes for Patients with Intermediate-risk Prostate Cancer (Gleason Score 7, International Society of Urological Pathology Gleason Group 2-3) and Implications for Risk Stratification: A Systematic Review. Eur Urol Focus 2017; 3:487-497. [PMID: 28753804 DOI: 10.1016/j.euf.2016.10.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/03/2016] [Accepted: 10/18/2016] [Indexed: 12/22/2022]
Abstract
CONTEXT Optimal management for patients with intermediate-risk (IR) prostate cancer (PCa) remains controversial. Clinical metrics provide guidance on appropriate management options. OBJECTIVE To report estimates for clinically relevant outcomes in men with IR PCa based on clinical and pathological features. EVIDENCE ACQUISITION PubMed and programs from key 2015 uro-oncology congresses were searched using the terms "intermediate", "Gleason 3 + 4", "Gleason 4 + 3", "active surveillance", "treatment", "adverse pathology", AND "prostate cancer." Articles meeting prespecified criteria were retrieved. Bibliographies were scanned for additional relevant references. EVIDENCE SYNTHESIS Men with IR PCa have a wide range of predicted clinically relevant outcomes. Within the IR category, estimate ranges for adverse surgical pathology and 5-yr disease progression are 15-64% and 21-91%, respectively. Clinical parameters and predictive nomograms refine these estimates, but do not uniformly differentiate favorable and unfavorable IR PCa. Variations in study design and data quality in source manuscripts mandate caution in interpreting results. CONCLUSIONS Outcomes in IR PCa are heterogeneous. Refinements in personalized risk assessment are needed to better select IR PCa patients for surveillance. PATIENT SUMMARY Current and future risk stratification tools may provide additional information to identify men with intermediate-risk prostate cancer who may consider active surveillance.
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Affiliation(s)
- Christopher J Kane
- Department of Urology, University of California San Diego Health System, San Diego, CA, USA.
| | - Scott E Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | | | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Prognostic Significance of Percentage and Architectural Types of Contemporary Gleason Pattern 4 Prostate Cancer in Radical Prostatectomy. Am J Surg Pathol 2017; 40:1400-6. [PMID: 27379821 DOI: 10.1097/pas.0000000000000691] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The International Society of Urological Pathology (ISUP) 2014 consensus meeting recommended a novel grade grouping for prostate cancer that included dividing Gleason score (GS) 7 into grade groups 2 (GS 3+4) and 3 (GS 4+3). This division of GS 7, essentially determined by the percent of Gleason pattern (GP) 4 (< or >50%), raises the question of whether a more exact quantification of the percent GP 4 within GS 7 will yield additional prognostic information. Modifications were also made by ISUP regarding the definition of GP 4, now including 4 main architectural types: cribriform, glomeruloid, poorly formed, and fused glands. This study was conducted to analyze the prognostic significance of the percent GP 4 and main architectural types of GP 4 according to the 2014 ISUP grading criteria in radical prostatectomies (RPs). The cohort included 585 RP cases of GS 6 (40.2%), 3+4 (49.0%), and 4+3 (10.8%) prostate cancers. Significantly different 5-year biochemical recurrence (BCR)-free survival rates were observed among GS 6 (99%, 95% confidence interval [CI]: 97%-100%), 3+4 (81%, 95% CI: 76%-86%), and 4+3 (60%, 95% CI: 45%-71%) cancers (P<0.01). Dividing the GP 4 percent into quartiles showed a 5-year BCR-free survival of 84% (95% CI: 78%-89%) for 1% to 20%, 74% (95% CI: 62%-83%) for 21% to 50%, 66% (95% CI: 50%-78%) for 51% to 70%, and 32% (95% CI: 9%-59%) for >70% (P<0.001). Among the GP 4 architectures, cribriform was the most prevalent (43.7%), and combination of architectures with cribriform present was more frequently observed in GS 4+3 (60.3%). Glomeruloid was mostly (67.1%) seen combined with other GP 4 architectures. Unlike the other GP 4 architectures, glomeruloid as the sole GP 4 was observed only as a secondary pattern (ie, 3+4). Among patients with GS 7 cancer, the presence of cribriform architecture was associated with decreased 5-year BCR-free survival when compared with GS 7 cancers without this architecture (68% vs. 85%, P<0.01), whereas the presence of glomeruloid architecture was associated with improved 5-year BCR-free survival when compared with GS 7 cancers without this architecture (87% vs. 75%, P=0.01). However, GS 7 disease having only the glomeruloid architecture had significantly lower 5-year BCR-free survival than GS 6 cancers (86% vs. 99%, P<0.01). Multivariable Cox proportional hazards regression model for factors associated with BCR among GS 7 cancers identified age (hazard ratio [HR] 0.95, P<0.01), preoperative prostate-specific antigen (HR 1.07, P<0.01), positive surgical margin (HR 2.70, P<0.01), percent of GP 4 (21% to 50% [HR 2.21], 51% to 70% [HR 2.59], >70% [HR 6.57], all P<0.01), presence of cribriform glands (HR 1.78, P=0.02), and presence of glomeruloid glands (HR 0.43, P=0.03) as independent predictors. In conclusion, our study shows that increments in percent of GP 4 correlate with increased risk for BCR supporting the ISUP recommendation of recording the percent of GP 4 in GS 7 prostate cancers at RP. However, additional larger studies are needed to establish the optimal interval for reporting percent GP 4 in GS 7 cancers. Among the GP 4 architectures, cribriform independently predicts BCR, whereas glomeruloid reduces the risk of BCR. Distinction should be made between cribriform and glomeruloid architectures, despite glomeruloid being considered as an early stage of cribriform, as cribriform confers a higher risk for poorer outcome.
