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Katelaris A, Amin A, Blazevski A, Scheltema MJ, Cusick T, Farraha M, Barreto D, Haynes AM, Gondoputro W, Agrawal S, Stricker P, Thompson J. Outcomes for active surveillance are similar for men with favourable risk ISUP-2 to those with ISUP-1 prostate cancer: A pair matched cohort study. JOURNAL OF CLINICAL UROLOGY 2023. [DOI: 10.1177/20514158231154702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Objective: To compare medium-term outcomes of active surveillance (AS) for men with favourable risk International Society for Urologic Pathology (ISUP)-2 prostate cancer (PCa) to a pair matched group of men with ISUP-1 PCa. Methods: This was a retrospective analysis of prospectively collected data from a single institution clinical outcomes registry, using propensity score matching. Men enrolled on AS with favourable risk ISUP-2 PCa with minimum 5-year follow-up were 1:2 propensity score matched to men with ISUP-1 disease. We assessed rates of progression to treatment, metastatic disease, adverse surgical pathology and overall survival. Results: Fifty-five ISUP-2 patients were matched to 105 ISUP-1 patients by propensity score. Median follow-up was 81 months (interquartile range (IQR), 61–109 months). Fifty-seven per cent in the ISUP-1 group progressed to treatment versus 58% in the ISUP-2 group (KM log rank p = 0.24). Estimated 1-, 2- and 5-year progression free survival rates were 93%, 60% and 33% for ISUP-1 patients and 94%, 63% and 16% for ISUP-2 patients, respectively. No patient from either group died of PCa. There was no statistical difference in rates of adverse pathology or metastatic disease between ISUP-2 and ISUP-1 patients on AS. Conclusion: AS for carefully selected men with favourable risk ISUP-2 disease appears safe, with similar oncologic outcomes to men with ISUP-1 disease. Level of evidence: Level 2b.
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Affiliation(s)
- Athos Katelaris
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
- St Vincent’s Prostate Cancer Centre, Australia
| | - Amer Amin
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
- St Vincent’s Prostate Cancer Centre, Australia
| | - Alexandar Blazevski
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
- St Vincent’s Prostate Cancer Centre, Australia
| | - Matthijs J Scheltema
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
- Department of Urology, Amsterdam University Medical Center, The Netherlands
| | | | - Melad Farraha
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
| | - Daniela Barreto
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
| | - Anne Maree Haynes
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
| | - William Gondoputro
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
- St Vincent’s Prostate Cancer Centre, Australia
| | - Shikha Agrawal
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
- St Vincent’s Prostate Cancer Centre, Australia
| | - Phillip Stricker
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
- St Vincent’s Prostate Cancer Centre, Australia
| | - James Thompson
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Australia
- St Vincent’s Prostate Cancer Centre, Australia
- Department of Urology, St George Hospital, Australia
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Abstract
OBJECTIVES Active surveillance (AS), now the standard of care for most men with favourable-risk prostate cancer, is appealing for selected men with 'favourable' intermediate-risk prostate cancer. METHODS This is a review of the indications for conservative management in this population, the outcomes reported in prospective series, and the use of molecular biomarkers and imaging to identify optimal candidates. RESULTS Candidates are those patients who are categorized as having intermediate-risk disease either because of a prostate-specific antigen level between 10 and 20 ng/mL, or by virtue of having Grade Group 2 disease, with a small percentage of Gleason 4 pattern, and a negative magnetic resonance imaging result or negative targeted biopsy of a region of interest. Confirmation with a favourable score on a tissue-based genetic assay can provide further reassurance. A subset of patients with intermediate-risk disease has indolent disease that may benefit from AS; at the same time, some patients with intermediate-risk disease have an aggressive clinical course that requires early definitive therapy. This heterogeneity is not adequately captured with traditional histopathological staging. Clinical, genomic and radiological biomarkers are the key to appropriate risk stratification and patient selection. CONCLUSIONS The benefits of AS make it an appealing option for selected patients with intermediate-risk disease.
