Pathological outcomes of men eligible for active surveillance after undergoing radical prostatectomy: are results predictable?

Role of neutrophil-to-lymphocyte ratio in prediction of Gleason score upgrading and disease upstaging in low-risk prostate cancer patients eligible for active surveillance

INTRODUCTION

Active surveillance (AS) is an option for management of low-risk prostate cancer (PCa). However, grade and stage progression is an important consideration. Neutrophil-to-lymphocyte ratio (NLR) is a useful marker of cancer-related inflammation. In this study, we aimed to identify the roles of neutrophil count (NC), lymphocyte count (LC), and NLR to predict Gleason score (GS) upgrading, disease upstaging, and biochemical recurrence rates (BCR) in low-risk PCa patients.

METHODS

We retrospectively evaluated data of 210 low-risk PCa patients eligible for AS, but who underwent radical prostatectomy. The roles of NC, LC, and NLR on the GS upgrading, disease upstaging, and BCR rates were investigated. Univariate and multivariate models were used to determine the effect of these parameters.

RESULTS

There were 104 and 106 patients in the NLR <2.5 and NLR ≥2.5 groups, respectively. GS upgrading in the NLR ≥2.5 group was more common than in the NLR<2.5 group (p=0.04). The NLR ≥2.5 group had significantly higher GS (8-10; p=0.03). With regard to NLR, the groups were found to have similar rates of disease upstaging (9/104 in NLR <2.5 vs. 16/106 in NLR ≥2.5; p=0.200). BCR rates were also significantly different between groups (p=0.033). NC an LC were not found to be associated with GS upgrading, disease upstaging, or BCR.

CONCLUSIONS

NLR is a predictor of GS upgrading and BCR, but not disease upstaging in patients with low-risk PCa. Furthermore, higher NLR was found to be associated with higher GS PCa. NLR is a cost-effective and easily accessible tool that can be used in the decision-making process for treatment of low-risk PCa cases.

The impact of baseline [-2]proPSA-related indices on the prediction of pathological reclassification at 1 year during active surveillance for low-risk prostate cancer: the Japanese multicenter study cohort

Purpose

Active surveillance (AS) is one potential solution to avoiding the overtreatment of favorable prostate cancer. By handling the AS strategy more safely, tumor aggressiveness may be evaluated more accurately. The aim of the present study was to evaluate the predictive impact of baseline prostate-specific antigen (PSA) isoform [−2]proPSA (p2PSA)-related indices on the pathological reclassification at 1 year during an AS program.

Methods

Between 2002 and 2003, 134 males diagnosed with low-risk prostate cancer were registered in the Japanese multicenter study cohort as candidates for AS, and 118 (88 %) males actually proceeded to AS. Of the 118 patients, the 67 that underwent protocol biopsy at 1 year after beginning AS were enrolled in the present study. The predictive significance of various baseline clinicopathological features and p2PSA-related indices on pathological reclassification at 1 year after beginning AS were investigated.

Results

The pathological reclassification rate was 37.3 %. According to the univariate analysis, prostate volume (p = 0.049), number of biopsy cores (p = 0.047), percentage of positive biopsy cores (p = 0.023), p2PSA to free PSA ratio (%p2PSA) (p = 0.003) and prostate health index (phi) (p = 0.010) at baseline were significantly different between the reclassification and non-reclassification groups. By multivariate logistic regression analysis, baseline %p2PSA (p = 0.008) and phi (p = 0.008) were the only independent predictive factors for pathological upgrade at 1 year after AS commencement.

Conclusions

Baseline %p2PSA and phi may predict the pathological reclassification at 1 year after starting AS, which could be due to the under detection of clinically significant prostate cancer at AS enrollment.

Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance?

PURPOSE

To determine whether multiparametric magnetic resonance (MR) imaging can help identify patients with prostate cancer who would most appropriately be candidates for active surveillance (AS) according to current guidelines and to compare the results with those of conventional clinical assessment scoring systems, including the D'Amico, Epstein, and Cancer of the Prostate Risk Assessment (CAPRA) systems, on the basis of findings at prostatectomy.

MATERIALS AND METHODS

This institutional review board-approved HIPAA-compliant retrospectively designed study included 133 patients (mean age, 59.3 years) with a mean prostate-specific antigen level of 6.73 ng/mL (median, 4.39 ng/mL) who underwent multiparametric MR imaging at 3.0 T before radical prostatectomy. Informed consent was obtained from all patients. Patients were then retrospectively classified as to whether they would have met AS eligibility criteria or were better served by surgery. AS eligibility criteria for prostatectomy specimens were a dominant tumor smaller than 0.5 mL without Gleason 4 or 5 patterns or extracapsular or seminal vesicle invasion. Conventional clinical assessment scores (the D'Amico, Epstein, and CAPRA scoring systems) were compared with multiparametric MR imaging findings for predicting AS candidates. The level of significance of difference between scoring systems was determined by using the χ(2) test for categoric variables with the level of significance set at P < .05.

RESULTS

Among 133 patients, 14 were eligible for AS on the basis of prostatectomy results. The sensitivity, positive predictive value (PPV), and overall accuracy, respectively, were 93%, 25%, and 70% for the D'Amico system, 64%, 45%, and 88% for the Epstein criteria, and 93%, 20%, and 59% for the CAPRA scoring system for predicting AS candidates (P < .005 for all, χ(2) test), while multiparametric MR imaging had a sensitivity of 93%, a PPV of 57%, and an overall accuracy of 92% (P < .005).

CONCLUSION

Multiparametric MR imaging provides useful additional information to existing clinicopathologic scoring systems of prostate cancer and improves the assignment of treatment (eg, AS or active treatment).