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Pedraza AM, Ferguson EL, Ramos-Carpinteyro R, Mikesell C, Chavali JS, Soputro N, Almassi N, Weight C, Gorgun E, Kaouk J. Managing prostate cancer after proctocolectomy and ileal pouch-anal anastomosis: feasibility and outcomes of single-port transvesical robot-assisted radical prostatectomy. World J Urol 2024; 42:368. [PMID: 38832957 DOI: 10.1007/s00345-024-05051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Patients with proctocolectomy and ileal pouch-anal anastomosis (PC-IPAA) face unique challenges in managing prostate cancer due to their hostile abdomens and heightened small bowel mucosa radiosensitivity. In such cases, external beam radiation therapy (EBRT) is contraindicated, and while brachytherapy provides a safer option, its oncologic effectiveness is limited. The Single-Port Transvesical Robot-Assisted Radical Prostatectomy (SP TV-RARP) offers promise by avoiding the peritoneal cavity. Our study aims to evaluate its feasibility and outcomes in patients with PC-IPAA. METHODS A retrospective evaluation was done on patients with PC-IPAA who had undergone SP TV-RARP from June 2020 to June 2023 at a high-volume center. Outcomes and clinicopathologic variables were analyzed. RESULTS Eighteen patients underwent SP TV-RARP without experiencing any complications. The median hospital stay was 5.7 h, with 89% of cases discharged without opioids. Foley catheters were removed in an average of 5.5 days. Immediate urinary continence was seen in 39% of the patients, rising to 76 and 86% at 6- and 12-month follow-ups. Half of the cohort had non-organ confined disease on final pathology. Two patients with ISUP GG3 and GG4 exhibited detectable PSA post-surgery and required systemic therapy; both had SVI, multifocal ECE, and large cribriform pattern. Positive surgical margins were found in 44% of cases, mostly Gleason pattern 3, unifocal, and limited. After 11.1 months of follow-up, no pouch failure or additional BCR cases were found. CONCLUSION Patients with PC-IPAA often exhibit aggressive prostate cancer features and may derive the greatest benefit from surgical interventions, particularly given that radiation therapy is contraindicated. SP TV-RARP is a safe option for this group, reducing the risk of bowel complications and promoting faster recovery.
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Affiliation(s)
- Adriana M Pedraza
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Roxana Ramos-Carpinteyro
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Carter Mikesell
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Jaya S Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Nicolas Soputro
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Nima Almassi
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Emre Gorgun
- Colorectal Surgery, DDSI, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA.
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Asafu Adjaye Frimpong G, Aboagye E, Asante E, Appiah KAA, Owusu-Afriyie O, Asare AO, Atuobi D, Akpaloo BD, Antwi B. Advancing Prostate Cancer Staging: A Single-Step Approach With Bi-parametric and Whole-Body Diffusion MRI in an African Cohort. Cureus 2024; 16:e59470. [PMID: 38826908 PMCID: PMC11142458 DOI: 10.7759/cureus.59470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVES To document our initial experience using whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) and bi-parametric magnetic resonance imaging (bpMRI) as a single exam in the staging of biopsy-proven prostate cancers. METHODS This retrospective study involved 120 African men with biopsy-confirmed prostate cancer (PCa). All the participants had a single exam that included both a bpMRI and a WB-DWI/MRI. The results were analyzed based on the American Urological Association's risk stratification system and evaluated using descriptive statistics. RESULTS The combined imaging approach confirmed PCa in all cases, identifying pelvic lymph node metastases in 21 (17.5%) patients. Among 72 high-risk patients, bpMRI+WB-DWI/MRI detected pelvic lymph node metastases in 18 (25.0%), bone metastases in 15 (20.8%), retroperitoneal lymph node metastases in six (8.3%), and extraprostatic extension in 18 (25%), with no solid organ metastases observed. CONCLUSION The combination of WB-DWI/MRI and bpMRI in a single-step approach demonstrates diagnostic potential in primary prostate cancer staging for high-risk groups, with the added advantage of shorter examination times, lower patients' costs, and elimination of the risks of adverse events associated with the use of contrast agents and exposure to radiation.
