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Paulson N, Zeevi T, Papademetris M, Leapman MS, Onofrey JA, Sprenkle PC, Humphrey PA, Staib LH, Levi AW. Prediction of Adverse Pathology at Radical Prostatectomy in Grade Group 2 and 3 Prostate Biopsies Using Machine Learning. JCO Clin Cancer Inform 2022; 6:e2200016. [PMID: 36179281 DOI: 10.1200/cci.22.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is ongoing clinical need to improve estimates of disease outcome in prostate cancer. Machine learning (ML) approaches to pathologic diagnosis and prognosis are a promising and increasingly used strategy. In this study, we use an ML algorithm for prediction of adverse outcomes at radical prostatectomy (RP) using whole-slide images (WSIs) of prostate biopsies with Grade Group (GG) 2 or 3 disease. METHODS We performed a retrospective review of prostate biopsies collected at our institution which had corresponding RP, GG 2 or 3 disease one or more cores, and no biopsies with higher than GG 3 disease. A hematoxylin and eosin-stained core needle biopsy from each site with GG 2 or 3 disease was scanned and used as the sole input for the algorithm. The ML pipeline had three phases: image preprocessing, feature extraction, and adverse outcome prediction. First, patches were extracted from each biopsy scan. Subsequently, the pre-trained Visual Geometry Group-16 convolutional neural network was used for feature extraction. A representative feature vector was then used as input to an Extreme Gradient Boosting classifier for predicting the binary adverse outcome. We subsequently assessed patient clinical risk using CAPRA score for comparison with the ML pipeline results. RESULTS The data set included 361 WSIs from 107 patients (56 with adverse pathology at RP). The area under the receiver operating characteristic curves for the ML classification were 0.72 (95% CI, 0.62 to 0.81), 0.65 (95% CI, 0.53 to 0.79) and 0.89 (95% CI, 0.79 to 1.00) for the entire cohort, and GG 2 and GG 3 patients, respectively, similar to the performance of the CAPRA clinical risk assessment. CONCLUSION We provide evidence for the potential of ML algorithms to use WSIs of needle core prostate biopsies to estimate clinically relevant prostate cancer outcomes.
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Affiliation(s)
| | - Tal Zeevi
- Yale School of Medicine, New Haven, CT
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Zelic R, Giunchi F, Fridfeldt J, Carlsson J, Davidsson S, Lianas L, Mascia C, Zugna D, Molinaro L, Vincent PH, Zanetti G, Andrén O, Richiardi L, Akre O, Fiorentino M, Pettersson A. Prognostic Utility of the Gleason Grading System Revisions and Histopathological Factors Beyond Gleason Grade. Clin Epidemiol 2022; 14:59-70. [PMID: 35082531 PMCID: PMC8784949 DOI: 10.2147/clep.s339140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background The International Society of Urological Pathology (ISUP) revised the Gleason system in 2005 and 2014. The impact of these changes on prostate cancer (PCa) prognostication remains unclear. Objective To evaluate if the ISUP 2014 Gleason score (GS) predicts PCa death better than the pre-2005 GS, and if additional histopathological information can further improve PCa death prediction. Patients and Methods We conducted a case–control study nested among men in the National Prostate Cancer Register of Sweden diagnosed with non-metastatic PCa 1998–2015. We included 369 men who died from PCa (cases) and 369 men who did not (controls). Two uro-pathologists centrally re-reviewed biopsy ISUP 2014 Gleason grading, poorly formed glands, cribriform pattern, comedonecrosis, perineural invasion, intraductal, ductal and mucinous carcinoma, percentage Gleason 4, inflammation, high-grade prostatic intraepithelial neoplasia (HGPIN) and post-atrophic hyperplasia. Pre-2005 GS was back-transformed using i) information on cribriform pattern and/or poorly formed glands and ii) the diagnostic GS from the registry. Models were developed using Firth logistic regression and compared in terms of discrimination (AUC). Results The ISUP 2014 GS (AUC = 0.808) performed better than the pre-2005 GS when back-transformed using only cribriform pattern (AUC = 0.785) or both cribriform and poorly formed glands (AUC = 0.792), but not when back-transformed using only poorly formed glands (AUC = 0.800). Similarly, the ISUP 2014 GS performed better than the diagnostic GS (AUC = 0.808 vs 0.781). Comedonecrosis (AUC = 0.811), HGPIN (AUC = 0.810) and number of cores with ≥50% cancer (AUC = 0.810) predicted PCa death independently of the ISUP 2014 GS. Conclusion The Gleason Grading revisions have improved PCa death prediction, likely due to classifying cribriform patterns, rather than poorly formed glands, as Gleason 4. Comedonecrosis, HGPIN and number of cores with ≥50% cancer further improve PCa death discrimination slightly.
