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Zheng T, Sun H, Tang Y, Bi K, Zeng Y, Wang J, Yan L. Comparing histology between prostate cognitive fusion targeted biopsy and radical prostatectomy: exploring risk factors of Gleason score upgrading in Chinese patients. J Cancer Res Clin Oncol 2023; 149:18029-18037. [PMID: 37979056 DOI: 10.1007/s00432-023-05506-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To explore and identify the relevant clinical and pathological predictors leading to biopsy Gleason score upgrading (GSU) in cognitive fusion targeted biopsy (COG-TB) in Chinese patients. METHODS Clinical and pathological information of 496 patients who underwent COG-TB and radical prostatectomy (RP) in our hospital from January 2020 to September 2023 were retrospectively compiled and analyzed. In this study, we screened valuable predictors through univariable and multivariable logistic regression analyses and then constructed predictive models. We draw nomograms to visualize the predictive models. In addition, the discriminatory power of the model was assessed using receiver operating characteristic (ROC) curves. Finally, calibration curves and decision curve analysis (DCA) were used to evaluate the predictive power of the model and the net benefits it could deliver. RESULTS Out of the 496 patients eligible for the study, 279 had a consistent Gleason score (GS) on biopsy and postoperative GS, 191 experienced GSU, and 26 experienced downgrading. Significant associations for GSU were identified for five risk factors through multivariable logistic regression analyses, which included age, prostate volume, BMI, tumor percentage in biopsy tissue, and tumor location. Our model had excellent discriminatory power through ROC analysis. Calibration curves and DCA showed that our model was well calibrated and provided certain benefits for patient treatment decisions. CONCLUSION Age, prostate volume, BMI, tumor percentage in biopsy tissue, and tumor location are risk indicators for predicting GSU in COG-TB. Our prediction model is more suitable for Chinese patients and can assist in accurately evaluating biopsy GS and developing effective treatment plans.
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Affiliation(s)
- Tianyun Zheng
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Huaibin Sun
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Yueqing Tang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Kaipeng Bi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Yuan Zeng
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Junyan Wang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Lei Yan
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
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Influence of Active Surveillance on Gleason Score Upgrade and Prognosis in Low- and Favorable Intermediate-Risk Prostate Cancer. Curr Oncol 2022; 29:7964-7978. [PMID: 36290907 PMCID: PMC9600547 DOI: 10.3390/curroncol29100630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022] Open
Abstract
Few studies have focused on the link between active surveillance (AS) and Gleason score upgrade (GSU) and its impact on the prognosis of patients with prostate cancer (PCa). This study aimed to analyze the effect of AS duration on GSU and prognostic value based on risk stratification. All eligible patients were risk-stratified according to AUA guidelines into low-risk (LR), favorable intermediate-risk (FIR), and unfavorable intermediate-risk (UIR) PCa. Within the Surveillance, Epidemiology, and End Results Program (SEER) database, 28,368 LR, 27,243 FIR, and 12,210 UIR PCa patients were included. The relationship between AS duration and GSU was identified with univariate and multivariate logistic regression. Discrimination according to risk stratification of AS duration and GSU was tested by Kaplan-Meier analysis and competing risk regression models. The proportion of patients who chose AS was the highest among LR PCa (3434, 12.1%), while the proportion in UIR PCa was the lowest (887, 7.3%). The AS duration was only associated with GSU in LR PCa, with a high Gleason score (GS) at diagnosis being a strong predictor of GSU for FIR and UIR PCa. Kaplan-Meier analysis indicated that long-term surveillance only made a significant difference in prognosis in UIR PCa. The competing risk analysis indicated that once GS was upgraded to 8 or above, the prognosis in each group was significantly worse. AS is recommended for LR and FIR PCa until GS is upgraded to 8, but AS may not be suitable for some UIR PCa patients.