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20
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Meliti A, Sadimin E, Diolombi M, Khani F, Epstein JI. Accuracy of Grading Gleason Score 7 Prostatic Adenocarcinoma on Needle Biopsy: Influence of Percent Pattern 4 and Other Histological Factors. Prostate 2017; 77:681-685. [PMID: 28155999 DOI: 10.1002/pros.23314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/13/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recognition of Gleason pattern 4 in prostatic needle biopsies is crucial for both prognosis and therapy. Recently, it has been recommended to record percent pattern 4 when Gleason score 7 cancer is the highest grade in a case. METHODS Four hundred and five prostate needle core biopsies received for a second opinion at our institution from February-June, 2015 were prospectively diagnosed with prostatic adenocarcinoma Gleason score 7 as the highest score on review by a consultant urological pathologist. Percentage of core involvement by cancer, percentage of Gleason pattern 4 per core, distribution of Gleason pattern 4 (clustered, scattered), morphology of pattern 4 (cribriform, non-cribriform), and whether the cancer was continuous or discontinuous were recorded. RESULTS Better agreement was noted between the consultant and referring pathologists when pattern 4 was clustered as opposed to dispersed in biopsies (P = 0.009). The percentage of core involvement by cancer, morphology of pattern 4, and continuity of cancer did not affect the agreement between the consultant and referring pathologists. There was a trend (P = 0.06) for better agreement based on the percent of pattern 4. CONCLUSIONS When pattern 4 is scattered amongst pattern 3 as opposed to being discrete foci, there is less interobserver reproducibility in grading Gleason score 7 cancer, and in this setting pathologists should consider obtaining second opinions either internally within their group or externally. Prostate 77: 681-685, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Abdelrazak Meliti
- The Departments of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Evita Sadimin
- The Departments of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Mario Diolombi
- The Departments of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Francesca Khani
- The Departments of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jonathan I Epstein
- The Departments of Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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22
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Athanazio D, Gotto G, Shea-Budgell M, Yilmaz A, Trpkov K. Global Gleason grade groups in prostate cancer: concordance of biopsy and radical prostatectomy grades and predictors of upgrade and downgrade. Histopathology 2017; 70:1098-1106. [DOI: 10.1111/his.13179] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/03/2017] [Accepted: 01/30/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Daniel Athanazio
- Department of Pathology and Laboratory Medicine; Calgary Laboratory Services and University of Calgary; Calgary Alberta Canada
| | - Geoffrey Gotto
- Division of Urology; University of Calgary; Calgary Alberta Canada
| | - Melissa Shea-Budgell
- Cancer Strategic Clinical Network, Research Innovation and Analytics; Alberta Health Services; University of Calgary; Calgary Alberta Canada
- Department of Oncology; University of Calgary; Calgary Alberta Canada
| | - Asli Yilmaz
- Department of Pathology and Laboratory Medicine; Calgary Laboratory Services and University of Calgary; Calgary Alberta Canada
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine; Calgary Laboratory Services and University of Calgary; Calgary Alberta Canada
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Leapman MS, Cowan JE, Simko J, Roberge G, Stohr BA, Carroll PR, Cooperberg MR. Application of a Prognostic Gleason Grade Grouping System to Assess Distant Prostate Cancer Outcomes. Eur Urol 2016; 71:750-759. [PMID: 27940155 DOI: 10.1016/j.eururo.2016.11.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is growing enthusiasm for the adoption of a novel grade grouping system to better represent Gleason scores. OBJECTIVE To evaluate the ability of prognostic Gleason grade groups to predict prostate cancer (PCa)-specific mortality (PCSM) and bone metastatic progression. DESIGN, SETTING, AND PARTICIPANTS We identified patients with PCa enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry across treatment strategies, including conservative and nondefinitive therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We examined the prognostic ability of Gleason grade groups to predict risk of PCSM and bone metastasis using the Kaplan-Meier method and unadjusted and adjusted Cox proportional hazards models. RESULTS AND LIMITATIONS We identified 10529 men with PCa followed for a median of 81 mo (interquartile range 40-127), including 64% in group I (< 3 + 4); 17% in group II (3+4); 9% in group III (4+3); 6% in group IV (4+4); and 4% in group V (≥ 4 + 5). Relative to grade group I, the unadjusted risks of PCSM and bone metastasis were significantly associated with prognostic grade groupings for both biopsy and prostatectomy samples (all p<0.01). Pairwise comparisons within Gleason sums collapsed within grade group V were not significant; however, this analysis was limited by a small representation of men with Gleason pattern ≥ 4 + 5. CONCLUSIONS The prognostic grade grouping system is associated with risk of PCSM and metastasis across management strategies, including definitive therapy, conservative management, and primary androgen deprivation. PATIENT SUMMARY A five-level reporting system for prostate cancer pathology is associated with the risk of late prostate cancer endpoints.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