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Affiliation(s)
- Renata Zelic
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Correspondence: Renata Zelic Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, K2 Medicin, Solna, K2 Klinisk epidemiologi K Ekström Smedby, Stockholm, 171 77, SwedenTel +46703136037Fax +46851779304 Email
| | - Francesca Giunchi
- Pathology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jonna Fridfeldt
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jessica Carlsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sabina Davidsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Luca Lianas
- Data-Intensive Computing Division, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Pula, Italy
| | - Cecilia Mascia
- Data-Intensive Computing Division, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Pula, Italy
| | - Daniela Zugna
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, and CPO-Piemonte, Turin, Italy
| | - Luca Molinaro
- Division of Pathology, A.O. Città della Salute e della Scienza Hospital, Turin, Italy
| | - Per Henrik Vincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Zanetti
- Data-Intensive Computing Division, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Pula, Italy
| | - Ove Andrén
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, and CPO-Piemonte, Turin, Italy
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Andreas Pettersson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Paulson N, Vollmer RT, Humphrey PA, Sprenkle PC, Onofrey J, Huber S, Amirkhiz K, Levi AW. Extent of High-Grade Prostatic Adenocarcinoma in Multiparametric Magnetic Resonance Imaging-Targeted Biopsy Enhances Prediction of Pathologic Stage. Arch Pathol Lab Med 2021; 146:201-204. [PMID: 34015819 DOI: 10.5858/arpa.2020-0568-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Multiparametric magnetic resonance imaging (mpMRI) of prostate with targeted biopsy has enhanced detection of high-grade prostatic adenocarcinoma (HG PCa). However, utility of amount of HG PCa (Gleason pattern 4/5) in mpMRI-targeted biopsies versus standard 12-core biopsies in predicting adverse outcomes on radical prostatectomy (RP) is unknown. OBJECTIVE.— To examine the utility of amount of HG PCa in mpMRI-targeted biopsies versus standard 12-core biopsies in predicting adverse RP outcomes. DESIGN.— We performed a retrospective review of prostate biopsies, which had corresponding RP, 1 or more mpMRI-targeted biopsy, and grade group 2 disease or higher. For the 169 cases identified, total millimeters of carcinoma and HG PCa, and longest length HG PCa in a single core were recorded for 12-core biopsies and each set of mpMRI-targeted biopsies. For RP specimens, Gleason grade, extraprostatic extension, seminal vesicle involvement, and lymph node metastasis were recorded. The main outcome studied was prostate-confined disease at RP. A logistic regression model was used to test which pre-RP variables related to this outcome. RESULTS.— Univariate analysis showed significant associations with adverse RP outcomes in 5 of 8 quantifiable variables; longest millimeter HG PCa in a single 12-core biopsy, highest grade group in any core, and total millimeter HG in mpMRI-targeted biopsies showed no statistical association (P = .54, P = .13, and P = .55, respectively). In multivariate analysis, total millimeter carcinoma in all cores, highest GrGrp in any core, and longest millimeter HG PCa in a single mpMRI-targeted core provided additional predictive value (P < .001, P = .004, and P = .03, respectively). CONCLUSIONS.— Quantitation of HG PCa in mpMRI-targeted biopsies provides additional value over 12-core biopsies alone in predicting nonorgan confined prostate cancer at RP. Linear millimeters of HG PCa in mpMRI-targeted biopsies is a significant parameter associated with higher pathologic stage and could be of value in risk models.