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Zhang B, Wu S, Zhang Y, Guo M, Liu R. Analysis of risk factors for Gleason score upgrading after radical prostatectomy in a Chinese cohort. Cancer Med 2021; 10:7772-7780. [PMID: 34528767 PMCID: PMC8559471 DOI: 10.1002/cam4.4274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
Background To study the risk factors of Gleason score upgrading (GSU) after radical prostatectomy (RP) in a Chinese cohort. Methods The data of 637 patients who underwent prostate biopsy and RP in our hospital from January 2014 to January 2021 were retrospectively analyzed. The age, body mass index (BMI), prostate‐specific antigen (PSA) level, testosterone (TT) level, neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), eosinophil‐to‐lymphocyte ratio (ELR), aspartate aminotransferase/alanine transaminase (AST/ALT) ratio, clinical stage, the biopsy method, and pathological characteristics of specimens after biopsy and RP were collected for all patients. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of GSU after RP. The predictive efficacy was verified with the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. We performed the analysis separately in the overall cohort and in the cohort with Gleason score (GS) = 6. Results In the overall cohort, 177 patients (27.79%) had GSU, and in the GS = 6 cohort, 68 patients (60.18%) had GSU. Multivariate logistic regression analysis showed that in the overall cohort, clinical stage ≥T2c (OR = 3.201, p < 0.001), the number of positive cores ≥3 (OR = 0.435, p = 0.04), and positive rate of biopsy (OR = 0.990, p = 0.016) can affect whether GS is upgraded, and the AUC of the combination of the three indicators for predicting the occurrence of GSU was 0.627. In the GS = 6 cohort, multivariate logistic regression analysis showed that clinical stage ≥T2c (OR = 4.690, p = 0.001) was a risk factor for GSU, and the AUC predicted to occur GSU is 0.675. Conclusion Clinical stage ≥T2c, the number of positive cores <3, and lower positive rate of biopsy are the risk factors of GSU. This study may provide some references for clinicians to judge the accuracy of biopsy pathological grading and formulate treatment strategies, but the specific effect still needs clinical practice certification.
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Affiliation(s)
- Baoling Zhang
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
| | - Shangrong Wu
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
| | - Yang Zhang
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
| | - Mingyu Guo
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
| | - Ranlu Liu
- Department of Urology, The second hospital of Tianjin Medical University, Tianjin, China.,Tianjin Institute of Urology, Tianjin, China
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Kim H, Pak S, Park KJ, Kim MH, Kim JK, Kim M, You D, Jeong IG, Song C, Hong JH, Kim CS, Ahn H. Utility of Multiparametric Magnetic Resonance Imaging With PI-RADS, Version 2, in Patients With Prostate Cancer Eligible for Active Surveillance: Which Radiologic Characteristics Can Predict Unfavorable Disease? Clin Genitourin Cancer 2019; 18:50-55. [PMID: 31640913 DOI: 10.1016/j.clgc.2019.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We investigated the utility of multiparametric magnetic resonance imaging (mpMRI) using Prostate Imaging Reporting and Data System, version 2 (PI-RADSv2), scoring in patients with prostate cancer eligible for active surveillance (AS). MATERIALS AND METHODS The medical records of the patients who had undergone mpMRI before radical prostatectomy from 2014 to 2018 were reviewed. All the patients had met the Prostate Cancer Research International AS criteria. PI-RADSv2 scores were assigned to 12 prostate regions. Unfavorable disease was stratified using the American Joint Committee on Cancer (AJCC) prognostic scale as stage IIB (Gleason score [GS], 3+4 and pathologic stage T2) and IIC-III (GS, ≥ 4+3 or pathologic stage T3). RESULTS Of 376 eligible patients, 184 (48.9%), 129 (34.3%), and 63 (16.8%) had AJCC stage I, IIB, and IIC-III disease, respectively. The patients with IIC-III disease were older and had a higher prostate-specific antigen density than those with stage I or IIB disease. PI-RADS 5 lesions were more frequent in patients with stage IIC-III than in patients with stage I or IIB disease. Multivariable analysis revealed that ≥ 2 lesions with a PI-RADS 5 score was an independent predictor for unfavorable disease (hazard ratio [HR], 3.612; P < .001 for IIB; HR, 6.562; P < .001 for IIC-III), and PI-RADS score of ≥ 4 was limited for predicting AJCC stage IIB disease (HR, 2.387; P = .01). CONCLUSION mpMRI with PI-RADSv2 showed high negative predictive value for patients with prostate cancer eligible for AS. Multiple PI-RADS 4-5 lesions were associated with unfavorable disease compared with solitary lesions. Multiple PI-RADS 5 lesions were strongly associated with GS ≥ 4+3 or pathologic T3 disease. Targeted biopsy or radical treatment should be considered for these patients.