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Affiliation(s)
- George Asafu Adjaye Frimpong
- Radiology, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
- Radiology, Spectra Health Imaging and Interventional Radiology, Kumasi, GHA
| | - Evans Aboagye
- Research and Development, Spectra Health Imaging and Interventional Radiology, Kumasi, GHA
| | - Emmanuel Asante
- Research and Development, Spectra Health Imaging and Interventional Radiology, Kumasi, GHA
| | | | - Osei Owusu-Afriyie
- Pathology, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
| | - Adwoa O Asare
- Oncology, Komfo Anokye Teaching Hospital, Kumasi, GHA
| | - Dorcas Atuobi
- Radiology, Spectra Health Imaging and Interventional Radiology, Kumasi, GHA
| | - Bernard D Akpaloo
- Radiology, Spectra Health Imaging and Interventional Radiology, Kumasi, GHA
| | - Bright Antwi
- Radiology, Spectra Health Imaging and Interventional Radiology, Kumasi, GHA
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Liu ZN, Li ZA, He JD, Wu JL, Qiu L, Zhao ZK, Lu M, Bi H, Lu J. Development and Validation of Nomograms Based on Nutritional Risk Index for Predicting Extracapsular Extension and Seminal Vesicle Invasion in Patients Undergoing Radical Prostatectomy. World J Oncol 2023; 14:505-517. [PMID: 38022403 PMCID: PMC10681782 DOI: 10.14740/wjon1718] [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: 08/27/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background The aim of the study was to investigate the predictive value of the nutritional risk index (NRI) for extracapsular extension (ECE) and seminal vesicle invasion (SVI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP), and further develop and validate predictive nomograms for ECE and SVI based on the NRI. Methods We retrospectively analyzed 734 PCa patients who underwent RP between 2010 and 2020 in the Department of Urology at Peking University Third Hospital. The enrolled patients were randomly divided into a primary cohort (n = 489) and a validation cohort (n = 245) in a 2:1 manner. The baseline NRI of patients was calculated using serum albumin level and body mass index, and a malnutrition status was defined as NRI ≤ 98. Univariate and multivariate logistic regression analyses were conducted to identify predictors for ECE and SVI. Nomograms for predicting ECE and SVI were established based on the results of the multivariate logistic regression analysis. The performance of the nomograms was estimated using Harrell's concordance index (C-index), the area under curve (AUC) of receiver operating characteristic (ROC) curves and the calibration curves. Results In the primary cohort, 70 (14.3%) patients with NRI ≤ 98 were classified as malnutrition, while the remaining 419 (85.7%) patients with NRI > 98 were considered to have normal nutrition. The nomograms for predicting ECE and SVI shared common factors including NRI, percentage of positive biopsy cores (PPC) and biopsy Gleason score, while prostate-specific antigen (PSA) levels and PSA density (PSAD) were only incorporated in ECE nomogram. The C-indexes of the nomograms for predicting ECE and SVI were 0.785 (95% confidence interval (CI): 0.745 - 0.826) and 0.852 (95% CI: 0.806 - 0.898), respectively. The calibration curves demonstrated excellent agreement between the predictions by the nomograms and the actual observations. The results remained reproducible when the nomograms were applied to the validation cohort. Conclusions The NRI is significantly associated with ECE and SVI in PCa patients. The nomogram established based on the NRI in our study can provide individualized risk estimation for ECE and SVI in PCa patients, and may be valuable for clinicians in making well-informed decisions regarding treatment strategies and patient management.
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Affiliation(s)
- Ze Nan Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
- These authors contributed equally to this work
| | - Zi Ang Li
- Department of Urology, Peking University Third Hospital, Beijing, China
- These authors contributed equally to this work
| | - Ji De He
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jia Long Wu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lei Qiu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhen Kun Zhao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Hai Bi
- Department of Urology, Shanghai General Hospital, Shanghai, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing, China
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Boehle A, Zywietz D, Robrahn-Nitschke I, Lusch A, König IR. LDR-Brachytherapy monotherapy appears unsuited for NCCN unfavorable intermediate-risk prostate cancer patients. Urol Oncol 2023; 41:454.e17-454.e24. [PMID: 37714724 DOI: 10.1016/j.urolonc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/19/2023] [Accepted: 08/12/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND To validate the subdivision of intermediate-risk (IR) prostate cancer (PCa) into favorable intermediate-risk (FIR) and unfavorable intermediate-risk (UIR) PCa in a historical patient cohort and to compare 2 different radiotherapy regimens. METHODS Patients with intermediate-risk (IR) PCa, treated either by 125J-LDR-brachytherapy monotherapy (BT) or by combined-modality radiation therapy (CRT), were retrospectively subclassified into FIR and UIR and reanalyzed with regard to biochemical recurrence-free survival (BRFS), metastasis-free survival (MFS), and prostate cancer-specific survival (CSS). Kaplan-Meier product-limit method and log-rank tests were applied to estimate survival probabilities and compare survival, respectively. Uni- and multivariable analyses were performed using Cox proportional hazard regression. RESULTS Of 490 IR patients, 252 had received BT (86.5% FIR, 13.5% UIR), and 238 had received CRT (30% FIR, 70% UIR). Retrospective analysis revealed that BRFS at 10 years was 81% for BT, and 94% for CRT in FIR patients. For UIR patients, BRFS at 10 years was 37% for BT, and 89% for CRT. MFS at 10 years for FIR patients was 87% for BT, and 94% for CRT. For UIR patients MFS at 10 years was 78% for BT, and 95% for CRT. In multivariable analysis treatment (BT vs. CRT) was the single associated factor for biochemical recurrence, and for metastases in the UIR group (BFRS, P < 0.001, HR 16.07 (CI 4.23-61.10); MFS, P = 0.011, HR 8.43 (CI 1.62-43.9). CONCLUSIONS Subclassification of IR prostate cancer into FIR and UIR subcategories appears mandatory. For FIR patients, outcomes after BT monotherapy were acceptable. However, clinical failure after 125J-LDR-BT in UIR patients was notably increased, suggesting that BT monotherapy was less successful in this risk group. In contrast, the outcome in UIR patients after CRT was excellent.