| | - Janet E Cowan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Jeffry Simko
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Gray Roberge
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Bradley A Stohr
- Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Peter R Carroll
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
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24
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Prognostic Value of Percent Gleason Grade 4 at Prostate Biopsy in Predicting Prostatectomy Pathology and Recurrence. J Urol 2016; 196:405-11. [DOI: 10.1016/j.juro.2016.01.120] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 01/07/2023]
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25
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The concordance between the volume hotspot and the grade hotspot: a 3-D reconstructive model using the pathology outputs from the PROMIS trial. Prostate Cancer Prostatic Dis 2016; 19:258-63. [PMID: 27401032 PMCID: PMC5411671 DOI: 10.1038/pcan.2016.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/30/2015] [Accepted: 01/26/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The rationale for directing targeted biopsy towards the centre of lesions has been questioned in light of prostate cancer grade heterogeneity. In this study, we assess the assumption that the maximum cancer Gleason grade (Gleason grade hotspot) lies within the maximum dimension (volume hotspot) of a prostate cancer lesion. METHODS 3-D histopathological models were reconstructed using the outputs of the 5-mm transperineal mapping (TPM) biopsies used as the reference test in the pilot phase of Prostate Mri Imaging Study (PROMIS), a paired validating cohort study investigating the performance of multi-parametric magnetic resonance imaging (MRI) against transrectal ultrasound (TRUS) biopsies. The prostate was fully sampled with 5 mm intervals; each core was separately labelled, inked and orientated in space to register 3-D cancer lesions location. The data from the histopathology results were used to create a 3-D interpolated reconstruction of each lesion and identify the spatial coordinates of the largest dimension (volume hot spot) and highest Gleason grade (Gleason grade hotspot) and assess their concordance. RESULTS Ninety-four men, with median age 62 years (interquartile range, IQR= 58-68) and median PSA 6.5 ng ml(-1) (4.6-8.8), had a median of 80 (I69-89) cores each with a median of 4.5 positive cores (0-12). In the primary analysis, the prevalence of homogeneous lesions was 148 (76%; 95% confidence interval (CI) ±6.0%). In all, 184 (94±3.2%) lesions showed concordant hotspots and 11/47 (23±12.1%) of heterogeneous lesions showed discordant hotspots. The median 3-D distance between discordant hotspots was 12.8 mm (9.9-15.5). These figures remained stable on secondary analyses using alternative reconstructive assumptions. Limitations include a certain degree of error within reconstructed models. CONCLUSIONS Guiding one biopsy needle to the maximum cancer diameter would lead to correct Gleason grade attribution in 94% of all lesions and 79% of heterogeneous ones if a true hit was obtained. Further correlation of histological lesions, their MRI appearance and the detectability of these hotspots on MRI will be undertaken once PROMIS results are released.
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Van der Kwast T. Gleason Score 7: When Qualitative Change Becomes Quantitative Change. J Urol 2016; 196:303-4. [PMID: 27188477 DOI: 10.1016/j.juro.2016.05.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/16/2022]
Affiliation(s)
- T Van der Kwast
- Department of Pathology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
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Shah RB, Zhou M. Recent advances in prostate cancer pathology: Gleason grading and beyond. Pathol Int 2016; 66:260-72. [DOI: 10.1111/pin.12398] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/27/2016] [Accepted: 02/03/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Rajal B Shah
- Division of Urologic Pathology; Miraca Research Institute, Miraca Life Sciences; Irving Texas
| | - Ming Zhou
- Department of Pathology; New York University Langone Medical Center; New York New York
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Nahar B, Soodana NP, Punnen S. Is it Time to Start Quantifying the Amount of High-grade Cancer on Pathology? Eur Urol 2016; 70:254-5. [PMID: 26810347 DOI: 10.1016/j.eururo.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL, USA
| | - Nachiketh Prakash Soodana
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL, USA.