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Affiliation(s)
- Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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A TMEFF2-regulated cell cycle derived gene signature is prognostic of recurrence risk in prostate cancer. BMC Cancer 2019; 19:423. [PMID: 31060542 PMCID: PMC6503380 DOI: 10.1186/s12885-019-5592-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/09/2019] [Indexed: 01/27/2023] Open
Abstract
Background The clinical behavior of prostate cancer (PCa) is variable, and while the majority of cases remain indolent, 10% of patients progress to deadly forms of the disease. Current clinical predictors used at the time of diagnosis have limitations to accurately establish progression risk. Here we describe the development of a tumor suppressor regulated, cell-cycle gene expression based prognostic signature for PCa, and validate its independent contribution to risk stratification in several radical prostatectomy (RP) patient cohorts. Methods We used RNA interference experiments in PCa cell lines to identify a gene expression based gene signature associated with Tmeff2, an androgen regulated, tumor suppressor gene whose expression shows remarkable heterogeneity in PCa. Gene expression was confirmed by qRT-PCR. Correlation of the signature with disease outcome (time to recurrence) was retrospectively evaluated in four geographically different cohorts of patients that underwent RP (834 samples), using multivariate logistical regression analysis. Multivariate analyses were adjusted for standard clinicopathological variables. Performance of the signature was compared to previously described gene expression based signatures using the SigCheck software. Results Low levels of TMEFF2 mRNA significantly (p < 0.0001) correlated with reduced disease-free survival (DFS) in patients from the Memorial Sloan Kettering Cancer Center (MSKCC) dataset. We identified a panel of 11 TMEFF2 regulated cell cycle related genes (TMCC11), with strong prognostic value. TMCC11 expression was significantly associated with time to recurrence after prostatectomy in four geographically different patient cohorts (2.9 ≤ HR ≥ 4.1; p ≤ 0.002), served as an independent indicator of poor prognosis in the four RP cohorts (1.96 ≤ HR ≥ 4.28; p ≤ 0.032) and improved the prognostic value of standard clinicopathological markers. The prognostic ability of TMCC11 panel exceeded previously published oncogenic gene signatures (p = 0.00017). Conclusions This study provides evidence that the TMCC11 gene signature is a robust independent prognostic marker for PCa, reveals the value of using highly heterogeneously expressed genes, like Tmeff2, as guides to discover prognostic indicators, and suggests the possibility that low Tmeff2 expression marks a distinct subclass of PCa. Electronic supplementary material The online version of this article (10.1186/s12885-019-5592-6) contains supplementary material, which is available to authorized users.
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van Strijp D, de Witz C, Vos PC, den Biezen-Timmermans E, van Brussel A, Wrobel J, Baillie GS, Tennstedt P, Schlomm T, Heitkötter B, Huss S, Bögemann M, Houslay MD, Bangma C, Semjonow A, Hoffmann R. The Prognostic PDE4D7 Score in a Diagnostic Biopsy Prostate Cancer Patient Cohort with Longitudinal Biological Outcomes. Prostate Cancer 2018; 2018:5821616. [PMID: 30147955 PMCID: PMC6083737 DOI: 10.1155/2018/5821616] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/11/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose. To further validate the prognostic power of the biomarker PDE4D7, we investigated the correlation of PDE4D7 scores adjusted for presurgical clinical variables with longitudinal postsurgical biological outcomes. Methods. RNA was extracted from biopsy punches of resected tumors (550 patients; RP cohort) and diagnostic needle biopsies (168 patients; DB cohort). Cox regression and survival were applied to correlate PDE4D7 scores with patient outcomes. Logistic regression was used to combine the clinical CAPRA score with PDE4D7. Results. In univariate analysis, the PDE4D7 score was significantly associated with PSA recurrence after prostatectomy in both studied patient cohorts' analysis (HR 0.53; 95% CI 0.41-0.67; p<1.0E-04 and HR 0.47; 95% CI 0.33-0.65; p<1.0E-04, respectively). After adjustment for the presurgical clinical variables preoperative PSA, PSA density, biopsy Gleason, clinical stage, percentage tumor in the biopsy (data only available for RP cohort), and percentage of positive biopsies, the HR was 0.49 (95% CI 0.38-0.64; p<1.0E-04) and 0.43 (95% CI 0.29-0.63; p<1.0E-04), respectively. The addition of the PDE4D7 to the clinical CAPRA score increased the AUC by 5% over the CAPRA score alone (0.82 versus 0.77; p=0.004). This combination model stratified 14.6% patients of the DB cohort to no risk of biochemical relapse (NPV 100%) over a follow-up period of up to 15 years. Conclusions. The PDE4D7 score provides independent risk information for pretreatment risk stratification. Combining CAPRA with PDE4D7 scores significantly improved the clinical risk stratification before surgery.
