1
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Hennes DMZB, Sewell J, Kerger M, Hovens CM, Peters JS, Costello AJ, Ryan A, Corcoran NM. The modified International Society of Urological Pathology system improves concordance between biopsy and prostatectomy tumour grade. BJU Int 2021; 128 Suppl 3:45-51. [PMID: 34310033 DOI: 10.1111/bju.15556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess the concordance between biopsy and radical prostatectomy (RP) specimens using the 2005 Gleason score (GS) and the International Society of Urological Pathology (ISUP) 2014/World Health Organization 2016 modified system, accounting for the introduction of transperineal biopsy and pre-biopsy multiparametric magnetic resonance imaging (mpMRI). PATIENTS AND METHODS Between 2002 and 2019, we identified 2431 patients with paired biopsy and RP histopathology from a prospectively recorded and maintained prostate cancer database. Biopsy specimens were graded according to the 2005 GS or ISUP 2014 modified system, according to the year of diagnosis. Multivariable logistic regression analysis was conducted to retrospectively assess the impact of prostate-specific antigen (PSA), PSA density, age, pre-biopsy mpMRI, and biopsy method, on the rate of upgraded disease. The kappa coefficient was used to establish the degree of change in concordance between groups. RESULTS Overall, 24% of patients had upgraded disease and 8% of patients had downgraded disease when using the modified ISUP 2014 criteria. Agreement in the updated ISUP 2014 cohort was 68%, compared with 55% in the 2005 GS group, which was validated by a kappa coefficient that was good (k = 0.5 ± 0.4) and poor (k = 0.3 ± 0.1), respectively. In multivariable models, a change in grading system independently improved overall disease concordance (P = 0.02), and there were no other co-segregated patient or pathological factors such as PSA, total number of cores, maximum cancer length, biopsy route or the use of mpMRI that impacted this finding. CONCLUSION The 2014 ISUP modifed system improves overall concordance between biopsy and surgical specimens, and thus allows more accurate prognostication and management in high-grade disease, independent of more extensive prostate sampling and the use of mpMRI.
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Affiliation(s)
- David M Z B Hennes
- Department of Urology, Melbourne Health, Royal Melbourne Hospital, Australia
| | - James Sewell
- Department of Urology, Melbourne Health, Royal Melbourne Hospital, Australia
| | - Michael Kerger
- Department of Surgery, University of Melbourne, Parkville, Australia
| | | | - Justin S Peters
- Department of Urology, Melbourne Health, Royal Melbourne Hospital, Australia
| | - Anthony J Costello
- Department of Urology, Melbourne Health, Royal Melbourne Hospital, Australia.,Department of Surgery, University of Melbourne, Parkville, Australia
| | | | - Niall M Corcoran
- Department of Urology, Melbourne Health, Royal Melbourne Hospital, Australia.,Department of Surgery, University of Melbourne, Parkville, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia
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2
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Abstract
Modern cancer treatment aims to conserve as much healthy tissue as possible. This has been challenging in the treatment of prostate cancer due to the difficulty in imaging the gland and concerns over leaving multifocal cancer untreated. With improvements in imaging and understanding of multifocal prostate cancer evidence now shows accurate treatment of just the primary focus of cancer or the index lesion can control progression or recurrence of the disease. Many different energy sources are now available to target the cancer lesion within the prostate with less significant side-effects on urinary and sexual function compared to radical treatment. Evidence shows that men value these functions highly and would even trade years of life in exchange for preserved retention of continence or erectile function. Focal treatment of prostate cancer aims to provide both cancer control and preservation of sexual and urinary functions so that men do not have to make a choice between the two. This is a treatment option that men clearly want and deserve.
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Affiliation(s)
- Nishant Bedi
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Deepika Reddy
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hashim U Ahmed
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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3
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Active surveillance for prostate and thyroid cancers: evolution in clinical paradigms and lessons learned. Nat Rev Clin Oncol 2019; 16:168-184. [PMID: 30413793 DOI: 10.1038/s41571-018-0116-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The adverse effects of overdiagnosis and overtreatment observed in men with clinically insignificant prostate cancers after the introduction of prostate-specific antigen-based screening are now being observed in those with thyroid cancer, owing to the introduction of new imaging technologies. Thus, the evolving paradigm of active surveillance in prostate and thyroid cancers might be valuable in informing the development of future active surveillance protocols. The lessons learned from active surveillance and their implications include the need to minimize the use of broad, population-based screening programmes that do not incorporate patient education and the need for individualized or shared decision-making, which can decrease the extent of overtreatment. Furthermore, from the experience in patients with prostate cancer, we have learned that consensus is required regarding the optimal selection of patients for active surveillance, using more-specific evidence-based methods for stratifying patients by risk. In this Review, we describe the epidemiology, pathology and screening guidelines for the management of patients with prostate and thyroid cancers; the evidence of overdiagnosis and overtreatment; and provide overviews of existing international active surveillance protocols.