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Klotz L. Active Surveillance: Rationale, Patient Selection, Follow-up, and Outcomes. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kır G, Seneldir H, Gumus E. Outcomes of Gleason score 3 + 4 = 7 prostate cancer with minimal amounts (<6%) vs ≥6% of Gleason pattern 4 tissue in needle biopsy specimens. Ann Diagn Pathol 2015; 20:48-51. [PMID: 26750655 DOI: 10.1016/j.anndiagpath.2015.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The International Society of Urological Pathology Gleason grading system was modified in 2005. Since the modified system was introduced, many cancers that previously would have been categorized as Gleason score (GS) 6 are now categorized as GS 7 based on biopsy specimens that only contain minimal amounts (<6%) of Gleason pattern (GP) 4 tissue. However, the clinical significance of observing <6% of GP 4 tissue in biopsies of GS 7 prostate cancer has not been studied. MATERIAL AND METHODS This study was based on needle biopsy specimens that were categorized as GS 6 or GS 7 and were obtained from patients who underwent radical prostatectomy (RP) with available follow-up data. We assessed the quantity of GP 4 tissue in biopsy specimens of GS 7 prostate cancer. Further, we evaluated the correlation between the quantity of GP 4 tissue and disease progression after RP. RESULTS GP 4 comprising 26-49% of the specimen, GS 4+3 and percentage of total core tissue scored as positive were significant and independent predictors of prostate-specific antigen (PSA) failure after RP, as assessed using a multivariate Cox regression model that included the quantity of GP 4 in the prostate biopsy specimen, preoperative PSA, perineural invasion, clinical stage, number of positive cores, and percentage of core tissue scored as positive. Cases with GS 3+3 and cases in which the observed GP 4 area was <6% did not differ significantly in terms of biochemical PSA recurrence (BPR) status. In contrast, cases with 6-25% GP 4 tissue, 26-49% GP 4 tissue, and GS 4+3 showed more frequent BPR than cases with GS 3+3. CONCLUSIONS Our data suggest that the quantity of GP 4 tissue in GS 7 cancer has clinical significance. However, there is a need for larger studies of the clinical significance of biopsy specimens that include <6% GP 4 tissue. We should reconsider whether the amount of GP 4 should be included in standart pathology reports.
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Affiliation(s)
- Gozde Kır
- Umraniye Education & Research Hospital, Istanbul, Turkey.
| | | | - Eyup Gumus
- Umraniye Education & Research Hospital, Istanbul, Turkey.
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Deng FM, Donin NM, Pe Benito R, Melamed J, Le Nobin J, Zhou M, Ma S, Wang J, Lepor H. Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy. Eur Urol 2015; 70:248-53. [PMID: 26525839 DOI: 10.1016/j.eururo.2015.10.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/08/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component. OBJECTIVE We sought to explore the value of several novel quantitative metrics of Gleason 4 disease for the prediction of BCR in men with Gleason 7 disease. DESIGN, SETTING, AND PARTICIPANTS We analyzed a cohort of 2630 radical prostatectomy cases from 1990-2007. All pathologic Gleason 7 cases were identified and assessed for quantity of Gleason pattern 4. Three methods were used to quantify the extent of Gleason 4: a quantitative Gleason score (qGS) based on the proportion of tumor composed of Gleason pattern 4, a size-weighted score (swGS) incorporating the overall quantity of Gleason 4, and a size index (siGS) incorporating the quantity of Gleason 4 based on the index lesion. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis. RESULTS AND LIMITATIONS qGS, swGS, and siGS were significantly associated with BCR on multivariate analysis when adjusted for traditional Gleason score, age, prostate specific antigen, surgical margin, and stage. Using Harrell's c-index to compare the scoring systems, qGS (0.83), swGS (0.84), and siGS (0.84) all performed better than the traditional Gleason score (0.82). CONCLUSIONS Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score. PATIENT SUMMARY In men with Gleason 7 prostate cancer, quantitative analysis of the proportion of Gleason pattern 4 (quantitative Gleason score), as well as size-weighted measurement of Gleason 4 (size-weighted Gleason score), and a size-weighted measurement of Gleason 4 based on the largest tumor nodule significantly improve the predicted risk of biochemical recurrence compared with the traditional Gleason score.