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Affiliation(s)
- Hwiwoo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sahyun Pak
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Kye Jin Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyun Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Kon Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myong Kim
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Liquid Biopsy Potential Biomarkers in Prostate Cancer. Diagnostics (Basel) 2018; 8:diagnostics8040068. [PMID: 30698162 PMCID: PMC6316409 DOI: 10.3390/diagnostics8040068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer (PCa) is the second most common cancer in men worldwide with an incidence of 14.8% and a mortality of 6.6%. Shortcomings in comprehensive medical check-ups in low- and middle-income countries lead to delayed detection of PCa and are causative of high numbers of advanced PCa cases at first diagnosis. The performance of available biomarkers is still insufficient and limited applicability, including logistical and financial burdens, impedes comprehensive implementation into health care systems. There is broad agreement on the need of new biomarkers to improve (i) early detection of PCa, (ii) risk stratification, (iii) prognosis, and (iv) treatment monitoring. This review focuses on liquid biopsy tests distinguishing high-grade significant (Gleason score (GS) ≥ 7) from low-grade indolent PCa. Available biomarkers still lack performance in risk stratification of biopsy naïve patients. However, biomarkers with highly negative predictive values may help to reduce unnecessary biopsies. Risk calculators using integrative scoring systems clearly improve decision-making for invasive prostate biopsy. Emerging biomarkers have the potential to substitute PSA and improve the overall performance of risk calculators. Until then, PSA should be used and may be replaced whenever enough evidence has accumulated for better performance of a new biomarker.
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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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Chen K, Tay KJ, Law YM, Aydin H, Ho H, Cheng C, Yuen JSP. Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance. Asian J Urol 2017; 5:184-193. [PMID: 29988897 PMCID: PMC6033238 DOI: 10.1016/j.ajur.2017.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/03/2016] [Accepted: 04/25/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Active surveillance (AS) offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer. An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place. We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging (MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer. Methods This prospective, single-blinded study included men with low-risk prostate cancer (D'Amico's Criteria) diagnosed on conventional transrectal ultrasound-guided biopsy. Patients first underwent multiparametric MRI of the prostate ≥6 weeks after initial biopsy. Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System (PIRADS) score. Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform. Results The age of the 19 men included is 65.4 ± 4.9 years (mean ± SD). Prostate specific antigen (PSA) at diagnosis and at the time of transperineal biopsy were comparable (7.3 ± 1.7 ng/mL and 7.0 ± 1.8 ng/mL, p = 0.67), so were prostate volumes (34.2 ± 8.9 mL and 32.1 ± 13.4 mL, p = 0.28). MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy (11.7% vs. 6.5%, p = 0.02), this was more than 3 times superior for Gleason 7 disease (5.9% vs. 1.6%, p < 0.01). Four of 18 (22.2%) patients with MRI lesions had significant disease with MRI-targeted biopsy alone. Three of 19 patients (15.8%) had significant disease with template biopsy alone. In combination, both techniques upclassified five patients (26.3%), all of whom underwent radical prostatectomy. Whole mount histology confirmed tumour location and grade. All six patients with PIRADS 5 lesions had cancer detected (66.6% significant disease). Conclusion A combination of MRI-targeted and template biopsy may optimally risk-classify “low-risk” patients diagnosed on initial conventional transrectal ultrasonography (TRUS) prostate biopsy.
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Affiliation(s)
- Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Hakan Aydin
- Department of Pathology, Singapore General Hospital, Singapore
| | - Henry Ho
- Department of Urology, Singapore General Hospital, Singapore
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Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2017. [DOI: 10.17517/ksutfd.205510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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9
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Holtz JN, Tay KJ, Polascik TJ, Gupta RT. Integration of multiparametric MRI into active surveillance of prostate cancer. Future Oncol 2016; 12:2513-2529. [DOI: 10.2217/fon-2016-0142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Prostate cancer is the most common noncutaneous cancer in men though many men will not die of this disease and may not require definitive treatment. Active surveillance (AS) is an increasingly utilized potential solution to the issue of overtreatment of prostate cancer. Traditionally, prostate cancer patients have been stratified into risk groups based on clinical stage on digital rectal examination, prostate-specific antigen and biopsy Gleason score, though each of these variables has significant limitations. This review will discuss the potential role for prostate multiparametric MRI and targeted biopsy techniques incorporating MRI in the selection of candidates for AS, monitoring patients on AS and as triggers for definitive treatment.