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Affiliation(s)
- Dianne van Strijp
- Philips Research Europe, High Tech Campus 34, 5656AE Eindhoven, Netherlands
| | - Christiane de Witz
- Philips Research Europe, High Tech Campus 34, 5656AE Eindhoven, Netherlands
| | - Pieter C. Vos
- Philips Research Europe, High Tech Campus 34, 5656AE Eindhoven, Netherlands
| | | | - Anne van Brussel
- Philips Research Europe, High Tech Campus 34, 5656AE Eindhoven, Netherlands
| | - Janneke Wrobel
- Philips Research Europe, High Tech Campus 34, 5656AE Eindhoven, Netherlands
| | - George S. Baillie
- Institute of Cardiovascular and Medical Science, University of Glasgow, G12 8TA Glasgow, Scotland, UK
| | - Pierre Tennstedt
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thorsten Schlomm
- Klinik für Urologie, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Birthe Heitkötter
- Gerhard-Domagk-Institute of Pathology, University Hospital Münster, 48149 Münster, Germany
| | - Sebastian Huss
- Gerhard-Domagk-Institute of Pathology, University Hospital Münster, 48149 Münster, Germany
| | - Martin Bögemann
- Prostate Center, University Hospital Münster, 48149 Münster, Germany
| | - Miles D. Houslay
- Institute of Pharmaceutical Science, King's College London, WC2R 2LS London, UK
- Mironid Ltd, BioCity Scotland, ML1 5UH Newhouse, Scotland, UK
| | - Chris Bangma
- Department of Urology, 3000CA Erasmus Medical Center, Rotterdam, Netherlands
| | - Axel Semjonow
- Prostate Center, University Hospital Münster, 48149 Münster, Germany
| | - Ralf Hoffmann
- Philips Research Europe, High Tech Campus 34, 5656AE Eindhoven, Netherlands
- Institute of Cardiovascular and Medical Science, University of Glasgow, G12 8TA Glasgow, Scotland, UK
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Abstract
PURPOSE OF REVIEW Active surveillance is now widely utilized for the management of low-risk prostate cancer (PCa). The limits of surveillance for men with intermediate risk cancer are controversial. While there is a broad consensus that men with low-risk disease can be safely managed with AS, many potential candidates, including those with Gleason 3 + 4 disease, PSA >10, younger men and African-Americans are often excluded. RECENT FINDINGS Outcome data for intermediate-risk patients managed by active surveillance demonstrate reasonable outcomes, but these men clearly are at higher risk for progression to metastatic disease. The use of biomarkers and multiparametric MRI will enable a more precise and personalized risk assessment. Literature describing the effects of young age on outcomes is limited, but the experience reported in prospective series with 15-20 year follow-up suggests it is a safe approach. African-American men are at greater risk for occult co-existent higher-grade disease, but in the absence of this their outcome is favorable. Patients with intermediate-risk PCa should not be excluded from active surveillance based on a single criterion. Treatment decisions should be based on multiple parameters, including percent Gleason 4, PSA density, cancer volume on biopsy, MRI findings, and patient age and co-morbidity. Genetic tissue-based biomarkers are also likely to play a role in enhancing decision making.
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Translating a Prognostic DNA Genomic Classifier into the Clinic: Retrospective Validation in 563 Localized Prostate Tumors. Eur Urol 2017; 72:22-31. [DOI: 10.1016/j.eururo.2016.10.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/10/2016] [Indexed: 01/27/2023]
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Beauval JB, Cabarrou B, Gandaglia G, Patard PM, Ouzzane A, de la Taille A, Soulié M, Briganti A, Ploussard G, Rozet F, Roumiguié M. External validation of a nomogram for identification of pathologically favorable disease in intermediate risk prostate cancer patients. Prostate 2017; 77:928-933. [PMID: 28370267 DOI: 10.1002/pros.23348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/02/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To establish an external validation of the new nomogram from Gandaglia et al which provides estimates of the probability of pathological favorable disease in pre-operatively defined intermediate-risk PCa. PATIENTS AND METHODS Overall, 2928 intermediate-risk PCa patients according to the D'Amico classification undergoing RP and bilateral lymph node dissection in seven academic centres between 2000 and 2011. Pathologically favorable PCa was defined as low-grade organ-confined disease. The Receiver Operating Characteristic (ROC) curve was obtained to quantify the overall accuracy (Area Under the Curve, AUC) of the model to predict specimen-confined (SC) disease. Calibration curve was then constructed to illustrate the relationship between the risk-estimates obtained by the model and the observed proportion of SC disease. Kaplan-Meier method was used for PSA recurrence-free survival (PSA-RFS) assessment. RESULTS Median age was 68 years. 10.6% patients finally presented pathologically favorable disease characteristics at RP. A higher PSAD (OR = 0.01; 95%CI = 0.00-0.04; P < 0.0001) and percentage of positive cores (OR = 0.97; 95%CI = 0.96-0.98; P < 0.0001) were associated with a reduced probability of favorable disease at RP in multivariate analysis. ROC curve analysis showed strongest accuracy of the model (AUC = 0.82; 95%CI = 0.79-0.84). Favorable PCa had a significantly better PSA recurrence-free survival rates as compared to unfavorable PCa after RP (94.2% vs 74.4% at 4 years, P < 0.0001). CONCLUSIONS This external validation of the Gandaglia nomogram shows relevant accuracy with one out of ten patients in this intermediate risk PCa group with pathologically proven organ-confined disease. This validated risk calculator can help physician to distinguish favorable intermediate risk PCa that can be treated by conservative approach or safer nerve-sparing surgery.