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Affiliation(s)
- Andreas Boehle
- Department of Urology, University of Luebeck, Luebeck, Germany; Department of Urology, HELIOS Agnes-Karll Hospital Bad Schwartau, Bad Schwartau, Germany.
| | | | | | - Achim Lusch
- Department of Urology, University of Luebeck, Luebeck, Germany; Department of Urology, HELIOS Agnes-Karll Hospital Bad Schwartau, Bad Schwartau, Germany
| | - Inke R König
- Institute for Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany
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Choi MH, Kim DH, Lee YJ, Rha SE, Lee JY. Imaging features of the PI-RADS for predicting extraprostatic extension of prostate cancer: systematic review and meta-analysis. Insights Imaging 2023; 14:77. [PMID: 37156971 PMCID: PMC10167060 DOI: 10.1186/s13244-023-01422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To systematically determine the diagnostic performance of each MRI feature of the PI-RADS for predicting extraprostatic extension (EPE) in prostate cancer. METHODS A literature search in the MEDLINE and EMBASE databases was conducted to identify original studies reporting the accuracy of each feature on MRI for the dichotomous diagnosis of EPE. The meta-analytic pooled diagnostic odds ratio (DOR), sensitivity, specificity, and their 95% confidence intervals (CIs) were obtained using a bivariate random-effects model. RESULTS After screening 1955 studies, 17 studies with a total of 3062 men were included. All six imaging features, i.e., bulging prostatic contour, irregular or spiculated margin, asymmetry or invasion of neurovascular bundle, obliteration of rectoprostatic angle, tumor-capsule interface > 10 mm, and breach of the capsule with evidence of direct tumor extension, were significantly associated with EPE. Breach of the capsule with direct tumor extension demonstrated the highest pooled DOR (15.6, 95% CI [7.7-31.5]) followed by tumor-capsule interface > 10 mm (10.5 [5.4-20.2]), asymmetry or invasion of neurovascular bundle (7.6 [3.8-15.2]), and obliteration of rectoprostatic angle (6.1 [3.8-9.8]). Irregular or spiculated margin showed the lowest pooled DOR (2.3 [1.3-4.2]). Breach of the capsule with direct tumor extension and tumor-capsule interface > 10 mm showed the highest pooled specificity (98.0% [96.2-99.0]) and sensitivity (86.3% [70.0-94.4]), respectively. CONCLUSIONS Among the six MRI features of prostate cancer, breach of the capsule with direct tumor extension and tumor-capsule interface > 10 mm were the most predictive of EPE with the highest specificity and sensitivity, respectively.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhao J, Epstein J. Significance of extraprostatic extension by Grade Groups 1-3 prostatic carcinoma on needle biopsy. Prostate 2023; 83:809-813. [PMID: 36946608 DOI: 10.1002/pros.24520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND It is rare for extraprostatic extension (EPE) on biopsy to be seen with Grade Groups (GG) 1-3 (Gleason scores 3 + 3 = 6; 3 + 4 = 7; 4 + 3 = 7) prostatic adenocarcinoma, and there is no data whether this finding should be a contraindication for performing radical prostatectomy (RP). METHODS Thirty eight cases with GG 1-3 prostatic adenocarcinoma as the highest grade in the case with EPE on biopsy were identified from our consultation files. Highly unfavorable findings at RP were those that if they could have been predicted preoperatively, might have factored into the decision of whether to proceed with surgery. For these purposes, highly unfavorable pathology at RP was defined as either the presence of seminal vesicle invasion or lymph node metastases or GG5 (Gleason score 9-10). RESULTS Among 37 patients with clinical follow-up data, 18 (49%) received radiation and/or hormonal therapy (RT/HT), 13 patients (35%) either underwent (n = 11) or are planning (n = 2) RP, and 6 patients (16%) received either ablation therapy or active surveillance. Based on the 11 RP pathology reports, 8 were GG2, one GG3 with tertiary pattern 5, and two GG3. Ten cases were reported to have EPE and six cases had positive margins. Only one had highly unfavorable pathology with pT3bN1 disease. The only difference between the RP and the RT/HT groups in their pretreatment parameters was the mean age of the RP patients was 61 compared with 69 for the RT/HT men (p = 0.02); the lack of many cases with highly unfavorable pathology at RP cannot be attributable to a selection bias of men with lower volume cancer on biopsy or lower serum prostate-specific antigen levels choosing RP over RT/HT. CONCLUSIONS Despite EPE on biopsy, most men do not have highly unfavorable pathology at RP, and this treatment should remain an option in this setting.