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Affiliation(s)
- Nathan Paulson
- From the Department of Pathology (Paulson, Humphrey, Levi), Yale University School of Medicine, New Haven, Connecticut
| | - Robin T Vollmer
- the Department of Pathology, Veterans Affairs and Duke University Medical Centers, Durham, North Carolina (Vollmer)
| | - Peter A Humphrey
- From the Department of Pathology (Paulson, Humphrey, Levi), Yale University School of Medicine, New Haven, Connecticut
| | - Preston C Sprenkle
- Department of Urology (Sprenkle, Onofrey, Amirkhiz), Yale University School of Medicine, New Haven, Connecticut
| | - John Onofrey
- Department of Urology (Sprenkle, Onofrey, Amirkhiz), Yale University School of Medicine, New Haven, Connecticut.,Radiology & Biomedical Imaging (Onofrey, Huber), Yale University School of Medicine, New Haven, Connecticut
| | - Steffen Huber
- Radiology & Biomedical Imaging (Onofrey, Huber), Yale University School of Medicine, New Haven, Connecticut
| | - Kamyar Amirkhiz
- Department of Urology (Sprenkle, Onofrey, Amirkhiz), Yale University School of Medicine, New Haven, Connecticut
| | - Angelique W Levi
- From the Department of Pathology (Paulson, Humphrey, Levi), Yale University School of Medicine, New Haven, Connecticut
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Vollmer RT. The Importance of Tumor Length in Needle Biopsies of the Prostate. Am J Clin Pathol 2020; 154:533-535. [PMID: 32556114 DOI: 10.1093/ajcp/aqaa068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To form a composite predictor variable that combines the effects of tumor length, serum prostate-specific antigen (PSA), and International Society of Urologic Pathologists (ISUP) grade on the observation of adverse prostatectomy pathology. METHODS Logistic regression analysis was used to demonstrate how tumor length, serum PSA, and ISUP grade related to adverse prostatectomy results and to derive weighting factors for a composite variable, cx. RESULTS The composite variable, cx, relates closely to adverse prostatectomy results as well as to observed PSA failure. CONCLUSIONS The composite variable cx uses preoperative information that may allow the sorting of patients into low, intermediate, and high risk for adverse outcomes after prostatectomy.
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Automated Gleason Scoring and Tumor Quantification in Prostate Core Needle Biopsy Images Using Deep Neural Networks and Its Comparison with Pathologist-Based Assessment. Cancers (Basel) 2019; 11:cancers11121860. [PMID: 31769420 PMCID: PMC6966453 DOI: 10.3390/cancers11121860] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 01/29/2023] Open
Abstract
The Gleason grading system, currently the most powerful prognostic predictor of prostate cancer, is based solely on the tumor’s histological architecture and has high inter-observer variability. We propose an automated Gleason scoring system based on deep neural networks for diagnosis of prostate core needle biopsy samples. To verify its efficacy, the system was trained using 1133 cases of prostate core needle biopsy samples and validated on 700 cases. Further, system-based diagnosis results were compared with reference standards derived from three certified pathologists. In addition, the system’s ability to quantify cancer in terms of tumor length was also evaluated via comparison with pathologist-based measurements. The results showed a substantial diagnostic concordance between the system-grade group classification and the reference standard (0.907 quadratic-weighted Cohen’s kappa coefficient). The system tumor length measurements were also notably closer to the reference standard (correlation coefficient, R = 0.97) than the original hospital diagnoses (R = 0.90). We expect this system to assist pathologists to reduce the probability of over- or under-diagnosis by providing pathologist-level second opinions on the Gleason score when diagnosing prostate biopsy, and to support research on prostate cancer treatment and prognosis by providing reproducible diagnosis based on the consistent standards.
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Simopoulos DN, Sisk AE, Priester A, Felker ER, Kwan L, Delfin MK, Reiter RE, Marks LS. Cancer core length from targeted biopsy: an index of prostate cancer volume and pathological stage. BJU Int 2019; 124:275-281. [PMID: 30694605 DOI: 10.1111/bju.14691] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To study the relationship of maximum cancer core length (MCCL), on targeted biopsy (TB) of magnetic resonance imaging (MRI)-visible index lesions, to volume of that tumour found at radical prostatectomy (RP). PATIENTS AND METHODS In all, 205 men undergoing fusion biopsy and RP were divided into two groups: 136 in whom the MCCL came from an index MRI-visible lesion (TB) and 69 in whom MCCL came from a non-targeted lesion (non-targeted biopsy [NTB]). MRI was 3-T multi-parametric and biopsy was via MRI-ultrasonography fusion. RESULTS In the TB group, MCCL correlated with volume of clinically significant index tumours (ρ = 0.44-0.60, P < 0.01). The correlation was similar for first and repeat biopsy and for transition and peripheral zone lesions (ρ = 0.42-0.49, P < 0.01). No correlations were found in the NTB group. TB MCCL (6-10 and >10 mm) and MRI lesion diameter (>20 mm) were independently associated with tumour volume. TB MCCLs >10 mm and Gleason scores >7 were each associated with pathological T3 disease (odds ratios 5.73 and 5.04, respectively), but MRI lesion diameter lesion was not. CONCLUSIONS MCCL on a TB from an MRI-visible lesion is an independent predictor of both cancer volume and pathological stage. This relationship does not exist for MCCL from a NTB core. Quantifying CCL on MRI-TBs may have a value, not previously described, to risk-stratify patients with prostate cancer before treatment.