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4
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Madan R, Deebajah M, Alanee S, Gupta NS, Carskadon S, Palanisamy N, Williamson SR. Prostate cancer with comedonecrosis is frequently, but not exclusively, intraductal carcinoma: a need for reappraisal of grading criteria. Histopathology 2019; 74:1081-1087. [DOI: 10.1111/his.13833] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Raghav Madan
- Wayne State University School of Medicine Detroit MI USA
| | - Mustafa Deebajah
- Department of Urology Vattikuti Urology Institute Henry Ford Health System Detroit MI USA
| | - Shaheen Alanee
- Department of Urology Vattikuti Urology Institute Henry Ford Health System Detroit MI USA
| | - Nilesh S Gupta
- Department of Pathology and Laboratory Medicine Henry Ford Cancer Institute Henry Ford Health System Detroit MI USA
| | - Shannon Carskadon
- Department of Urology Vattikuti Urology Institute Henry Ford Health System Detroit MI USA
| | - Nallasivam Palanisamy
- Department of Urology Vattikuti Urology Institute Henry Ford Health System Detroit MI USA
| | - Sean R Williamson
- Department of Pathology and Laboratory Medicine Henry Ford Cancer Institute Henry Ford Health System Detroit MI USA
- Department of Pathology Wayne State University School of Medicine Detroit MI USA
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5
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Offermann A, Hupe MC, Sailer V, Merseburger AS, Perner S. The new ISUP 2014/WHO 2016 prostate cancer grade group system: first résumé 5 years after introduction and systemic review of the literature. World J Urol 2019; 38:657-662. [PMID: 30941561 DOI: 10.1007/s00345-019-02744-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/27/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To systematically and comprehensively review and summarize the most recent literature assessing the value of the new grading system introduced by the International Society of Urological Pathology (ISUP) in 2014 and accepted by the World Health Organization (WHO) in 2016. METHODS A systematic literature search in the PubMed database was performed up to November 2018. Overall, 15 studies in the period from 2016 to 2018 evaluating the new grading system have been selected for evidence synthesis. RESULTS The main goals of the new ISUP 2014/WHO 2016 grading system were to establish (I) a more accurate and simplified grade stratification, (II) less overtreatment of indolent prostate cancer as well as (III) an improved patient communication. The majority of the studies chose biochemical recurrence as an endpoint for evaluation and statistically assigns the new ISUP 2014/WHO 2016 grading system a higher prognostic accuracy than the former Gleason grading. However, in only a subset of studies it was clearly evident that the historical samples were not only re-grouped according to the new grade groups but also re-graded according to the new histomorphological 2014 ISUP criteria. CONCLUSIONS The vast majority of the studies support an improved prognostic accuracy of the ISUP 2014/WHO 2016 grade groups and endorse its worldwide application.
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Affiliation(s)
- A Offermann
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - M C Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - V Sailer
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - A S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - S Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. .,Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.
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6
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Barakzai MA. Prostatic Adenocarcinoma: A Grading from Gleason to the New Grade-Group System: A Historical and Critical Review. Asian Pac J Cancer Prev 2019; 20:661-666. [PMID: 30909661 PMCID: PMC6825755 DOI: 10.31557/apjcp.2019.20.3.661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The introduction of the Gleason grading system revolutionised prognostic parameters and determination of
patient treatment regiments for prostatic adenocarcinomas, and has become synonymous with prostate cancer, almost
universally applied in clinical settings to predict radical prostatectomy specimen findings, potential biochemical failure,
local recurrences, lymph nodes or distant metastases in patients not receiving any treatment as well as those receiving
treatment including radiation therapy, surgical treatment such as radical prostatectomy and other therapies etc,. However,
characterisation and classification of prostate cancer is very different compared to 40-50 years ago when Gleason scores
were first introduced. Despite this radical shift in classification, the Gleason system has remained one of the most
important prognostic factors in prostate cancer, only possible as a result of timely and appropriate modifications to
this characterisation system made in 2005 and 2014. However, even after these modifications, certain limitations of
the Gleason system remain, due to which a new prostate cancer prognostic grade group system was introduced in 2014,
which was widely accepted in the 2014 ISUP consensus conference, and incorporated into the WHO classification of
thetumor of the Urinary System and Male Genital Tract in 2016. Herein, this article will discuss how this new prognostic
grade group system, which is regarded as simpler and more accurate than the Gleason system risk stratification groups,
will be used in conjunction with the Gleason system to improve patient prognosis and treatment.
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7
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Gielchinsky I, Chang J, Cusick T, Delprado W, Nguyen Q, Yuen C, Savdie R, Böhm M, Haynes AM, Scheltema MJ, Stricker PD. Prostate cancer in 432 men aged <50 years in the prostate-specific antigen era: a new outlook. BJU Int 2018; 122 Suppl 5:35-41. [DOI: 10.1111/bju.14586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ilan Gielchinsky
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - John Chang
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Thomas Cusick
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Warick Delprado
- Douglass Hanly Moir Pathology; Macquarie Park NSW Australia
- School of Medicine; University of New South Wales; Kensington NSW Australia
| | - Quoc Nguyen
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Carlo Yuen
- School of Medicine; University of New South Wales; Kensington NSW Australia
- St Vincent's Clinic; Sydney NSW Australia
| | - Richard Savdie
- School of Medicine; University of New South Wales; Kensington NSW Australia
- St Vincent's Clinic; Sydney NSW Australia
| | - Maret Böhm
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Matthijs J. Scheltema
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Phillip D. Stricker
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- School of Medicine; University of New South Wales; Kensington NSW Australia
- St Vincent's Clinic; Sydney NSW Australia
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8
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Trends in prostate cancer incidence between 1996 and 2013 in two Swiss regions by age, grade, and T-stage. Cancer Causes Control 2017; 29:269-277. [PMID: 29204913 DOI: 10.1007/s10552-017-0993-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate differences in prostate cancer incidence between two distinct Swiss regions from 1996 to 2013 stratified by age group, grade, and T-stage. METHODS The dataset included 17,495 men living in Zurich and 3,505 men living in Ticino, diagnosed with prostate cancer between 1996 and 2013. We computed age-standardized incidence rates per 100,000 person-years using the European Standard Population. Trends were assessed using JoinPoint regression analysis Software. RESULTS Age-standardized incidence rates were generally higher in Zurich compared to Ticino but the difference decreased over time. Incidence rates increased significantly up to 2002 in Zurich and 2007 in Ticino and then decreased. A statistically significant increase was observed for men aged < 65 years, for grade 3 tumors, and for T-stage 2 and 3 tumors. The largest decrease was seen for grade 1 tumors. Furthermore, the incidence of tumors of unknown grade or T-stage decreased significantly in both regions. CONCLUSIONS The trends in prostate cancer incidence rates were similar in both regions, although on a higher level in Zurich compared to Ticino. However, the difference decreased over time. The distribution of T-stage and grade did not explain the difference in incidence rates. Different use of opportunistic screening may play a role.