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Affiliation(s)
- Fang-Ming Deng
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Nicholas M Donin
- Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Ruth Pe Benito
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Jonathan Melamed
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Julien Le Nobin
- Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Ming Zhou
- Department of Pathology, New York University School of Medicine, New York, NY, USA; Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Sisi Ma
- Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, NY, USA
| | - Jinhua Wang
- Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, NY, USA; NYU Cancer Institute, New York University School of Medicine, New York, NY, USA
| | - Herbert Lepor
- Department of Urology, New York University School of Medicine, New York, NY, USA
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Prostate Biopsy and Radical Prostatectomy Gleason Score Correlation in Heterogenous Tumors. Am J Surg Pathol 2015; 39:1213-8. [DOI: 10.1097/pas.0000000000000499] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Defining ‘progression’ and triggers for curative intervention during active surveillance. Curr Opin Urol 2015; 25:258-66. [DOI: 10.1097/mou.0000000000000158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cooperberg MR. Long-Term Active Surveillance for Prostate Cancer: Answers and Questions. J Clin Oncol 2015; 33:238-40. [DOI: 10.1200/jco.2014.59.2329] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matthew R. Cooperberg
- University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Identification of proteomic biomarkers predicting prostate cancer aggressiveness and lethality despite biopsy-sampling error. Br J Cancer 2014; 111:1201-12. [PMID: 25032733 PMCID: PMC4453845 DOI: 10.1038/bjc.2014.396] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 12/11/2022] Open
Abstract
Background: Key challenges of biopsy-based determination of prostate cancer aggressiveness include tumour heterogeneity, biopsy-sampling error, and variations in biopsy interpretation. The resulting uncertainty in risk assessment leads to significant overtreatment, with associated costs and morbidity. We developed a performance-based strategy to identify protein biomarkers predictive of prostate cancer aggressiveness and lethality regardless of biopsy-sampling variation. Methods: Prostatectomy samples from a large patient cohort with long follow-up were blindly assessed by expert pathologists who identified the tissue regions with the highest and lowest Gleason grade from each patient. To simulate biopsy-sampling error, a core from a high- and a low-Gleason area from each patient sample was used to generate a ‘high' and a ‘low' tumour microarray, respectively. Results: Using a quantitative proteomics approach, we identified from 160 candidates 12 biomarkers that predicted prostate cancer aggressiveness (surgical Gleason and TNM stage) and lethal outcome robustly in both high- and low-Gleason areas. Conversely, a previously reported lethal outcome-predictive marker signature for prostatectomy tissue was unable to perform under circumstances of maximal sampling error. Conclusions: Our results have important implications for cancer biomarker discovery in general and development of a sampling error-resistant clinical biopsy test for prediction of prostate cancer aggressiveness.
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Akaza H, Kim CS, Carroll P, Choi IY, Chung BH, Cooperberg MR, Hirao Y, Hinotsu S, Horie S, Lee JY, Namiki M, Ng CF, Onozawa M, Ozono S, Ueno S, Umbas R, Ye D, Zhu G. Seventh Joint Meeting of K-J-CaP and CaPSURE: extending the global initiative to improve prostate cancer management. Prostate Int 2014; 2:50-69. [PMID: 26153555 PMCID: PMC4099396 DOI: 10.12954/pi.14047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/17/2014] [Indexed: 11/07/2022] Open
Abstract
This report summarizes the presentations and discussions that took place at the Seventh Joint Meeting of the Korea–Japan Study Group of Prostate Cancer (K-J-CaP) and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) held in Seoul, Korea, in September 2013. The original J-CaP and CaPSURE Joint Initiative has now been established since 2007 and since the initial collaboration between research teams in the United States (US) and Japan, the project has expanded to include several other Asian countries. The objective of the initiative is to analyze and compare data for prostate cancer patients in the participating countries, looking at similarities and differences in patient management and outcomes. Until now the focus has been primarily on data generated within J-CaP and CaPSURE, both large-scale, longitudinal, observational databases of prostate cancer patients in Japan and the US, respectively. This year’s meeting was hosted for the first time in Korea which has recently established its own national database–K-CaP–to add to the wealth of data generated by J-CaP and CaPSURE. As a newly-developed database, K-CaP has also provided a valuable ‘template’ for other countries, such as China and Indonesia, planning to establish their own national databases and this will ultimately allow greater opportunities for international data comparisons. A range of topics was discussed at this Seventh Joint Meeting including comparison of outcomes following androgen deprivation therapy or radical prostatectomy in patients with localized prostate cancer, the use of active surveillance as a treatment option and the triggers for intervention when employing this regimen, patient quality of life during treatment, the impact of comorbidities on outcomes, and a comparison of recent outcomes data between J-CaP and CaPSURE. The participants recognized that prostate cancer was now a global disease and therefore major insights into understanding and improving the management of this condition would arise from global interactions such as this joint initiative.