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Affiliation(s)
- Jean-Baptiste Beauval
- Department of Urology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bastien Cabarrou
- Department of Statistics, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | | | - Pierre-Marie Patard
- Department of Urology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Adil Ouzzane
- Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | | | - Michel Soulié
- Department of Urology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Alberto Briganti
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
| | | | | | - Mathieu Roumiguié
- Department of Urology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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9
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Musunuru HB, Yamamoto T, Klotz L, Ghanem G, Mamedov A, Sethukavalan P, Jethava V, Jain S, Zhang L, Vesprini D, Loblaw A. Active Surveillance for Intermediate Risk Prostate Cancer: Survival Outcomes in the Sunnybrook Experience. J Urol 2016; 196:1651-1658. [PMID: 27569437 DOI: 10.1016/j.juro.2016.06.102] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess the applicability of active surveillance in patients with intermediate risk prostate cancer, we compared the survival outcomes of patients with low risk and intermediate risk disease. MATERIALS AND METHODS Active surveillance was offered to all patients with low risk (cT1-T2b and Gleason score 6 and prostate specific antigen 10 ng/ml or less) and select intermediate risk disease (age greater than 70 years with cT2c or prostate specific antigen 15 ng/ml or less, or Gleason score 3+4 or less). Data from November 1995 to May 2013 were extracted from a prospectively collected database. The primary outcome was metastasis-free survival, and secondary outcomes were overall survival, cause specific survival and treatment-free survival. RESULTS A total of 213 intermediate risk and 732 low risk cases were identified. Median age was 72 years (IQR 67.3, 76.8) in the intermediate risk cohort and 67 years (IQR 60.6, 71.9) in the low risk group. Median followup was comparable (6.7 years for intermediate risk vs 6.5 years for low risk). Gleason 7 disease comprised 60% of the intermediate risk cohort. The 15-year metastasis-free, overall, cause specific and treatment-free survival rates were inferior in the intermediate risk group (metastasis-free survival HR 3.14, 95% CI 1.51-6.53, p=0.001, 82% for intermediate risk vs 95% for low risk). On further evaluation the estimated 15-year metastasis-free survival for cases of Gleason 6 or less with prostate specific antigen less than 10 ng/ml was 94%, Gleason 6 or less with prostate specific antigen 10 to 20 ng/ml was 94%, Gleason 3+4 with prostate specific antigen 20 ng/ml or less was 84% and Gleason 4+3 with prostate specific antigen 20 ng/ml or less was 63%. CONCLUSIONS These data support the use of active surveillance in low risk and intermediate risk cases of Gleason 6 but not Gleason 7 prostate cancer. Multiparametric magnetic resonance imaging and novel biomarkers might be vital in detecting favorable Gleason 7 disease.