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Affiliation(s)
- Jianping Zhao
- Departments of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Jonathan Epstein
- Departments of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
- Departments of Urology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
- Departments of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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Pedraza AM, Parekh S, Joshi H, Grauer R, Wagaskar V, Zuluaga L, Gupta R, Barthe F, Nasri J, Pandav K, Patel D, Gorin MA, Menon M, Tewari AK. Side-specific, Microultrasound-based Nomogram for the Prediction of Extracapsular Extension in Prostate Cancer. EUR UROL SUPPL 2022; 48:72-81. [PMID: 36743400 PMCID: PMC9895764 DOI: 10.1016/j.euros.2022.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/29/2022] Open
Abstract
Background Prediction of extracapsular extension (ECE) is essential to achieve a balance between oncologic resection and neural tissue preservation. Microultrasound (MUS) is an attractive alternative to multiparametric magnetic resonance imaging (mpMRI) in the staging scenario. Objective To create a side-specific nomogram integrating clinicopathologic parameters and MUS findings to predict ipsilateral ECE and guide nerve sparing. Design setting and participants Prospective data were collected from consecutive patients who underwent robotic-assisted radical prostatectomy from June 2021 to May 2022 and had preoperative MUS and mpMRI. A total of 391 patients and 612 lobes were included in the analysis. Outcome measurements and statistical analysis ECE on surgical pathology was the primary outcome. Multivariate regression analyses were carried out to identify predictors for ECE. The resultant multivariable model's performance was visualized using the receiver-operating characteristic curve. A nomogram was developed based on the coefficients of the logit function for the MUS-based model. A decision curve analysis (DCA) was performed to assess clinical utility. Results and limitations The areas under the receiver-operating characteristic curve (AUCs) of the MUS-based model were 81.4% and 80.9% (95% confidence interval [CI] 75.6, 84.6) after internal validation. The AUC of the mpMRI-model was also 80.9% (95% CI 77.2, 85.7). The DCA demonstrated the net clinical benefit of the MUS-based nomogram and its superiority compared with MUS and MRI alone for detecting ECE. Limitations of our study included its sample size and moderate inter-reader agreement. Conclusions We developed a side-specific nomogram to predict ECE based on clinicopathologic variables and MUS findings. Its performance was comparable with that of a mpMRI-based model. External validation and prospective trials are required to corroborate our results. Patient summary The integration of clinical parameters and microultrasound can predict extracapsular extension with similar results to models based on magnetic resonance imaging findings. This can be useful for tailoring the preservation of nerves during surgery.
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Affiliation(s)
- Adriana M. Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.,Corresponding authors at: Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA. Tel. +1 2122416500
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Himanshu Joshi
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.,Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Raghav Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Flora Barthe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jordan Nasri
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Dhruti Patel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Michael A. Gorin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ashutosh K. Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.,Corresponding authors at: Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA. Tel. +1 2122416500
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Kachanov M, Vetterlein MW, Soave A, Karakiewicz PI, Liakos N, Jankowski T, Pose RM, Mandrek M, Fisch M, Witt JH, Graefen M, Leyh-Bannurah SR. Oncologic impact of concomitant prostate cancer characteristics at the time of radical cystoprostatectomy for bladder cancer: a population-based analysis. Aging Male 2022; 25:54-61. [PMID: 35179092 DOI: 10.1080/13685538.2022.2040982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the prognostic impact of concomitant prostate cancer (PCa) of the cancer-specific mortality (CSM) in the aging patient's papulation with bladder cancer (BCa) treated with radical cystoprostatectomy (RCP). MATERIALS AND METHODS Within the SEER database (2004-2015), 1468 patients were treated with RCP for BCa harboring histopathological PCa findings. To account for other cause mortality (OCM), multivariable competing risk regression (CRR) tested for potential BCa-CSM differences according to PCa characteristics risk factors predicting CSM. RESULTS CRR analysis revealed that only following BCa characteristics, as high pathological tumor stages(Ta/Tis/T1 [REF.] vs. T2; HR 2.03, 95% CI: 1.16-3.57, p = 0.014 vs. T3; HR 4.32, 95% CI: 2.45-7.61, p < 0.001 vs. T4; HR 5.06, 95% CI: 2.77-9.22, p < 0.001), as well unfavorable BCa grade IV (Grade I-II [REF.] vs. Grade IV; HR 0.58, 95% CI: 0.35-0.98, p < 0.041) achieved independent predictor status of CSM. With regard to PCa characteristics, none of the covariates yielded independent predictor status of CSM. CONCLUSIONS Our study, based on the largest population cohort, demonstrates that even in organ-confined BCa patients, concomitant PCa as second malignancy does not represent a risk factor for survival.