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9
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Alitto AR, Gatta R, Vanneste B, Vallati M, Meldolesi E, Damiani A, Lanzotti V, Mattiucci GC, Frascino V, Masciocchi C, Catucci F, Dekker A, Lambin P, Valentini V, Mantini G. PRODIGE: PRediction models in prOstate cancer for personalized meDIcine challenGE. Future Oncol 2017; 13:2171-2181. [PMID: 28758431 DOI: 10.2217/fon-2017-0142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIM Identifying the best care for a patient can be extremely challenging. To support the creation of multifactorial Decision Support Systems (DSSs), we propose an Umbrella Protocol, focusing on prostate cancer. MATERIALS & METHODS The PRODIGE project consisted of a workflow for standardizing data, and procedures, to create a consistent dataset useful to elaborate DSSs. Techniques from classical statistics and machine learning will be adopted. The general protocol accepted by our Ethical Committee can be downloaded from cancerdata.org . RESULTS A standardized knowledge sharing process has been implemented by using a semi-formal ontology for the representation of relevant clinical variables. CONCLUSION The development of DSSs, based on standardized knowledge, could be a tool to achieve a personalized decision-making.
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Affiliation(s)
- A R Alitto
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - R Gatta
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - Bgl Vanneste
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Vallati
- School of Computing & Engineering, University of Huddersfield, Huddersfield, UK
| | - E Meldolesi
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - A Damiani
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - V Lanzotti
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - G C Mattiucci
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - V Frascino
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - C Masciocchi
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - F Catucci
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - A Dekker
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P Lambin
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - V Valentini
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
| | - G Mantini
- Radiation Oncology Area, Gemelli-ART, Catholic University of the Sacred Heart, Rome, Italy
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10
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Cullen J, Young D, Chen Y, Degon M, Farrell J, Sedarsky J, Baptiste W, Rosen P, Tolstikov V, Kiebish M, Kagan J, Srivastava S, Kuo HC, Moncur JT, Rosner IL, Narain N, Akmaev V, Petrovics G, Dobi A, McLeod DG, Srivastava S, Sesterhenn IA. Predicting Prostate Cancer Progression as a Function of ETS-related Gene Status, Race, and Obesity in a Longitudinal Patient Cohort. Eur Urol Focus 2017; 4:818-824. [PMID: 28753864 DOI: 10.1016/j.euf.2017.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/14/2017] [Accepted: 02/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND ETS-related gene (ERG) oncogenic activation is the most common genomic alteration in prostate cancer (CaP) although it occurs less frequently in African American (AA) versus Caucasian (CA) patients, and the potential role of ERG as a prognostic marker has not been confirmed. OBJECTIVE This study was conducted to confirm strong racial variation in the prevalence of ERG oncoprotein expression and to examine ERG oncoprotein expression, race, and body mass index as independent and joint predictors of CaP biochemical recurrence (BCR) following radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of CA and AA CaP patients enrolled at Walter Reed National Military Medical Center, who donated clinically annotated, whole-mounted, prostatectomy specimens between 1994 and 2014 following RP, was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier (KM) estimation curves and multivariable Cox proportional hazards models were used to examine time to BCR as a function of ERG status, patient race, and obesity. RESULTS AND LIMITATIONS Among 930 eligible patients (36.1% AA and 63.9% CA), with 155 (16.7%) BCR events and a median follow-up time of 5.1 yr, ERG oncoprotein expression was significantly less prevalent in index tumors of AA versus CA patients (23.2% vs 49.3%; p<0.0001). KM curves showed significantly poorer BCR-free survival for CA patients with ERG-negative index tumors but not for AA patients. Race-stratified multivariable analyses revealed a significant association between ERG-negative index tumors and poorer BCR-free survival among CA patients (hazards ratio=1.67, confidence interval=1.07, 2.61; p=0.024). Less heterogeneity in ERG expression among AA patients may reduce the ability to show its association with BCR. CONCLUSIONS Striking racial variation in ERG oncoprotein expression was confirmed. A novel observation was the importance of index tumor ERG-negative status in predicting CaP progression for CA patients. PATIENT SUMMARY ETS-related gene (ERG) typing of tumors may be useful in prognosticating prostate cancer aggressiveness.
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Affiliation(s)
- Jennifer Cullen
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Denise Young
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Yongmei Chen
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael Degon
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - James Farrell
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Jason Sedarsky
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Wagner Baptiste
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Philip Rosen
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | | | | | - Jacob Kagan
- Cancer Biomarkers Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Sudhir Srivastava
- Cancer Biomarkers Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Huai-Ching Kuo
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joel T Moncur
- Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Inger L Rosner
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | | | | | - Gyorgy Petrovics
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Albert Dobi
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David G McLeod
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Shiv Srivastava
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Isabell A Sesterhenn
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Joint Pathology Center, Silver Spring, MD, USA
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11
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Montironi R, Santoni M, Mazzucchelli R, Burattini L, Berardi R, Galosi AB, Cheng L, Lopez-Beltran A, Briganti A, Montorsi F, Scarpelli M. Prostate cancer: from Gleason scoring to prognostic grade grouping. Expert Rev Anticancer Ther 2016; 16:433-40. [PMID: 27008205 DOI: 10.1586/14737140.2016.1160780] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Gleason grading system was developed in the late 1960s by Dr. Donald F. Gleason. Due to changes in prostatic adenocarcinoma (PAC) detection and treatment, newer technologies to better characterize prostatic pathology, subsequently described variants of PAC and further data relating various morphologic patterns to prognosis, the application of the Gleason grading system changed substantially in surgical pathology. First in 2005 and more recently in 2014, consensus conferences were held to update PAC grading. Here, we review of the successive changes in the grading of PAC from the original system, with emphasis on the newest prognostic grade grouping.