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Affiliation(s)
- Demetrios N Simopoulos
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Anthony E Sisk
- Department of Pathology, David Geffen School of Medicine, UCLA, Los Angeles, CA,, USA
| | - Alan Priester
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Ely R Felker
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Merdie K Delfin
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA,, USA
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The Learning Curve for Magnetic Resonance Imaging/Ultrasound Fusion-guided Prostate Biopsy. Eur Urol Oncol 2018; 2:135-140. [PMID: 31017088 DOI: 10.1016/j.euo.2018.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/28/2018] [Accepted: 07/16/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Magnetic resonance imaging/ultrasound-guided fusion biopsy (FBx) is more accurate at detecting clinically significant prostate cancer than conventional transrectal ultrasound-guided systematic biopsy. However, learning curves for attaining accuracy may limit the generalizability of published outcomes. OBJECTIVE To delineate and quantify the learning curve for FBx by assessing the targeted biopsy accuracy and pathological quality of systematic biopsy over time. DESIGN, SETTING, AND PARTICIPANTS We carried out a retrospective analysis of 173 consecutive men who underwent Artemis FBx with computer-template systematic sampling between July 2015 and May 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The accuracy of targeted biopsy was determined by calculating the distance between planned and actual core trajectories stored on Artemis. Systematic sampling proficiency was assessed via pathological analysis of fibromuscular tissue in all cores and then comparing pathology elements from individual cores from men in the first and last tertiles. Polynomial linear regression models, change-point analysis, and piecewise linear regression were used to quantify the learning curve. RESULTS AND LIMITATION A significant improvement in targeted biopsy accuracy occurred up to 98 cases (p<0.01). There was a significant decrease in fibromuscular tissue in the systematic biopsy cores up to 84 cases (p<0.01) and an improvement in pathological quality when comparing systematic cores from the first and third tertiles. Use of a different fusion platform may limit the generalizability of our results. CONCLUSIONS There is a significant learning curve for targeted and systemic biopsy using the Artemis platform. Improvements in accuracy of targeted biopsy and better sampling for systematic biopsy can be achieved with greater experience. PATIENT SUMMARY We define the learning curve for magnetic resonance imaging/ultrasound-guided fusion biopsy (FBx) using targeted biopsy accuracy and systematic core sampling quality as measures. Our findings underscore the importance of overcoming learning curves inherent to FBx to minimize patient discomfort and biopsy risk and improve the quality of care for accurate risk stratification, active surveillance, and treatment selection.
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8
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Egevad L, Delahunt B, Kristiansen G, Samaratunga H, Varma M. Contemporary prognostic indicators for prostate cancer incorporating International Society of Urological Pathology recommendations. Pathology 2018; 50:60-73. [DOI: 10.1016/j.pathol.2017.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/28/2017] [Indexed: 12/21/2022]
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Konyalioglu E, Tarhan H, Cakmak O, Pala EE, Zorlu F. Prostate cancer volume estimations based on transrectal ultrasonography-guided biopsy in order to predict clinically significant prostate cancer. Int Braz J Urol 2015. [PMID: 26200537 PMCID: PMC4752136 DOI: 10.1590/s1677-5538.ibju.2014.0251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tumor diameter is a reliable parameter to estimate tumor volume in solid organ cancers; its use in prostate cancer is controversial since it exhibits a more irregular pattern of growth. This study aimed to examine the association between the tumor volume estimations based on transrectal ultrasound (TRUS) guided biopsy results and the tumor volume measured on the pathological specimen. MATERIALS AND METHODS A total of 237 patients who underwent radical retropubic prostatectomy (RRP) were included in this retrospective study. The differences and correlations between cancer volume estimations based on TRUS guided biopsy findings and cancer volume estimations based on post-prostatectomy pathology specimens were examined. In addition, diagnostic value of TRUS guided biopsy-based volume estimations in order to predict clinically significant cancer (>0.5 cc) were calculated. RESULTS The mean cancer volume estimated using TRUS biopsy results was lower (5.5±6.5 cc) than the mean cancer volume calculated using prostatectomy specimens (6.4±7.6 cc) (p<0.041).TRUS guided biopsy examination resulted in 5 false positive and 15 false negative cases. There was a significant but weak correlation between the two parameters (r=0.62, p<0.001). The sensitivity and specificity of TRUS guided biopsy in predicting the presence of clinically significant cancer was 93.4% (95% CI, 89.1-96.1) and 50.0% (95% CI, 20.1-79.9), respectively. CONCLUSIONS TRUS guided biopsy-derived estimations seem to have a limited value to predict pathologically established tumor volume. Further studies are warranted to identify additional methods that may more accurately predict actual pathological characteristics and prognosis of prostate cancer.