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Affiliation(s)
- Mykyta Kachanov
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Nikolaos Liakos
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Thomas Jankowski
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Randi M Pose
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mikolaj Mandrek
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jorn H Witt
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Markus Graefen
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sami-Ramzi Leyh-Bannurah
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
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A side-specific nomogram for extraprostatic extension may reduce the positive surgical margin rate in radical prostatectomy. World J Urol 2022; 40:2919-2924. [DOI: 10.1007/s00345-022-04191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022] Open
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Pinckaers H, Bulten W, van der Laak J, Litjens G. Detection of Prostate Cancer in Whole-Slide Images Through End-to-End Training With Image-Level Labels. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:1817-1826. [PMID: 33729928 DOI: 10.1109/tmi.2021.3066295] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Prostate cancer is the most prevalent cancer among men in Western countries, with 1.1 million new diagnoses every year. The gold standard for the diagnosis of prostate cancer is a pathologists' evaluation of prostate tissue. To potentially assist pathologists deep / learning / based cancer detection systems have been developed. Many of the state-of-the-art models are patch / based convolutional neural networks, as the use of entire scanned slides is hampered by memory limitations on accelerator cards. Patch-based systems typically require detailed, pixel-level annotations for effective training. However, such annotations are seldom readily available, in contrast to the clinical reports of pathologists, which contain slide-level labels. As such, developing algorithms which do not require manual pixel-wise annotations, but can learn using only the clinical report would be a significant advancement for the field. In this paper, we propose to use a streaming implementation of convolutional layers, to train a modern CNN (ResNet / 34) with 21 million parameters end-to-end on 4712 prostate biopsies. The method enables the use of entire biopsy images at high-resolution directly by reducing the GPU memory requirements by 2.4 TB. We show that modern CNNs, trained using our streaming approach, can extract meaningful features from high-resolution images without additional heuristics, reaching similar performance as state-of-the-art patch-based and multiple-instance learning methods. By circumventing the need for manual annotations, this approach can function as a blueprint for other tasks in histopathological diagnosis. The source code to reproduce the streaming models is available at https://github.com/DIAGNijmegen/ pathology-streaming-pipeline.
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ANO7: Insights into topology, function, and potential applications as a biomarker and immunotherapy target. Tissue Cell 2021; 72:101546. [PMID: 33940566 DOI: 10.1016/j.tice.2021.101546] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/21/2021] [Accepted: 04/11/2021] [Indexed: 01/01/2023]
Abstract
Anoctamin 7 (ANO7) is a member of the transmembrane protein TMEM16 family. It has a conservative topology similar to other members in this family, such as the typical eight-transmembrane domain, but it also has unique features. Although the ion channel role of ANO7 has been well accepted, evolutionary analyses and relevant studies suggest that ANO7 may be a multi-facet protein in function. Studies have shown that ANO7 may also function as a scramblase. ANO7 is highly expressed in prostate cancer as well as normal prostate tissues. A considerable amount of evidence has confirmed that ANO7 is associated with human physiology and pathology, particularly with the development of prostate cancer, which makes ANO7 a good candidate as a diagnostic and prognostic biomarker. In addition, ANO7 may be a potential target for prostate cancer immunotherapy. Antibody-based or T cell-mediated immunotherapies against prostate cancer by targeting ANO7 have been highly anticipated. ANO7 may also correlate with several other types of cancers or diseases, where further studies are warranted.