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Affiliation(s)
- Hideyuki Akaza
- Department of Strategic Investigation on Comprehensive Cancer Network, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
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Klein EA, Cooperberg MR, Magi-Galluzzi C, Simko JP, Falzarano SM, Maddala T, Chan JM, Li J, Cowan JE, Tsiatis AC, Cherbavaz DB, Pelham RJ, Tenggara-Hunter I, Baehner FL, Knezevic D, Febbo PG, Shak S, Kattan MW, Lee M, Carroll PR. A 17-gene assay to predict prostate cancer aggressiveness in the context of Gleason grade heterogeneity, tumor multifocality, and biopsy undersampling. Eur Urol 2014; 66:550-60. [PMID: 24836057 DOI: 10.1016/j.eururo.2014.05.004] [Citation(s) in RCA: 451] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/12/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prostate tumor heterogeneity and biopsy undersampling pose challenges to accurate, individualized risk assessment for men with localized disease. OBJECTIVE To identify and validate a biopsy-based gene expression signature that predicts clinical recurrence, prostate cancer (PCa) death, and adverse pathology. DESIGN, SETTING, AND PARTICIPANTS Gene expression was quantified by reverse transcription-polymerase chain reaction for three studies-a discovery prostatectomy study (n=441), a biopsy study (n=167), and a prospectively designed, independent clinical validation study (n=395)-testing retrospectively collected needle biopsies from contemporary (1997-2011) patients with low to intermediate clinical risk who were candidates for active surveillance (AS). OUTCOME MEASURES AND STATISTICAL ANALYSIS The main outcome measures defining aggressive PCa were clinical recurrence, PCa death, and adverse pathology at prostatectomy. Cox proportional hazards regression models were used to evaluate the association between gene expression and time to event end points. Results from the prostatectomy and biopsy studies were used to develop and lock a multigene-expression-based signature, called the Genomic Prostate Score (GPS); in the validation study, logistic regression was used to test the association between the GPS and pathologic stage and grade at prostatectomy. Decision-curve analysis and risk profiles were used together with clinical and pathologic characteristics to evaluate clinical utility. RESULTS AND LIMITATIONS Of the 732 candidate genes analyzed, 288 (39%) were found to predict clinical recurrence despite heterogeneity and multifocality, and 198 (27%) were predictive of aggressive disease after adjustment for prostate-specific antigen, Gleason score, and clinical stage. Further analysis identified 17 genes representing multiple biological pathways that were combined into the GPS algorithm. In the validation study, GPS predicted high-grade (odds ratio [OR] per 20 GPS units: 2.3; 95% confidence interval [CI], 1.5-3.7; p<0.001) and high-stage (OR per 20 GPS units: 1.9; 95% CI, 1.3-3.0; p=0.003) at surgical pathology. GPS predicted high-grade and/or high-stage disease after controlling for established clinical factors (p<0.005) such as an OR of 2.1 (95% CI, 1.4-3.2) when adjusting for Cancer of the Prostate Risk Assessment score. A limitation of the validation study was the inclusion of men with low-volume intermediate-risk PCa (Gleason score 3+4), for whom some providers would not consider AS. CONCLUSIONS Genes representing multiple biological pathways discriminate PCa aggressiveness in biopsy tissue despite tumor heterogeneity, multifocality, and limited sampling at time of biopsy. The biopsy-based 17-gene GPS improves prediction of the presence or absence of adverse pathology and may help men with PCa make more informed decisions between AS and immediate treatment. PATIENT SUMMARY Prostate cancer (PCa) is often present in multiple locations within the prostate and has variable characteristics. We identified genes with expression associated with aggressive PCa to develop a biopsy-based, multigene signature, the Genomic Prostate Score (GPS). GPS was validated for its ability to predict men who have high-grade or high-stage PCa at diagnosis and may help men diagnosed with PCa decide between active surveillance and immediate definitive treatment.