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Affiliation(s)
| | - Huseyin Tarhan
- Department of Urology, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Ozgur Cakmak
- Department of Urology, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Emel Ebru Pala
- Department of Pathology, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Ferruh Zorlu
- Department of Urology, Tepecik Research and Training Hospital, Izmir, Turkey
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Kajikawa K, Kanao K, Kobayashi I, Nishikawa G, Yoshizawa T, Kato Y, Watanabe M, Zennami K, Nakamura K, Sumitomo M. Optimal method for measuring tumor extent in needle biopsy specimens to identify small-volume prostate cancer. Int J Urol 2015; 23:62-8. [DOI: 10.1111/iju.12961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 09/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Keishi Kajikawa
- Department of Urology; Aichi Medical University; Nagakute Aichi Japan
| | - Kent Kanao
- Department of Urology; Aichi Medical University; Nagakute Aichi Japan
| | - Ikuo Kobayashi
- Department of Urology; Aichi Medical University; Nagakute Aichi Japan
| | - Genya Nishikawa
- Department of Urology; Aichi Medical University; Nagakute Aichi Japan
| | | | - Yoshiharu Kato
- Department of Urology; Aichi Medical University; Nagakute Aichi Japan
| | - Masahito Watanabe
- Department of Urology; Aichi Medical University; Nagakute Aichi Japan
| | - Kenji Zennami
- Department of Urology; Aichi Medical University; Nagakute Aichi Japan
| | - Kogenta Nakamura
- Department of Urology; Aichi Medical University; Nagakute Aichi Japan
| | - Makoto Sumitomo
- Department of Urology; Aichi Medical University; Nagakute Aichi Japan
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Billis A, Quintal MMQ, Freitas LLL, Costa LBE, Ferreira U. Predictive criteria of insignificant prostate cancer: what is the correspondence of linear extent to percentage of cancer in a single core? Int Braz J Urol 2015; 41:367-72. [PMID: 26005981 PMCID: PMC4752103 DOI: 10.1590/s1677-5538.ibju.2015.02.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/28/2014] [Indexed: 01/30/2023] Open
Abstract
Objective The aim of active surveillance of early prostate cancer is to individualize therapy by selecting for curative treatment only patients with significant cancer. Epstein’s criteria for prediction of clinically insignificant cancer in surgical specimens are widely used. Epstein’s criterion “no single core with >50% cancer” has no correspondence in linear extent. The aim of this study is to find a possible correspondence. Materials and Methods From a total of 401 consecutive patients submitted to radical prostatectomy, 17 (4.2%) met criteria for insignificant cancer in the surgical specimen. The clinicopathologic findings in the correspondent biopsies were compared with Epstein’s criteria for insignificant cancer. Cancer in a single core was evaluated in percentage as well as linear extent in mm. Results Comparing the clinicopathologic findings with Epstein’s criteria predictive of insignificant cancer, there was 100% concordance for clinical stage T1c, no Gleason pattern 4 or 5, ≤2 cores with cancer, and no single core with >50% cancer. However, only 25% had density ≤0.15. The mean, median and range of the maximum length of cancer in a single core in mm were 1.19, 1, and 0.5-2.5, respectively. Additionally, the mean, median, and range of length of cancer in all cores in mm were 1.47, 1.5, and 0.5-3, respectively. Conclusion To pathologists that use Epstein’s criteria predictive of insignificant cancer and measure linear extent in mm, our study favors that “no single core with >50% cancer” may correspond to >2.5 mm in linear extent.