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Dai WB, Xu J, Yu B, Chen L, Chen Y, Zhan J. Correlation of Stiffness of Prostate Cancer Measured by Shear Wave Elastography with Grade Group: A Preliminary Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:288-295. [PMID: 33234327 DOI: 10.1016/j.ultrasmedbio.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/15/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
The aim of study was to explore the correlation between shear wave elastography (SWE) and grade group (GG) of prostate cancer (PCa). This retrospective study involved prostate-specific antigen elevated patients with elevated prostate-specific antigen levels who underwent SWE before transrectal ultrasound-guided needle biopsy. A total of 49 PCa lesions were reviewed after radical prostatectomy; 3-7 regions of interest were placed within the cancerous area on axial view compared with the tumor foci outlined on the slides by pathologist. The maximum SWE value was measured, quantitative SWE parameters (Emax, Emean, Emin and standard deviation [SD]) were recorded and correlated with GG and then parameters were compared between indolent (≤2) and aggressive (≥3) GGs. The diagnostic value of each parameter was compared with the receiver operating characteristic curve. Forty-nine PCa foci were divided into two groups on the basis of their GGs. All SWE parameters exhibited a significant linear trend with GG. The area under the receiver operating characteristic curve (AUC) was 0.816 for Emax; with a cutoff point of 84 kPa, sensitivity and specificity were 81.3% and 82.4% to differentiate low and high GGs in PCa. The AUC was 0.776 for Emean; with a cutoff point of 71 kPa, sensitivity and specificity were 78.1% and 76.5%. For Emin, the AUC was 0.739; with a cutoff point of 60 kPa, sensitivity and specificity were 68.8% and 70.6%. For SD, the AUC was 0.681; with a cutoff point of 8.3 kPa, sensitivity and specificity were 46.9% and 94.1%. There were no significant differences between the four SWE parameters (p < 0.05 for all). SWE features were correlated with GGs, and this correlation may have excellent diagnostic performance in predicting high GG in PCa.
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Affiliation(s)
- Wen-Bin Dai
- Department of Urology Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Jun Xu
- Department of Urology Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Bo Yu
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.
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Cohesive cancer invasion of the biophysical barrier of smooth muscle. Cancer Metastasis Rev 2021; 40:205-219. [PMID: 33398621 DOI: 10.1007/s10555-020-09950-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/15/2020] [Indexed: 01/22/2023]
Abstract
Smooth muscle is found around organs in the digestive, respiratory, and reproductive tracts. Cancers arising in the bladder, prostate, stomach, colon, and other sites progress from low-risk disease to high-risk, lethal metastatic disease characterized by tumor invasion into, within, and through the biophysical barrier of smooth muscle. We consider here the unique biophysical properties of smooth muscle and how cohesive clusters of tumor use mechanosensing cell-cell and cell-ECM (extracellular matrix) adhesion receptors to move through a structured muscle and withstand the biophysical forces to reach distant sites. Understanding integrated mechanosensing features within tumor cluster and smooth muscle and potential triggers within adjacent adipose tissue, such as the unique damage-associated molecular pattern protein (DAMP), eNAMPT (extracellular nicotinamide phosphoribosyltransferase), or visfatin, offers an opportunity to prevent the first steps of invasion and metastasis through the structured muscle.
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Soeterik TFW, van Melick HHE, Dijksman LM, Biesma DH, Witjes JA, van Basten JPA. Multiparametric Magnetic Resonance Imaging Should Be Preferred Over Digital Rectal Examination for Prostate Cancer Local Staging and Disease Risk Classification. Urology 2020; 147:205-212. [PMID: 33129868 DOI: 10.1016/j.urology.2020.08.089] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the impact of multiparametric magnetic resonance imaging (mp-MRI) local tumor staging on prostate cancer risk stratification and choice of treatment. MATERIALS AND METHODS Prostate cancer patients, newly diagnosed from 2017 to 2018 at 7 Dutch teaching hospitals were included. Risk group classification was done twice, using either digital rectal examination (DRE) or mp-MRI information. Risk group migration and rates of treatment intensification associated with mp-MRI upstaging were established. Diagnostic accuracy measures for the detection of nonorgan-confined disease (stage ≥T3a), for both DRE and mp-MRI, were assessed in patients undergoing robot-assisted radical prostatectomy. RESULTS A total of 1683 patients were included. Upstaging due to mp-MRI staging occurred in 493 of 1683 (29%) patients and downstaging in 43 of 1683 (3%) patients. Upstaging was associated with significant higher odds for treatment intensification (odds ratio [OR]: 3.5 95% confidence interval [CI] 1.9-6.5). Stage ≥T3a on mp-MRI was the most common reason for risk group upstaging (77%). Sensitivity for the detection of stage ≥T3a was higher for mp-MRI compared to DRE (51% vs 12%, P <.001), whereas specificity was lower (82% vs 97%, P <.001). Mp-MRI resulted in a significantly higher cumulative rate of true positive and true negative stage ≥T3a predictions compared with DRE (67% vs 58%, P <.001). CONCLUSION Use of mp-MRI tumor stage for prostate cancer risk classification leads to upstaging in 1 of 3 patients. Mp-MRI enables superior detection of nonorgan-confined disease compared with DRE, and should be the preferred tool for determining clinical tumor stage.