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Affiliation(s)
- Rodolfo Montironi
- a Section of Pathological Anatomy , Polytechnic University of the Marche Region, School of Medicine, United Hospitals , Ancona , Italy
| | - Matteo Santoni
- b Clinica di Oncologia Medica, AOU Ospedali Riuniti , Polytechnic University of the Marche Region , Ancona , Italy
| | - Roberta Mazzucchelli
- a Section of Pathological Anatomy , Polytechnic University of the Marche Region, School of Medicine, United Hospitals , Ancona , Italy
| | - Luciano Burattini
- b Clinica di Oncologia Medica, AOU Ospedali Riuniti , Polytechnic University of the Marche Region , Ancona , Italy
| | - Rossana Berardi
- b Clinica di Oncologia Medica, AOU Ospedali Riuniti , Polytechnic University of the Marche Region , Ancona , Italy
| | - Andrea B Galosi
- c Urology Clinic , Polytechnic University of the Marche Region, School of Medicine , Ancona , Italy
| | - Liang Cheng
- d Department of Pathology and Laboratory Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | | | - Alberto Briganti
- f Unit of Urology/Division of Oncology , URI, IRCCS Ospedale San Raffaele , Milan , Italy
| | - Francesco Montorsi
- f Unit of Urology/Division of Oncology , URI, IRCCS Ospedale San Raffaele , Milan , Italy
| | - Marina Scarpelli
- a Section of Pathological Anatomy , Polytechnic University of the Marche Region, School of Medicine, United Hospitals , Ancona , Italy
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12
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Servian P, Celma A, Planas J, Placer J, de Torres IM, Morote J. Clinical Significance of Proliferative Inflammatory Atrophy in Negative Prostatic Biopsies. Prostate 2016; 76:1501-1506. [PMID: 27404228 DOI: 10.1002/pros.23234] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/21/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE To analyze the association between prostatic proliferative inflammatory atrophy finding in negative prostate biopsies and future detection of prostate cancer (PCa) and its aggressiveness in men subjected to repeat biopsies, due to persistent suspicion of PCa. MATERIALS AND METHODS Prospective and observational study of 474 men scheduled to repeated PBs. Assessment of PIA and its extension in the previous biopsy. PCa detection rate and tumor aggressiveness. Age, serum total PSA, free PSA, percent free PSA (%fPSA), digital rectal exam (DRE), prostate volume (PV), PSA density (PSAD), PSA kinetics (PSAV and PSADT) findings of PIA and HGPIN, and number of affected cores in previous PBs were included in the univariate and multivariate analysis. Aggressive tumors were considered when any Gleason pattern 4 was found. RESULTS PCa was detected in 133 men (28.1%). Age, serum total PSA, %fPSA, PV, PSAD, PSAV, PSADT, and PIA finding were significantly associated to PCa detection. However, only age, OR: 1.06 (95%CI: 1.03-1.10), P < 0.01; DRE, OR: 1.76 (95%CI: 1.05-2.92), P = 0.03; %fPSA, OR: 0.96 (95%CI: 0.93-0.99), P = 0.03; PV, OR: 0.98 (95%CI: 0.97-0.99) and PIA finding, OR: 0.49 (95%CI: 0.29-0.83), P < 0.01, were independent predictors of PCa detection. PCa was found in 18% of 159 men with previous PIA finding while in 33% of 315 men without previous PIA (P < 0.01). None of the studied parameters including PIA in the previous biopsy were related with subsequent PCa aggressiveness. CONCLUSIONS PIA finding in negative biopsies correlates with a decreased frequency of detecting PCa in men with persistent suspicion of PCa. The aggressiveness of future detected tumors was not associated with previous PIA finding. Prostate 76:1501-1506, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Pol Servian
- Department of Urology, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Ana Celma
- Department of Urology, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jacques Planas
- Department of Urology, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - José Placer
- Department of Urology, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Inés M de Torres
- Department of Pathology, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan Morote
- Department of Urology, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
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Patel KM, Gnanapragasam VJ. Novel concepts for risk stratification in prostate cancer. JOURNAL OF CLINICAL UROLOGY 2016; 9:18-23. [PMID: 28344812 PMCID: PMC5356178 DOI: 10.1177/2051415816673502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 09/07/2016] [Indexed: 01/15/2023]
Abstract
Since Partin introduced the analysis of prostate-specific antigen, clinical T-stage and Gleason scores to estimate the risk of progression in men with localised prostate cancer, our understanding of factors that modify this risk has changed drastically. There are now multiple risk stratification tools available, including look-up tables, risk stratification/classification analyses, regression-tree analyses, nomograms and artificial neural networks. Concurrently, descriptions of novel biopsy strategies, imaging modalities and biomarkers are frequently published with the aim of improving risk stratification. With an abundance of new information available, incorporating advances into clinical practice can be confusing. This article aims to outline the major novel concepts in prostate cancer risk stratification for men with biopsy confirmed prostate cancer. We will detail which of these novel techniques and tools are likely to be adopted to aid treatment decisions and enable more accurate post-diagnosis, pretreatment risk stratification.