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Affiliation(s)
- Athanase Billis
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Maisa M Q Quintal
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Leandro L L Freitas
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Larissa B E Costa
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Ubirajara Ferreira
- Department of Urology (UF), School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
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12
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Russo GI, Morgia G. How to define cumulative cancer length for selecting candidate for active surveillance? J Clin Pathol 2015; 68:323-4. [PMID: 25770160 DOI: 10.1136/jclinpath-2014-202786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/22/2015] [Indexed: 11/04/2022]
Affiliation(s)
| | - Giuseppe Morgia
- Department of Urology, University of Catania, Catania, Italy
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13
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Amin MB, Lin DW, Gore JL, Srigley JR, Samaratunga H, Egevad L, Rubin M, Nacey J, Carter HB, Klotz L, Sandler H, Zietman AL, Holden S, Montironi R, Humphrey PA, Evans AJ, Epstein JI, Delahunt B, McKenney JK, Berney D, Wheeler TM, Chinnaiyan AM, True L, Knudsen B, Hammond MEH. The critical role of the pathologist in determining eligibility for active surveillance as a management option in patients with prostate cancer: consensus statement with recommendations supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists, and the Prostate Cancer Foundation. Arch Pathol Lab Med 2014; 138:1387-405. [PMID: 25092589 DOI: 10.5858/arpa.2014-0219-sa] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Prostate cancer remains a significant public health problem. Recent publications of randomized trials and the US Preventive Services Task Force recommendations have drawn attention to overtreatment of localized, low-risk prostate cancer. Active surveillance, in which patients undergo regular visits with serum prostate-specific antigen tests and repeat prostate biopsies, rather than aggressive treatment with curative intent, may address overtreatment of low-risk prostate cancer. It is apparent that a greater awareness of the critical role of pathologists in determining eligibility for active surveillance is needed. OBJECTIVES To review the state of current knowledge about the role of active surveillance in the management of prostate cancer and to provide a multidisciplinary report focusing on pathologic parameters important to the successful identification of patients likely to succeed with active surveillance, to determine the role of molecular tests in increasing the safety of active surveillance, and to provide future directions. DESIGN Systematic review of literature on active surveillance for low-risk prostate cancer, pathologic parameters important for appropriate stratification, and issues regarding interobserver reproducibility. Expert panels were created to delineate the fundamental questions confronting the clinical and pathologic aspects of management of men on active surveillance. RESULTS Expert panelists identified pathologic parameters important for management and the related diagnostic and reporting issues. Consensus recommendations were generated where appropriate. CONCLUSIONS Active surveillance is an important management option for men with low-risk prostate cancer. Vital to this process is the critical role pathologic parameters have in identifying appropriate candidates for active surveillance. These findings need to be reproducible and consistently reported by surgical pathologists with accurate pathology reporting.
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Affiliation(s)
- Mahul B Amin
- From the Departments of Pathology and Laboratory Medicine (Drs Amin and Knudsen), Radiation Oncology (Dr Sandler), Urology (Dr Holden), and Biomedical Sciences (Dr Knudsen), Cedars-Sinai Medical Center, Los Angeles, California; the Departments of Urology (Drs Lin and Gore) and Pathology (Dr True), University of Washington, Seattle; Trillium Health Partners, Mississauga, Ontario, Canada, and McMaster University, Hamilton, Ontario, Canada (Dr Srigley); Aquesta Pathology, Toowong, Queensland, Australia, and the University of Queensland, Brisbane (Dr Samaratunga); the Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden (Dr Egevad); the Institute for Precision Medicine and the Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, Ithaca, New York, and New York-Presbyterian Hospital, New York (Dr Rubin); the Departments of Surgery (Dr Nacey) and Pathology and Molecular Medicine (Dr Delahunt), Wellington School of Medicine and Health Sciences, University of Otago, Newtown, Wellington, New Zealand; the James Buchanan Brady Urological Institute (Dr Carter) and the Departments of Pathology (Dr Epstein), Urology (Dr Epstein), and Oncology (Dr Epstein), Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Urology, the Sunnybrook Health Sciences Centre (Dr Klotz) and the University Health Network (Dr Evans), University of Toronto, Toronto, Ontario, Canada; the Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Zietman); the Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, Polytechnic University of the Marche Region, Ancona, Italy (Dr Montironi); the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Dr Humphrey); the Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio (Dr McKenney); the Department of Cell
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Russo GI, Cimino S, Castelli T, Favilla V, Urzì D, Veroux M, Madonia M, Morgia G. Percentage of cancer involvement in positive cores can predict unfavorable disease in men with low-risk prostate cancer but eligible for the prostate cancer international: Active surveillance criteria. Urol Oncol 2014; 32:291-6. [DOI: 10.1016/j.urolonc.2013.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/03/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022]