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Affiliation(s)
- Hima Bindu Musunuru
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Toshihiro Yamamoto
- Department of Surgical Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laurence Klotz
- Department of Surgical Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gabriella Ghanem
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alexandre Mamedov
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peraka Sethukavalan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Vibhuti Jethava
- Department of Surgical Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Suneil Jain
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, Ireland
| | - Liying Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Vesprini
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Measurement and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Zakian KL, Hatfield W, Aras O, Cao K, Yakar D, Goldman DA, Moskowitz CS, Shukla-Dave A, Tehrani YM, Fine S, Eastham J, Hricak H. Prostate MRSI predicts outcome in radical prostatectomy patients. Magn Reson Imaging 2016; 34:674-81. [PMID: 26821278 DOI: 10.1016/j.mri.2016.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND New non-invasive methods are needed for sub-stratifying high-risk prostate cancer patients. Magnetic resonance spectroscopic imaging (MRSI) maps metabolites in prostate cancer, providing information on tumor aggressiveness and volume. PURPOSE To investigate the correlation between MRSI and treatment failure (TF) after radical prostatectomy (RP). METHODS Two-hundred sixty-two patients who underwent endorectal MRI/MRSI followed by RP at our institution from 2003 to 2007 were studied. MRI stage, number of voxels in the MRSI index lesion (NILV), number of high-grade voxels (NHGV), and number of voxels containing undetectable polyamines (NUPV) were derived. Clinical outcome was followed until August, 2014. Treatment failure was defined as 1) biochemical recurrence (BCR), 2) persistently detectable PSA after RP, or 3) adjuvant therapy initiated in the absence of BCR. MRI/MRSI features and clinical parameters were compared to TF by univariate Cox Proportional Hazards Regression. After backward selection, each MRSI parameter was included in a separate regression model adjusted for NCCN-based clinical risk score (CRS), number of biopsy cores positive (NPC), and MRI stage. RESULTS In univariate analysis, all clinical variables were associated with TF in addition to MRI stage, NILV, NHGV, and NUPV. In multivariate analysis, NILV, NHGV, and NUPV were also significant risk factors for TF (p=0.016, p=0.002, p=0.006, respectively). The association between the number of tumor voxels with undetectable polyamines and the probability of treatment failure has not been previously reported. The number of MRSI cancer voxels correlated with extracapsular extension (ECE) (p<0.0001). CONCLUSIONS MRSI was associated with post-radical prostatectomy treatment failure in models adjusted for the number of positive biopsy cores and clinical risk score. This is the first report that in radical prostatectomy patients MRSI has an association with treatment failure independent of the number of positive biopsy cores. MRSI may help the clinician determine whether patients with high risk disease who undergo RP are candidates for specialized additional treatment.
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Affiliation(s)
- Kristen L Zakian
- Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY, NY, 10065, USA.
| | | | - Omer Aras
- MSKCC, 1275 York Avenue, NY, NY, 10065, USA.
| | - Kun Cao
- MSKCC, 1275 York Avenue, NY, NY, 10065, USA.
| | - Derya Yakar
- MSKCC, 1275 York Avenue, NY, NY, 10065, USA.
| | | | | | | | | | - Samson Fine
- MSKCC, 1275 York Avenue, NY, NY, 10065, USA.
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11
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Gandaglia G, Schiffmann J, Schlomm T, Fossati N, Moschini M, Suardi N, Chun FKH, Montorsi F, Graefen M, Briganti A. Identification of pathologically favorable disease in intermediate-risk prostate cancer patients: Implications for active surveillance candidates selection. Prostate 2015; 75:1484-91. [PMID: 26177942 DOI: 10.1002/pros.23040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 05/26/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intermediate-risk prostate cancer (PCa) represents a heterogeneous disease, where a non-negligible proportion of patients harbor favorable pathologic characteristics and are potentially eligible for active surveillance (AS). We aimed at developing a model for the identification of pathologically favorable PCa at radical prostatectomy (RP) among intermediate-risk patients. METHODS Overall, 3,821 intermediate-risk patients treated with RP at two centers between 2005 and 2013 were identified. Pathologically favorable PCa was defined as low-grade organ-confined disease. Age, biopsy Gleason, PSA density (PSAD), and the percentage of positive cores were included in multivariable logistic regression analyses predicting favorable PCa and formed the basis for a logistic regression-based risk calculator. The internally validated discrimination and calibration of the risk calculator were quantified using 200 bootstrap resamples. Decision curve analysis (DCA) provided an estimate of the net benefit obtained using this model versus treating no one and treating everyone. RESULTS Overall, 10.0% of all intermediate risk patients had favorable disease. In multivariable analyses, patients with biopsy Gleason score ≤6 had higher probability of favorable disease compared to those with higher-grade disease (P < 0.001). Similarly, age, PSAD, and percentage of positive cores were associated with the probability of favorable disease (all P ≤ 0.01). The risk calculator achieved a validated accuracy of 82.5%. The DCA showed that our prediction model is better than both treating no one and treating everyone. CONCLUSIONS One out of ten intermediate-risk patients harbors favorable disease at RP. Our novel, pre-operative, validated risk calculator may help clinicians identifying patients who could be considered for conservative therapy approaches such as AS.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jonas Schiffmann
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schlomm
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Moschini
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nazareno Suardi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Felix K H Chun
- Department of Urology, University Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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van der Kwast TH, Roobol MJ. Prostate cancer: Is prostatectomy for Gleason score 6 a treatment failure? Nat Rev Urol 2014; 12:10-1. [PMID: 25487050 DOI: 10.1038/nrurol.2014.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Theodorus H van der Kwast
- Department of Pathology-University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Monique J Roobol
- Department of Urology, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015 CE, Rotterdam, Netherlands
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