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Affiliation(s)
- Keval M Patel
- Cancer Research UK Cambridge Institute, University of Cambridge, UK; Academic Urology Group, University of Cambridge, UK
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Ammani A, Janane A, Bouzide B, Dehayni Y, Lezrek M, Ghadouane M, Ameur A, Abbar M, Qarro A, Alami M. Accuracy of the contemporary Epstein criteria to predict insignificant prostate cancer in North African Man. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Miah S, Ahmed HU, Freeman A, Emberton M. Does true Gleason pattern 3 merit its cancer descriptor? Nat Rev Urol 2016; 13:541-8. [DOI: 10.1038/nrurol.2016.141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Minardi D, Mazzucchelli R, Scarpelli M, Massari F, Ciccarese C, Lopez-Beltran A, Cheng L, Montironi R. Prostate cancer glands with cribriform architecture and with glomeruloid features should be considered as Gleason pattern 4 and not pattern 3. Future Oncol 2016; 12:1431-3. [DOI: 10.2217/fon-2016-0113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Daniele Minardi
- Dipartimento di Scienze Cliniche e Specialistiche, Sezione di Urologia, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Roberta Mazzucchelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | | | - Chiara Ciccarese
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | | | - Liang Cheng
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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Radiotherapy Boost for the Dominant Intraprostatic Cancer Lesion—A Systematic Review and Meta-Analysis. Clin Genitourin Cancer 2016; 14:189-97. [DOI: 10.1016/j.clgc.2015.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/24/2015] [Accepted: 12/09/2015] [Indexed: 12/14/2022]
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Acquisition with (11)C-choline and (18)F-fluorocholine PET/CT for patients with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Ann Nucl Med 2016; 30:385-92. [PMID: 27173771 DOI: 10.1007/s12149-016-1078-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
The objective of the systematic review and meta-analysis was to evaluate whether the choice between two radiotracers, (11)C-choline ((11)C-cho) and (18)F-fluorocholine ((18)F-FCH) for PET/CT, and different acquisition protocols contributed to detect metastases for patients with biochemical recurrence of prostate cancer after radical prostatectomy or radiotherapy. We searched in January 2016 in Pubmed and Embase for articles that had used radiolabeled choline PET/CT in restaging. The meta-analysis evaluated technical and clinical aspects. Across 18 articles 1 219 of 2 213 patients (54.9 %) had a positive radiolabeled PET/CT image. Mean of the mean/median restaging PSA levels was 3.6 ± 2.7 ng/mL (range 0.5-10.7 ng/mL). Six articles with (11)C-cho PET/CT had a radiation activity of 561 ± 122 MBq and it was 293 ± 47 MBq in 12 articles with (18)F-FCH PET/CT. The difference was significant (P = 0.007, t test). Uptake time was 5 min in articles with (11)C-cho PET/CT and it was 29 ± 24 min in articles with (18)F-FCH PET/CT. The difference was significant (P = 0.02, t test). Thereby the detection rates of metastatic sites in articles with (11)C-cho (30 ± 5 %) and (18)F-FCH (39 ± 5 %) did not differ significantly (P = 0.26, t test). In linear regression analyses of the articles, the radiation activity of (11)C-cho and (18)F-FCH was not significantly associated with the detection rate of metastatic sites (P = 0.75 and P = 0.60). Restaging with radiolabeled choline PET/CT detected metastatic sites for patients with biochemical recurrence and PSA levels of 1-10 ng/mL at clinically relevant level. The choice between the two choline radiotracers and different acquisition protocols had no significant impact on detection.
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Monn MF, Tatem AJ, Cheng L. Prevalence and management of prostate cancer among East Asian men: Current trends and future perspectives. Urol Oncol 2015; 34:58.e1-9. [PMID: 26493449 DOI: 10.1016/j.urolonc.2015.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/08/2015] [Accepted: 09/11/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Previously East Asian men had been considered less likely to develop or die of prostate cancer. Emerging research and the onset of prostate-specific antigen screening in East Asian countries suggests that this may not be the case. We sought to analyze epidemiology and molecular genetic data and recent trends in the management of prostate cancer among East Asian men. METHODS AND MATERIALS We performed literature searches using PubMed, Embase, and Google Scholar to examine current literature on prostate cancer in East Asian men. Additionally, articles were searched for further references related to the topic. RESULTS Recent studies have reported increasing incidence of prostate cancer identified in East Asian men. Prostate cancer mortality has increased and is currently the fourth leading cause of death among men in Shanghai, China. Although prostate cancer was considered less aggressive among East Asian men, studies suggest that it is similarly aggressive to prostate cancer in Western populations. Molecular markers such as the TEMPRESS:ERG fusion gene and PTEN loss may provide novel methods of screening East Asian men for prostate cancer. National-level guidelines for prostate cancer screening and management are only available in Japan. CONCLUSIONS The prevalence of prostate cancer in East Asian men is likely similar to that in Western male populations. East Asian men present at higher stages of prostate cancer, likely because of a lack of standardized screening protocols. Urologists in Western countries should screen East Asian men for prostate cancer using the same standards as used for Western men.
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Affiliation(s)
- M Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Alexander J Tatem
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Liang Cheng
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN; Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.