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Affiliation(s)
- Jamie N Holtz
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
| | - Kae Jack Tay
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
| | - Thomas J Polascik
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
| | - Rajan T Gupta
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
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10
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Evans SM, Patabendi Bandarage V, Kronborg C, Earnest A, Millar J, Clouston D. Gleason group concordance between biopsy and radical prostatectomy specimens: A cohort study from Prostate Cancer Outcome Registry - Victoria. Prostate Int 2016; 4:145-151. [PMID: 27995114 PMCID: PMC5153432 DOI: 10.1016/j.prnil.2016.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 07/27/2016] [Indexed: 11/26/2022] Open
Abstract
Background A new prostate cancer (PCa) prognostic grading system [Gleason groups (GGs)] has been proposed based on the contemporary Gleason scores (GSs), which has five simplified prognostic categories. The objective of this study was to evaluate the agreement between the GGs of prostate biopsy and radical prostatectomy specimens and to identify predictive factors for upgrading GGs. Methods A total of 5339 cases of RP notified to the Prostate Cancer Outcomes Registry, Victoria, Australia over 6 years (2009–2014) from 46 hospitals, were included. The upgrading was evaluated using the new PCa prognostic grading system, the International Society of Urologic Pathology grade groups, which has five prognostic categories. GG 1 is GS ≤ 6, GG 2 is GS 3 + 4 = 7, GG 3 is GS 4 + 3 = 7, GG 4 is GS 8, and GG 5 is GS 9 and 10. Predictors of upgrading were assessed using univariate and multivariate models. Results The GG of prostate biopsies and RP specimens were concordant in 54.5% of cases, while 31.1% were upgraded and 14.3% were downgraded. Longer time interval between biopsy and RP [44–99 days: odds ratio (OR) = 1.3, 95% confidence interval (CI) = 1.1–1.6; > 99 days: OR = 3.0, 95% CI = 2.4–3.8), and RP performed in a metropolitan hospital (biopsy in a regional hospital: OR = 2.2, 95% CI = 1.6–3.2, biopsy in a metropolitan hospital: OR = 1.7, 95% CI = 1.2–2.2) were significant predictors of GG upgrading. Patients who were diagnosed by transperineal biopsy compared to transrectal ultrasound (OR = 0.6, 95% CI = 0.5–0.8) and higher percentage of positive biopsy cassettes (25–62.5%: OR = 0.7, 95% CI = 0.6–0.8, > 62.5: OR = 0.6, 95% CI = 0.5–0.8) were significantly associated with less likelihood of upgrade. Conclusion The lack of concordance among hospitals may be attributable to the specialist expertise of the pathologist. Expert review of specimens may help to overcome this discordance. Clinicians should consider clinical parameters and potential limitations of the GG at biopsy when making treatment decisions with regard to PCa.
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Affiliation(s)
- Sue M Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Caroline Kronborg
- Department of Medicine, The Alfred Hospital, Alfred Health, Melbourne, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeremy Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Clouston
- Tissupath Pathology Services, Mount Waverley, Melbourne, Australia
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11
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The use of targeted MR-guided prostate biopsy reduces the risk of Gleason upgrading on radical prostatectomy. J Cancer Res Clin Oncol 2015; 141:2061-8. [PMID: 26013424 DOI: 10.1007/s00432-015-1991-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Gleason grading is the strongest predictor of prostate cancer outcome and commonly used to decide for or against the different treatment options. However, Gleason upgrading between systematic transrectal ultrasound-guided prostate biopsy (TRUS-GB) and radical prostatectomy (RPE) has frequently been observed. With respect to the high accuracy of multiparametric MRI (mpMRI) for high-grade cancers and the higher percentage of cancer involvement per biopsy core in targeted MR-guided prostate biopsy (MR-GB), we hypothesized that MR-GB reduces the risk of Gleason upgrading on RPE as compared to the gold standard. The purpose of this study was to compare the rate of Gleason upgrading on RPE for MR-GB, TRUS-GB, and the combination of both biopsy modalities. METHODS Overall, 52 consecutive patients with RPE had received an mpMRI of the prostate and subsequently underwent targeted MR-GB prior to surgery. All patients underwent an additional TRUS-GB during the same biopsy session. Gleason grading was measured by two different methods: the conventional Gleason score (cGS = primary + secondary pattern) and the highest Gleason pattern (hGP). RESULTS In relation to TRUS-GB, MR-GB alone showed lower rates of upgrading when comparing the cGS (40.4 vs. 50.0 %) and the hGP (21.2 vs. 32.7 %). The combination of MR-GB and TRUS-GB showed the lowest rates of upgrading (cGS: 28.8 %; hGP: 11.5 %), and compared to TRUS-GB, significantly reduced the risk of upgrading for both measurements of Gleason grading (cGS: OR 0.41, 95 % CL 0.18-0.91, p = 0.0289; hGP: OR 0.27, 95 % CL 0.10-0.75, p = 0.0123). CONCLUSION MpMRI and targeted MR-GB are useful tools to better characterize and stage the extent of disease, and therefore enable the urologist to better risk-stratify and counsel the patient. The combined use of targeted MR-GB and TRUS-GB presents the least risk of Gleason underestimation.