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Cheney MD, Chen MH, Zhang D, Phillips JG, Loffredo MJ, D'Amico AV. Greatest percentage of involved core length and the risk of death from prostate cancer in men with highest Gleason score ≥ 7. Clin Genitourin Cancer 2014; 12:234-40. [PMID: 24594503 DOI: 10.1016/j.clgc.2014.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/17/2014] [Accepted: 01/23/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/BACKGROUND Men with highest GS ≥ 7 and a differing, lower GS core (ComboGS) have decreased PC-specific mortality (PCSM) risk after RT or RT and androgen deprivation therapy (ADT). Whether the greatest percentage of involved core length (GPC) modulates this risk is unknown. PATIENTS AND METHODS Men with GS ≥ 7 PC (n = 333) consecutively treated between December 1989 and July 2000 using RT (n = 268; 80%) or RT and 6 months of ADT (n = 65; 20%) comprised the study cohort. The GPC was calculated using biopsy core and tumor lengths. We used competing risks regression to assess whether increasing GPC was associated with increased PCSM risk in men with or without ComboGS adjusting for risk group, age, and treatment. RESULTS After a median follow-up of 5.36 years (interquartile range, 3.22-7.61 years), 92 (28%) men died, 28 (30%) of PC. Increasing GPC was significantly associated with increased risk of PCSM (adjusted hazard ratio, 1.02; 95% confidence interval, 1.01-1.03; P = .005). Men with GPC ≥ 50% versus < 50% had significantly greater PCSM estimates when ComboGS was present (P < .001) versus absent (P = .55). Of the 127 men with ComboGS and GPC < 50%, 83% were treated with RT alone and 2 PC deaths were observed; neither in men with GS 7 and favorable intermediate-risk PC. CONCLUSION Men treated with RT for ComboGS, GPC < 50%, GS 7, and favorable intermediate-risk PC have a very low risk of early PCSM. The RTOG 0815 trial will establish whether ADT is necessary to optimize curability in these men.
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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
| | | | - 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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Prostate Total Tumor Extent Versus Index Tumor Extent—Which is Predictive of Biochemical Recurrence Following Radical Prostatectomy? J Urol 2013; 189:99-104. [DOI: 10.1016/j.juro.2012.08.179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 07/03/2012] [Indexed: 11/19/2022]
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A Contemporary Update on Pathology Reporting for Prostate Cancer: Biopsy and Radical Prostatectomy Specimens. Eur Urol 2012; 62:20-39. [DOI: 10.1016/j.eururo.2012.02.055] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/29/2012] [Indexed: 11/23/2022]
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Pandha H, Sorensen KD, Orntoft TF, Langley S, Hoyer S, Borre M, Morgan R. Urinary engrailed-2 (EN2) levels predict tumour volume in men undergoing radical prostatectomy for prostate cancer. BJU Int 2012; 110:E287-92. [PMID: 22583908 DOI: 10.1111/j.1464-410x.2012.11208.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? There are a lot of potential prostate cancer biomarkers being evaluated. All aim to improve on the sensitivity and specificity of PSA. EN2 was recently shown by our group to have better sensitivity and specificity than PSA. EN2 is a simple ELISA test and is not dependent on other parameters, even PSA, unlike all the other current biomarkers under evaluation. To date, no marker correlates with the amount of cancer present - the present study shows this positive correlation with EN2 in men undergoing prostatectomy. The potential utility of this work is that by knowing that the level of EN2 corresponds to the amount of cancer present, irrelevant of tumour grade and number of cancer foci, we can define an EN2 level corresponding to small cancers, which can then undergo surveillance. We are conducting a further study that is aimed at determining whether the levels of EN2 in urine can indicate 'significant' vs 'non-significant cancer' using the threshold of 0.5 mL cancer (after Epstein's work). OBJECTIVES To evaluate the relationship between levels of a recently described prostate cancer biomarker engrailed-2 (EN2) in urine and cancer volume in men who had undergone radical prostatectomy (RP) for prostate cancer. To date, prostate-specific antigen (PSA) levels have not reliably predicted prostate cancer volume. Reliable volume indicator biomarker(s) may aid management decisions, e.g. active treatment vs active surveillance. PATIENTS AND METHODS Archived patient samples from the Aarhus Prostate Cancer Project, Denmark, were assessed. Pre-treatment mid-stream urines, without preceding prostatic massage, were collected and stored at -80 °C. Urinary EN2 levels were measured by a recently published enzyme-linked immunosorbent assay. RESULTS In all, 88 of the whole cohort of 125 men (70%) were positive for EN2 in their urine (>42.5 µg/L); 38/58 (65%) men where cancer volume data was available. There was no statistical relationship between urinary EN2 levels and serum PSA levels. PSA levels did not correlate with tumour stage, combined Gleason grade, total prostatic weight or cancer volume. There was a strong statistical relationship between urinary EN2 and prostate cancer volume by linear regression (P = 0.006). Higher EN2 levels correlated with tumour stage T1 vs T2 (P = 0.027). CONCLUSIONS Pre-surgical urinary EN2 levels were associated with increasing tumour stage and closely reflected the volume of cancer in RP specimens. Given the ease of collection (no prostatic massage required) and the simplicity, low cost and robustness of the assay, EN2 may become a useful biomarker in not only identifying which patients have prostate cancer but may also facilitate risk stratification by indicating the burden of tumour volume.