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Servian P, Celma A, Planas J, Placer J, de Torres IM, Olivan M, Morote J. Clinical significance of proliferative inflammatory atrophy finding in prostatic biopsies. Prostate 2015; 75:1669-75. [PMID: 26184870 DOI: 10.1002/pros.23047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/03/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proliferative inflammatory atrophy (PIA) has been involved in prostatic carcinogenesis. However, little is known about the clinical significance of a PIA finding in prostatic biopsies (PBs). The aim of this study is to determine the incidence of prostate inflammatory atrophy (PIA) in prostate biopsies (PBs), its association to high-grade prostatic intraepithelial neoplasia (HGPIN), prostate cancer (PCa), and tumor aggressiveness. METHODS Prospective and observational study of PIA lesion in 528 extended PBs and 200 radical prostatectomy specimens (RPS). OUTCOME MEASUREMENTS PIA, HGPIN, PCa incidence, Gleason score, clinical and pathologic tumor stage and insignificant tumor rate. Univariate and multivariate analysis. RESULTS Overall incidence of PIA and HGPIN was 30.3% and 54%. In RPS, the incidence was 30.5% and 72%, respectively. No significant association was found between PIA and HGPIN. Overall PCa detection rate in PBs was 38.1%. PCa was found in 27.5% PBs with PIA and 42.7% of those without PIA, P < 0.001. In contrast, PCa was detected in 50.9% of PBs with HGPIN and 23% of those without HGPIN, P = 0.001. Multivariate analysis revealed that PIA decreased the risk of PCa, OR:0.59 (95%CI:0.37-0.95), P = 0.029, while HGPIN increased OR:3.16 (95%CI:2.04-4.90), P = 0.001. PIA was not related to Gleason grade and clinical stage, however it was associated to an insignificant tumors increase, OR:3.08 (95%CI:1.09-8.7), P = 0.033. The information in RPS suggests that PIA is associated with less aggressive tumors and a higher probability of insignificant tumors. CONCLUSIONS PIA is present in one third of PBs, HGPIN in one half of them, and no association exists between both lesions. Contrary to HGPIN, PIA finding is associated to lower risk of PCa detection. Tumors accompanying PIA seem to be less aggressive and have a greater probability of being insignificant.
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Affiliation(s)
| | - Ana Celma
- Departments of Urology, Barcelona, Spain
| | | | | | | | - Mireia Olivan
- Department of Urology research unit Vall d'Hebrón Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan Morote
- Departments of Urology, Barcelona, Spain
- Department of Urology research unit Vall d'Hebrón Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
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22
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Ma C, Liu C, Huang P, Kaku H, Chen J, Guo K, Ueki H, Sakai A, Nasu Y, Kumon H, Shimizu K, Watanabe M. Significant association between the Axin2 rs2240308 single nucleotide polymorphism and the incidence of prostate cancer. Oncol Lett 2014; 8:789-794. [PMID: 25013500 PMCID: PMC4081410 DOI: 10.3892/ol.2014.2177] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/01/2014] [Indexed: 12/03/2022] Open
Abstract
The Wnt signaling pathway plays a crucial role in human cancer development, and axis inhibition protein 2 (Axin2) is a master scaffold protein involved in Wnt signaling. Axin2 negatively regulates Wnt signaling and acts as a tumor suppressor protein. The present study evaluated the association between the Axin2 single nucleotide polymorphism (SNP) rs2240308 [guanine (G)/adenine (A)] and the incidence of prostate cancer. In total, 103 patients with prostate cancer and 100 cancer-free control males were included in this case-control study, and were genotyped using the genomic DNA extracted from peripheral blood samples. The results revealed a higher incidence of prostate cancer in the subjects with the homozygous GG genotype and a reduced cancer incidence in the patients with the GA genotype of the rs2240308 SNP (G/A) in the Axin2 gene. The adjusted odds ratio for carriers with the GA genotype was 0.377 (95% CI, 0.206–0.688; P=0.001) and that for the AA genotype was 0.830 (95% CI, 0.309–2.232; P=0.712) compared with the GG genotype. Therefore, the GA genotype was found to exhibit a protective effect that decreased the risk of prostate cancer. To the best of our knowledge, this is the first study to demonstrate the significant association between this SNP (rs2240308, G/A) and the risk of prostate cancer. This association indicates the possibility that the variations in the Axin2 gene in this position may play a significant role in promoting the development of cancer in the prostate. We believe that the Axin2 SNP (rs2240308) could be a useful biomarker for the predisposition and early diagnosis of the disease.
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Affiliation(s)
- Chao Ma
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Peng Huang
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China ; Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan ; Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Haruki Kaku
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan ; Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jie Chen
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan ; Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kai Guo
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China ; Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan ; Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hideo Ueki
- Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akiko Sakai
- Department of Molecular Genetics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasutomo Nasu
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan ; Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromi Kumon
- Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenji Shimizu
- Department of Molecular Genetics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masami Watanabe
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan ; Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Penney KL, Stampfer MJ, Jahn JL, Sinnott JA, Flavin R, Rider JR, Finn S, Giovannucci E, Sesso HD, Loda M, Mucci LA, Fiorentino M. Gleason grade progression is uncommon. Cancer Res 2014; 73:5163-8. [PMID: 23946472 DOI: 10.1158/0008-5472.can-13-0427] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gleason grade is universally used for pathologic scoring of the differentiation of prostate cancer. However, it is unknown whether prostate tumors arise well differentiated and then progress to less differentiated forms or if Gleason grade is an early and largely unchanging feature. Prostate-specific antigen (PSA) screening has reduced the proportion of tumors diagnosed at advanced stage, which allows assessment of this question on a population level. If Gleason grade progresses as stage does, one would expect a similar reduction in high-grade tumors. We studied 1,207 Physicians' Health Study and Health Professionals Follow-up Study participants diagnosed with prostate cancer from 1982 to 2004 and treated with prostatectomy. We compared the distribution of grade and clinical stage across the pre-PSA and PSA screening eras. We re-reviewed grade using the ISUP 2005 revised criteria. The proportion of advanced stage tumors dropped more than six-fold, from the earliest period (12/1982-1/1993), 19.9% stage ≥ T3, to the latest (5/2000-12/2004), 3% stage T3, none T4. The proportion of Gleason score ≥ 8 decreased substantially less, from 25.3% to 17.6%. A significant interaction between stage and diagnosis date predicting grade (P = 0.04) suggests that the relationship between grade and stage varies by time period. As the dramatic shift in stage since the introduction of PSA screening was accompanied by a more modest shift in Gleason grade, these findings suggest that grade may be established early in tumor pathogenesis. This has implications for the understanding of tumor progression and prognosis, and may help patients diagnosed with lower grade disease feel more comfortable choosing active surveillance.