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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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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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Bratt O, Carlsson S, Holmberg E, Holmberg L, Johansson E, Josefsson A, Nilsson A, Nyberg M, Robinsson D, Sandberg J, Sandblom D, Stattin P. The Study of Active Monitoring in Sweden (SAMS): a randomized study comparing two different follow-up schedules for active surveillance of low-risk prostate cancer. Scand J Urol 2013; 47:347-55. [PMID: 23883427 PMCID: PMC3810035 DOI: 10.3109/21681805.2013.813962] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Only a minority of patients with low-risk prostate cancer needs treatment, but the methods for optimal selection of patients for treatment are not established. This article describes the Study of Active Monitoring in Sweden (SAMS), which aims to improve those methods. MATERIAL AND METHODS SAMS is a prospective, multicentre study of active surveillance for low-risk prostate cancer. It consists of a randomized part comparing standard rebiopsy and follow-up with an extensive initial rebiopsy coupled with less intensive follow-up and no further scheduled biopsies (SAMS-FU), as well as an observational part (SAMS-ObsQoL). Quality of life is assessed with questionnaires and compared with patients receiving primary curative treatment. SAMS-FU is planned to randomize 500 patients and SAMS-ObsQoL to include at least 500 patients during 5 years. The primary endpoint is conversion to active treatment. The secondary endpoints include symptoms, distant metastases and mortality. All patients will be followed for 10-15 years. RESULTS Inclusion started in October 2011. In March 2013, 148 patients were included at 13 Swedish urological centres. CONCLUSIONS It is hoped that the results of SAMS will contribute to fewer patients with indolent, low-risk prostate cancer receiving unnecessary treatment and more patients on active surveillance who need treatment receiving it when the disease is still curable. The less intensive investigational follow-up in the SAMS-FU trial would reduce the healthcare resources allocated to this large group of patients if it replaced the present standard schedule.
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Affiliation(s)
- Ola Bratt
- Department of Urology, Helsingborg Hospital, Lund University , Sweden
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Vora A, Large T, Aronica J, Haynes S, Harbin A, Marchalik D, Nissim H, Lynch J, Bandi G, McGeagh K, Kowalczyk K, Ghasemian R, Venkatesan K, Verghese M, Hwang J. Predictors of Gleason score upgrading in a large African-American population. Int Urol Nephrol 2013; 45:1257-62. [PMID: 23864415 DOI: 10.1007/s11255-013-0495-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/10/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Gleason score from biopsy specimens is important for prostate cancer (PCa) risk stratification and influences treatment decisions. Gleason score upgrading (GSU) between biopsy and surgical pathology specimens has been reported as high as 50 % and presents a challenge in counseling low-risk patients. While recent studies have investigated predictors of GSU, populations in these studies have been largely Caucasian. We report our analysis of predictors of GSU in a large urban African-American population. METHODS A total of 959 patients with D'Amico low-risk prostate cancer underwent radical prostatectomy at Georgetown University or Washington Hospital Center between January 2005 and July 2012. Race, age, PSA, body mass index (BMI), cancer of the prostate risk assessment (CAPRA) score, and transrectal ultrasound (TRUS) biopsy characteristics (percent of biopsy cores showing adenocarcinoma, highest percent of biopsy core involved with cancer, and measured TRUS prostate volume) were analyzed with both univariate and multivariate analyses to identify significant predictors of GSU while controlling for clinical parameters. RESULTS Of the 959 cases, 288 (30.0 %) were upgraded on final pathologic specimen with approximately 38 % (133/355) of African-American patients experiencing GSU. BMI (P = 0.02), percent positive biopsy cores (P < 0.01) and percent of core involved with cancer (P < 0.01), increasing CAPRA score, and serum PSA were independent predictors of GSU on both uni- and multivariate regression analyses. African Americans had a 73 % increase in the incidence of GSU over other races. CONCLUSION More than a quarter of low-risk prostate cancer patients were upgraded on final pathology in our series. Higher BMI, serum PSA, CAPRA score, percent of cores positive, and percent of cores involved were independent predictors of GSU. Individuals with those clinical parameters may harbor occult high-grade disease and should be carefully counseled on treatment decisions.
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Affiliation(s)
- Anup Vora
- Departments of Urology, Washington Hospital Center and Georgetown University Hospital, 3401 38th ST NW, Suite 915, Washington, DC, 20016, USA,
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