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Affiliation(s)
- Timo F W Soeterik
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | | | - Lea M Dijksman
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Douwe H Biesma
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Soeterik TFW, van Melick HHE, Dijksman LM, Küsters-Vandevelde H, Stomps S, Schoots IG, Biesma DH, Witjes JA, van Basten JPA. Development and External Validation of a Novel Nomogram to Predict Side-specific Extraprostatic Extension in Patients with Prostate Cancer Undergoing Radical Prostatectomy. Eur Urol Oncol 2020; 5:328-337. [PMID: 32972895 DOI: 10.1016/j.euo.2020.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prediction of side-specific extraprostatic extension (EPE) is crucial in selecting patients for nerve-sparing radical prostatectomy (RP). OBJECTIVE To develop and externally validate nomograms including multiparametric magnetic resonance imaging (mpMRI) information to predict side-specific EPE. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of 1870 consecutive prostate cancer patients who underwent robot-assisted RP from 2014 to 2018 at three institutions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Four multivariable logistic regression models were established, including combinations of patient-based and side-specific variables: prostate-specific antigen (PSA) density, highest ipsilateral International Society of Urological Pathology (ISUP) biopsy grade, ipsilateral percentage of positive cores on systematic biopsy, and side-specific clinical stage assessed by both digital rectal examination and mpMRI. Discrimination (area under the curve [AUC]), calibration, and net benefit of these models were assessed in the development cohort and two external validation cohorts. RESULTS AND LIMITATIONS On external validation, AUCs of the four models ranged from 0.80 (95% confidence interval [CI] 0.68-0.88) to 0.83 (95% CI 0.72-0.90) in cohort 1 and from 0.77 (95% CI 0.62-0.87) to 0.78 (95% CI 0.64-0.88) in cohort 2. The three models including mpMRI staging information resulted in relatively higher AUCs compared with the model without mpMRI information. No major differences between the four models regarding net benefit were established. The model based on PSA density, ISUP grade, and mpMRI T stage was superior in terms of calibration. Using this model with a cut-off of 20%, 1980/2908 (68%) prostatic lobes without EPE would be found eligible for nerve sparing, whereas non-nerve sparing would be advised in 642/832 (77%) lobes with EPE. CONCLUSIONS Our analysis resulted in a simple and robust nomogram for the prediction of side-specific EPE, which should be used to select patients for nerve-sparing RP. PATIENT SUMMARY We developed a prediction model that can be used to assess accurately the likelihood of tumour extension outside the prostate. This tool can guide patient selection for safe nerve-sparing surgery.
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Affiliation(s)
- Timo F W Soeterik
- Department of Value-Based Healthcare, Santeon Group, Utrecht, The Netherlands; Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, Netherlands.
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, Netherlands
| | - Lea M Dijksman
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | | | - Saskia Stomps
- Department of Urology, Hospital Group Twente, Hengelo/Almelo, The Netherlands
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Douwe H Biesma
- Department of Value-Based Healthcare, Santeon Group, Utrecht, The Netherlands
| | - J A Witjes
- Department of Urology, Radboud University Medical centre, Nijmegen, The Netherlands
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Soeterik TFW, van Melick HHE, Dijksman LM, Küsters-Vandevelde HVN, Biesma DH, Witjes JA, van Basten JPA. External validation of the Martini nomogram for prediction of side-specific extraprostatic extension of prostate cancer in patients undergoing robot-assisted radical prostatectomy. Urol Oncol 2020; 38:372-378. [PMID: 32088104 DOI: 10.1016/j.urolonc.2019.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/24/2019] [Accepted: 12/08/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To establish oncological safe nerve-sparing robot-assisted radical prostatectomy, accurate assessment of extraprostatic extension (EPE) is critical. A recently developed nomogram including magnetic resonance imaging parameters accurately predicted side-specific EPE in the development cohort. The aim of this study is to assess this model's performance in an external patient population. PATIENTS AND METHODS Model fit was assessed in a cohort of 550 patients who underwent robot-assisted radical prostatectomy in 2014 to 2017 for prostate cancer. Model calibration was evaluated using calibration slopes. Discriminative ability was quantified using the area under the receiver operating characteristic curve. Model updating was done by adjusting the linear predictor to minimize differences in expected and observed risk for EPE. RESULTS A total of 792 prostate lobes were included for model validation. Discriminative ability expressed in terms of receiver operating characteristic curve was 0.78, 95%CI 0.75-0.82. Graphical evaluation of the calibration showed poor fit with a high disagreement between predicted probabilities and observed probabilities of EPE in the population. Model updating resulted in excellent agreement between mean predicted and observed probabilities. However, calibration plots showed substantial miscalibration; including both under- and overestimation. CONCLUSION External validation of the novel nomogram for the prediction of side specific EPE developed by Martini and co-workers showed good discriminative ability but poor calibration. After updating, substantial miscalibration was still present. Use of this nomogram for individualized risk predictions is therefore not recommended.