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Affiliation(s)
- Kathryn L Penney
- Department of Epidemiology, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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van Soest RJ, de Morrée ES, Shen L, Tannock IF, Eisenberger MA, de Wit R. Initial biopsy Gleason score as a predictive marker for survival benefit in patients with castration-resistant prostate cancer treated with docetaxel: data from the TAX327 study. Eur Urol 2013; 66:330-6. [PMID: 23957945 DOI: 10.1016/j.eururo.2013.08.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Since 2004, docetaxel has been the standard first-line systemic therapy for patients with metastatic castration-resistant prostate cancer (mCRPC). With abiraterone recently becoming available in the predocetaxel setting, it is warranted to identify subgroups of patients who may obtain the greatest benefit from docetaxel and particularly qualify for receiving docetaxel as first-line treatment for mCRPC. OBJECTIVE We aimed to identify factors that could characterize subgroups of patients who obtain the greatest benefit from the use of docetaxel. DESIGN, SETTING, AND PARTICIPANTS TAX327 was multinational, randomized, phase 3 study that was conducted from 2000 to 2002 in 1006 men with mCRPC. INTERVENTION Patients were randomized to receive docetaxel every 3 wk (D3), weekly docetaxel (D1), or mitoxantrone every 3 wk (M3), each with prednisone. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We investigated whether patients with poorly differentiated tumors (Gleason score ≥7) at diagnosis had greater benefit from D3 compared with M3 than patients with better differentiated tumors (Gleason score ≤6). Using a Cox model, we compared overall survival (OS) between the treatment groups within each subgroup of Gleason score. RESULTS AND LIMITATIONS The TAX 327 data showed that the OS benefit of D3 versus M3 was greater in patients with high-grade tumors (median OS: 18.9 vs 14.5 mo; p=0.009) than in patients with low-grade tumors (median OS: 21.6 vs 20.7 mo; p=0.674). Limitations of a retrospective analysis apply. CONCLUSIONS The survival benefit obtained with docetaxel is most pronounced in patients with high-Gleason-score tumors (Gleason ≥7). In a time of shifting paradigms in mCRPC, with abiraterone becoming available prior to docetaxel chemotherapy, Gleason score may help in selecting patients who obtain the greatest benefit from docetaxel as first-line treatment for mCRPC. Prospective validation of these findings is warranted.
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Affiliation(s)
- Robert J van Soest
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Ellen S de Morrée
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Ian F Tannock
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Mario A Eisenberger
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus University Medical Center and Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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25
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Montironi R, Lopez-Beltran A, Cheng L, Montorsi F, Scarpelli M. Central prostate pathology review: should it be mandatory? Eur Urol 2013; 64:199-201; discussion 202-3. [PMID: 23608669 DOI: 10.1016/j.eururo.2013.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/03/2013] [Indexed: 11/27/2022]
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26
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Davidsson S, Ohlson AL, Andersson SO, Fall K, Meisner A, Fiorentino M, Andrén O, Rider JR. CD4 helper T cells, CD8 cytotoxic T cells, and FOXP3(+) regulatory T cells with respect to lethal prostate cancer. Mod Pathol 2013; 26:448-55. [PMID: 23041830 DOI: 10.1038/modpathol.2012.164] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate cancer represents a major contributor to cancer mortality, but the majority of men with prostate cancer will die of other causes. Thus, a challenge is identifying potentially lethal disease at diagnosis. Conflicting results have been reported when investigating the relationship between infiltration of lymphocytes and survival in prostate cancer. One of the mechanisms suggested is the recruitment of regulatory T cells (T(regs)), a subpopulation of T cells that have a role in promoting tumor growth. T(regs) counteract tumor rejection through suppressive functions on the anti-immune response but their prognostic significance is still unknown. We report here the results of a conducted case-control study nested in a cohort of men treated with transurethral resection of the prostate and diagnosed incidentally with prostate cancer. Cases are men who died of prostate cancer (n=261) and controls are men who survived >10 years after their diagnosis (n=474). Infiltration of both T(helper) and T(cytotoxic) cells was frequently observed and the majority of the T(regs) were CD4(+). T(helper) or T(cytotoxic) cells were not associated with lethal prostate cancer. However, we found a nearly twofold increased risk of lethal prostate cancer when comparing the highest with the lowest quartile of CD4(+) T(regs) cells (95% confidence interval: 1.3-2.9). Our conclusion is that men with greater numbers of CD4(+) T(regs) in their prostate tumor environment have an increased risk of dying of prostate cancer. Identification of CD4(+) T(regs) in tumor tissue may predict clinically relevant disease at time of diagnosis independently of other clinical factors.
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Affiliation(s)
- Sabina Davidsson
- Department of Urology, Örebro University Hospital, Örebro, Sweden.
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27
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Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Di Primio R, Montironi R. Morphological Analysis of Radical Prostatectomy Specimens: Recent Topics Relevant to Prognosis. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The pathology report should include clinically relevant information as well as provide clinically useful information derived from the macroscopic examination and microscopic evaluation of the radical prostatectomy (RP) specimens. The reporting pathologist should pay particular attention to the evaluation of the prognostic factors proven to be of prognostic importance and useful in clinical patient management, including histological type, grade and volume of cancer, the extent of local invasion and stage of cancer as well as the surgical margins status.