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Affiliation(s)
- Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Cristina Magi-Galluzzi
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffry P Simko
- Department of Urology, University of California, San Francisco and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Sara M Falzarano
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - June M Chan
- Department of Urology, University of California, San Francisco and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jianbo Li
- Genomic Health, Inc., Redwood City, CA, USA
| | - Janet E Cowan
- Department of Urology, University of California, San Francisco and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | | | | | - Imelda Tenggara-Hunter
- Department of Urology, University of California, San Francisco and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Frederick L Baehner
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA; Genomic Health, Inc., Redwood City, CA, USA
| | | | | | | | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Lee
- Genomic Health, Inc., Redwood City, CA, USA
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
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Phillips JG, Aizer AA, Chen MH, Zhang D, Hirsch MS, Richie JP, Tempany CM, Williams S, Hegde JV, Loffredo MJ, D'Amico AV. The effect of differing Gleason scores at biopsy on the odds of upgrading and the risk of death from prostate cancer. Clin Genitourin Cancer 2014; 12:e181-7. [PMID: 24721618 DOI: 10.1016/j.clgc.2014.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION/BACKGROUND The GS is an established prostate cancer prognostic factor. Whether the presence of differing GSs at biopsy (eg, 4+3 and 3+3), which we term ComboGS, improves the prognosis that would be predicted based on the highest GS (eg, 4+3) because of decreased upgrading is unknown. Therefore, we evaluated the odds of upgrading at time of radical prostatectomy (RP) and the risk of PCSM when ComboGS was present versus absent. PATIENTS AND METHODS Logistic and competing risks regression were performed to assess the effect that ComboGS had on the odds of upgrading at time of RP in the index (n = 134) and validation cohorts (n = 356) and the risk of PCSM after definitive therapy in a long-term cohort (n = 666), adjusting for known predictors of these end points. We calculated and compared the area under the curve using a receiver operating characteristic analysis when ComboGS was included versus excluded from the upgrading models. RESULTS ComboGS was associated with decreased odds of upgrading (index: adjusted odds ratio [AOR], 0.14; 95% confidence interval [CI], 0.04-0.50; P = .003; validation: AOR, 0.24; 95% CI, 0.11-0.51; P < .001) and added significantly to the predictive value of upgrading for the in-sample index (P = .02), validation (P = .003), and out-of-sample prediction models (P = .002). ComboGS was also associated with a decreased risk of PCSM (adjusted hazard ratio, 0.40; 95% CI, 0.19-0.85; P = .02). CONCLUSION Differing biopsy GSs are associated with a lower odds of upgrading and risk of PCSM. If validated, future randomized noninferiority studies evaluating deescalated treatment approaches in men with ComboGS could be considered.
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Affiliation(s)
| | | | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT
| | - Danjie Zhang
- Department of Statistics, University of Connecticut, Storrs, CT
| | | | - Jerome P Richie
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Clare M Tempany
- Division of MRI, Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Stephen Williams
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Marian J Loffredo
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
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Rosenkrantz AB, Triolo MJ, Melamed J, Rusinek H, Taneja SS, Deng FM. Whole-lesion apparent diffusion coefficient metrics as a marker of percentage Gleason 4 component within Gleason 7 prostate cancer at radical prostatectomy. J Magn Reson Imaging 2014; 41:708-14. [PMID: 24616064 DOI: 10.1002/jmri.24598] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/25/2014] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To retrospectively assess the utility of whole-lesion apparent diffusion coefficient (ADC) metrics in characterizing the Gleason 4 component of Gleason 7 prostate cancer (PCa) at radical prostatectomy. MATERIALS AND METHODS Seventy patients underwent phased-array coil 3T-magnetic resonance imaging (MRI) before prostatectomy. A uropathologist mapped locations and Gleason 4 percentage (G4%) of Gleason 7 tumors. Two radiologists independently reviewed ADC maps, aware of tumor locations but not G4%, and placed a volume-of-interest (VOI) on all slices including each lesion on the ADC map to obtain whole-lesion mean ADC and ADC entropy. Entropy reflects textural variation and increases with greater macroscopic heterogeneity. Performance for characterizing Gleason 7 tumors was assessed with mixed-model analysis of variance (ANOVA) and logistic regression. RESULTS Among 84 Gleason 7 tumors (G4% 5%-85%, median 30%; 59 Gleason 3+4, 25 Gleason 4+3), ADC entropy was significantly higher in Gleason 4+3 than Gleason 3+4 tumors (R1: 5.27 ± 0.61 vs. 4.62 ± 0.78, P = 0.001; R2: 5.91 ± 0.32 vs. 5.57 ± 0.56, P = 0.004); mean ADC was not significantly different between these groups (R1: 0.90 ± 0.15*10(-3) cm(2) /s vs. 0.98 ± 0.21*10(-3) cm(2) /s, P = 0.075; R2: 1.06 ± 0.19*10(-3) cm(2) /s vs. 1.14 ± 0.16*10(-3) cm(2) /s, P = 0.083). The area under the receiver operating characteristic (ROC) curve (AUC) for differentiating groups was significantly higher with ADC entropy than mean ADC for one observer (R1: 0.74 vs. 0.57, P = 0.027; R2: 0.69 vs. 0.61, P = 0.329). For R1, correlation with G4% was moderate for ADC entropy (r = 0.45) and weak for mean ADC (r = -0.25). For R2, correlation with G4% was moderate for ADC entropy (r = 0.41) and mean ADC (r = -0.32). For both readers, ADC entropy (P = 0.028-0.003), but not mean ADC (P = 0.384-0.854), was a significant independent predictor of G4%. CONCLUSION Whole-lesion ADC entropy outperformed mean ADC in characterizing Gleason 7 tumors and may help refine prognosis for this heterogeneous PCa subset.