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Affiliation(s)
- Hardev Pandha
- Oncology, Postgraduate Medical School, Guildford, UK.
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Epstein JI. Prognostic significance of tumor volume in radical prostatectomy and needle biopsy specimens. J Urol 2011; 186:790-7. [PMID: 21788055 DOI: 10.1016/j.juro.2011.02.2695] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE This review addresses the controversies that persist relating to the prognosis and reporting of tumor volume in adenocarcinoma of the prostate. MATERIALS AND METHODS A search was performed using the MEDLINE database and referenced lists of relevant studies to obtain articles addressing the quantification of cancer on radical prostatectomy and needle biopsy. RESULTS In the 2010 TNM classification system T2 tumor at radical prostatectomy is subdivided into pT2a (unilateral tumor occupying less than ½ a lobe), pT2b (unilateral tumor greater than ½ a lobe) and pT2c (bilateral tumor). This pathological substaging of T2 disease fails on several accounts. In most studies pT2b disease almost does not exist. By the time a tumor is so large that it microscopically occupies more than ½ a lobe, in the majority of cases there is bilateral (pT2c) tumor. An even greater flaw of the substaging system for stage pT2 disease is the lack of prognostic significance. In reporting pathologically organ confined cancer, it should be merely noted as pT2 without further subclassification. The data are conflicting as to the independent prognostic significance of objective measurements of tumor volume in radical prostatectomy specimens. The most likely explanation for the discordant results lies in the strong correlation of tumor volume with other prognostic markers such as extraprostatic extension and positive margins. In studies where it is statistically significant on multivariate analysis, it is unlikely that knowing tumor volume improves prediction of prognosis beyond routinely reported parameters to the degree that it would be clinically useful for an individual patient. An alternative is to record tumor volume as minimal, moderate or extensive, which gives some indication to the urologist as to the extent of disease. Not only does providing an objective measurement not add useful prognostic information beyond what is otherwise routinely reported by the pathologist, but many objective measurements done in routine practice will likely not be an accurate indicator of the true tumor volume. There is also a lack of consensus regarding the best method of measuring tumor length when there are multiple foci in a single core separated by benign intervening prostatic stroma. Some pathologists, this author included, consider discontinuous foci of cancer as if it was 1 uninterrupted focus, the rationale being that these discontinuous foci are undoubtedly the same cancer going in and out of the plane of section. Measuring the cancer from where it starts to where it ends on the core gives the minimal length of cancer in the prostate. Others measure each focus individually, and the sum of these measurements is considered the cancer length on the core. Quantifying cancer with an ocular micrometer to record the total length or percent length of cancer is time-consuming, and the data are conflicting whether this is superior to other, simpler methods and whether any potential differences in predictive accuracy would translate into changes in clinical management. It is recommended that at a minimum the number of positive cores be recorded, unless fragmented involved cores preclude evaluation, along with at least 1 other more detailed measurement such as the percent of core involvement or length of cancer. CONCLUSIONS Consensus has been reached on some of the issues relating to quantifying tumor volume in prostate cancer, such as the lack of utility of substaging pT2 disease. Other questions such as whether to include or subtract intervening benign prostate tissue on prostate needle cores will require additional studies. Finally, matters such as the need to quantify cancer at radical prostatectomy or which method of quantifying cancer on needle biopsy is superior will likely remain contentious due to the close interrelationship and redundancy of prognostic variables.
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Affiliation(s)
- Jonathan I Epstein
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21231, USA.
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