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Affiliation(s)
- R. Mazzucchelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - M. Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - A. Lopez-Beltran
- Department of Pathology, Reina Sofia University Hospital and Faculty of Medicine, Cordoba, Spain
| | - L. Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R. Di Primio
- Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, School of Medicine, Ancona, Italy
| | - R. Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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28
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Egevad L, Mazzucchelli R, Montironi R. Implications of the International Society of Urological Pathology modified Gleason grading system. Arch Pathol Lab Med 2012; 136:426-34. [PMID: 22458905 DOI: 10.5858/arpa.2011-0495-ra] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Histologic grading is the clinically most useful tissue-based predictor of prognosis for prostate cancer. Over the years, there has been a gradual shift in how the Gleason grading is applied in practice, with a general trend toward upgrading. A consensus conference was organized in 2005 by the International Society of Urological Pathology (ISUP) for standardizing both the perception of histologic patterns and how the grade information is compiled and reported. OBJECTIVE To review the implications of the ISUP modified Gleason grading system. DATA SOURCES Personal experience and review of the current literature. CONCLUSIONS The recommendations regarding pattern interpretation and reporting are summarized. The practical consequences of the ISUP modification of the Gleason grading are reported. The prognostic importance of the Gleason score, its reproducibility, and its preoperative assessment are discussed. Subsequent proposals for slight modifications to the ISUP grading system are described.
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Affiliation(s)
- Lars Egevad
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
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29
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Allory Y. [Diagnostic issues of prostate biopsies. Case 7. Gleason grade 4 adenocarcinoma, with ill-defined glands and poorly formed glandular lumina]. Ann Pathol 2012; 32:137-40. [PMID: 22520608 DOI: 10.1016/j.annpat.2012.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Yves Allory
- Département de pathologie, hôpital Henri-Mondor, AP-HP, Créteil, France.
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31
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Aytac B, Vuruskan H. Clinicopathologic features of incidental prostatic adenocarcinoma in radical cystoprostatectomy specimens. World J Surg Oncol 2011; 9:81. [PMID: 21774802 PMCID: PMC3155901 DOI: 10.1186/1477-7819-9-81] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/20/2011] [Indexed: 11/28/2022] Open
Abstract
Background The aim of this study is to review all features of incidentally discovered prostate adenocarcinoma in patients undergoing radical cystoprostatectomy for bladder cancer. Methods The medical charts of 300 male patients who underwent radical cystoprostatectomy for bladder cancer between 1997 and 2005 were retrospectively reviewed. The mean age of the patients was 62 (range 51-75) years. Results Prostate adenocarcinoma was present in 60 (20%) of 300 specimens. All were acinar adenocarcinoma. Of these, 40 (66.7%) were located in peripheral zone, 20 (33.3%) had pT2a tumor, 12 (20%) had pT2b tumor, 22(36.7%) had pT2c and, 6 (10%) had pT3a tumor. Gleason score was 6 or less in 48 (80%) patients. Surgical margins were negative in 54 (90%) patients, and tumor volume was less than 0.5 cc in 23 (38.3%) patients. Of the 60 incidentally detected cases of prostate adenocarcinoma 40 (66.7%) were considered clinically significant. Conclusion Incidentally detected prostate adenocarcinoma is frequently observed in radical cystoprostatectomy specimens. The majority are clinically significant.
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Affiliation(s)
- Berna Aytac
- Department of Surgical Pathology, Uludag University Medical Faculty, Bursa, Turkey.
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Reply to Kiril Trpkov, Asli Yilmaz’ Letter to the Editor re: Rodolfo Montironi, Liang Cheng, Antonio Lopez-Beltran, et al. Original Gleason System Versus 2005 ISUP Modified Gleason System: The Importance of Indicating Which System Is Used in the Patient’s Pathology and Clinical Reports. Eur Urol 2010;58:369–73. Eur Urol 2011. [DOI: 10.1016/j.eururo.2010.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
UNLABELLED Study Type - Prognosis (systematic review). LEVEL OF EVIDENCE 2b. What's known on the subject? and What does the study add? Overtreatment of prostate cancer is a major problem in contemporary urological practice. The Epstein Criteria reduces overtreatment by identifying insignificant prostate cancers that may be amenable to surveillance therapy. This systematic review of the Epstein Criteria validation studies provides a collective insight into the application and accuracy of the Epstein Criteria to predict for insignificant prostate cancer across different institutions and geographies. OBJECTIVE • To review the accuracy of the Epstein Criteria for insignificant prostate cancer and to explore the effect of the modified Gleason classification system on this system. METHODS • We searched PubMed, EMBASE and the Cochrane Database using search terms 'Epstein Criteria', 'Prostate Cancer', 'Validation' and 'Insignificant Cancer' between 1994 to 2010 for validation articles. • These were divided into pre-2005 and post-2005 and concordances for organ-confined status, Gleason score ≤ 6 and insignificant cancer were analysed. RESULTS • A pre-2005 study showed concordance for insignificant prostate cancer, Gleason score ≤ 6 and organ-confined status at 84%, 90.3% and 91.6%, respectively. • Five post-2005 validation studies were concordant for insignificant cancer, Gleason score ≤ 6 and organ-confined status at 37-76%, 54.3-75.9% and 80.0-96.9%, respectively. CONCLUSIONS • The Epstein Criteria has a suboptimal accuracy for predicting for insignificant prostate cancer. • The modification to Gleason scoring may be responsible for a reduced accuracy over time. • However, significant heterogeneity in the validation studies means better quality validation studies are required.
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Affiliation(s)
- Sheng F Oon
- Conway Institute, University College Dublin, Dublin, Ireland.
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Trpkov K, Yilmaz A. Re: Rodolfo Montironi, Liang Cheng, Antonio Lopez-Beltran, et al. Original Gleason system versus 2005 ISUP modified Gleason system: the importance of indicating which system is used in the patient's pathology and clinical reports. Eur Urol 2010;58:369-73. Eur Urol 2010; 59:e5-6; author reply e7-8. [PMID: 21134713 DOI: 10.1016/j.eururo.2010.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 11/18/2010] [Indexed: 11/26/2022]
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