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Cooperberg MR, Cowan JE, Carroll PR. Reply to A. Azad et al. J Clin Oncol 2013; 31:3296-7. [PMID: 23943835 DOI: 10.1200/jco.2013.51.4919] [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)
- Matthew R Cooperberg
- University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Guidelines on processing and reporting of prostate biopsies: the 2013 update of the pathology committee of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Virchows Arch 2013; 463:367-77. [DOI: 10.1007/s00428-013-1466-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/22/2013] [Indexed: 01/31/2023]
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Robertson NL, Hu Y, Ahmed HU, Freeman A, Barratt D, Emberton M. Prostate cancer risk inflation as a consequence of image-targeted biopsy of the prostate: a computer simulation study. Eur Urol 2013; 65:628-34. [PMID: 23312572 PMCID: PMC3925797 DOI: 10.1016/j.eururo.2012.12.057] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 12/23/2012] [Indexed: 11/17/2022]
Abstract
Background Prostate biopsy parameters are commonly used to attribute cancer risk. A targeted approach to lesions found on imaging may have an impact on the risk attribution given to a man. Objective To evaluate whether, based on computer simulation, targeting of lesions during biopsy results in reclassification of cancer risk when compared with transrectal ultrasound (TRUS) guided biopsy. Design, setting, and participants A total of 107 reconstructed three-dimensional models of whole-mount radical prostatectomy specimens were used for computer simulations. Systematic 12-core TRUS biopsy was compared with transperineal targeted biopsies using between one and five cores. All biopsy strategies incorporated operator and needle deflection error. A target was defined as any lesion ≥0.2 ml. A false-positive magnetic resonance imaging identification rate of 34% was applied. Outcome measurements and statistical analysis Sensitivity was calculated for the detection of all cancer and clinically significant disease. Cases were designated as high risk based on achieving ≥6 mm cancer length and/or ≥50% positive cores. Statistical significance (p values) was calculated using both a paired Kolmogorov-Smirnov test and the t test. Results and limitations When applying a widely used biopsy criteria to designate risk, 12-core TRUS biopsy classified only 24% (20 of 85) of clinically significant cases as high risk, compared with 74% (63 of 85) of cases using 4 targeted cores. The targeted strategy reported a significantly higher proportion of positive cores (44% vs 11%; p < 0.0001) and a significantly greater mean maximum cancer core length (7.8 mm vs 4.3 mm; p < 0.0001) when compared with 12-core TRUS biopsy. Computer simulations may not reflect the sources of errors encountered in clinical practice. To mitigate this we incorporated all known major sources of error to maximise clinical relevance. Conclusions Image-targeted biopsy results in an increase in risk attribution if traditional criteria, based on cancer core length and the proportion of positive cores, are applied. Targeted biopsy strategies will require new risk stratification models that account for the increased likelihood of sampling the tumour.
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Affiliation(s)
| | - Yipeng Hu
- UCL Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Hashim U Ahmed
- Department of Urology, University College London Hospital Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital Trust, London, UK
| | - Dean Barratt
- UCL Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospital Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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Glass AS, Cooperberg MR, Meng MV, Carroll PR. Role of active surveillance in the management of localized prostate cancer. J Natl Cancer Inst Monogr 2012; 2012:202-6. [PMID: 23271774 PMCID: PMC3540869 DOI: 10.1093/jncimonographs/lgs032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Active surveillance is an increasingly recognized treatment option for men with low-risk prostate cancer. Despite encouraging evidence for oncologic efficacy and reduction in morbidity, several barriers contribute to the underuse of this management strategy. Consistent selection criteria as well as identification and validation of triggers for subsequent intervention are essential. Incorporation of novel biomarkers as well as advanced imaging techniques may improve surveillance strategies by better defining eligibility as well as improving prompt detection of disease progression.
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Affiliation(s)
- Allison S Glass
- Department of Urology, University of California-San Francisco, CA 94143-1695, USA.
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