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Affiliation(s)
- Timo F W Soeterik
- Department of Value-Based Healthcare, Santeon-group, Utrecht, The Netherlands; Department of Urology, St. Antonius Hospital, Santeon-group, Nieuwegein, The Netherlands.
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Santeon-group, Nieuwegein, The Netherlands
| | - Lea M Dijksman
- Department of Value-Based Healthcare, St. Antonius Hospital, Santeon-group, Nieuwegein/Utrecht, The Netherlands
| | | | - Douwe H Biesma
- Department of Value-Based Healthcare, St. Antonius Hospital, Santeon-group, Nieuwegein/Utrecht, The Netherlands
| | - J A Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jean-Paul A van Basten
- Department of Urology, Canisius Wilhelmina Hospital, Santeon-group, Nijmegen, The Netherlands
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Pathological Association Between Radical Prostatectomy and Needle Biopsy Specimen in Prostate Cancer Patients. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.91609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Murugan P, Shukla D, Morocho J, Smith D, Sciacca D, Pickard M, Wahlsten M, Gunderson A, Konety B, Khalifa MA, Warlick C. Prostate Biopsy Processing. Am J Clin Pathol 2019; 152:757-765. [PMID: 31433833 DOI: 10.1093/ajcp/aqz101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Current protocols for processing multiple prostate biopsy cores per case are uneconomical and cumbersome. Tissue fragmentation and loss compromise cancer diagnosis. We sought to study an alternate method to improve processing and diagnosis of prostate cancer. METHODS Two sets of sextant biopsy specimens from near-identical locations were obtained ex vivo from 48 prostate specimens. One set was processed in the standard fashion while the other was processed using the BxChip, a proprietary biomimetic matrix that accommodates six cores on a single chip. Parameters including grossing, embedding, sectioning and reading time, length of tissue, and degree of fragmentation were compared. RESULTS A significant reduction (more than threefold) in preanalytical and analytical time was observed using the multiplex method. Nonlinear fragmentation was absent, in contrast to standard processing. CONCLUSIONS The BxChip reduced tissue fragmentation and increased efficiency of prostate biopsy diagnosis. It also resulted in overall cost savings and significantly increased tissue length.
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Affiliation(s)
- Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Dip Shukla
- University of Minnesota Medical School, Minneapolis
| | | | - Deanne Smith
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Drew Sciacca
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Meghan Pickard
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | | | | | | | - Mahmoud A Khalifa
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
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[Prostate pathology recommendations from the Uropathology working group of the Spanish Society of Pathology]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 52:167-177. [PMID: 31213258 DOI: 10.1016/j.patol.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/24/2022]
Abstract
These guidelines from the uropathology working group of the Spanish Society of Pathology (SEAP) are based on the European and ISUP 2015 recommendations and those of the College of American Pathologists, as well as the latest WHO 2016, TNM (AJCC) 2017 classifications. They include recommendations for specimen sampling, macro- and microscopic examination and immunohistochemistry. Gleason patterns are specified: Gleason pattern 3 includes hyperplastic, atrophic and microcystic glands, while pattern 4 includes all cribriform or glomeruloid glands. The Gleason score in prostatectomy specimens may change; if a tertiary pattern occurs in more than 5% of the tumour, it becomes a secondary pattern. In both biopsies and prostatectomy specimens, if the Gleason score is 7, the percentage of pattern 4 should be stated. Gleason scoring in tumor variants and special situations should also be specified. These recommendations should be adapted according to the resources available.
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20
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Kalantari E, Abolhasani M, Roudi R, Farajollahi MM, Farhad S, Madjd Z, Askarian-Amiri S, Mohsenzadegan M. Co-expression of TLR-9 and MMP-13 is associated with the degree of tumour differentiation in prostate cancer. Int J Exp Pathol 2019; 100:123-132. [PMID: 31090157 DOI: 10.1111/iep.12314] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/19/2019] [Accepted: 03/10/2019] [Indexed: 01/07/2023] Open
Abstract
In vitro experiments demonstrated that stimulation of Toll-like receptor 9 (TLR-9) by synthetic TLR-9 ligands induces the invasion of TLR-9-expressing prostate cancer cells through matrix metalloproteinase 13 (MMP-13). However, the clinical value of TLR-9 and MMP-13 co-expression in the pathophysiology of the prostate is unknown. In the study, we evaluated the expression levels and clinical significance of the TLR-9 and MMP-13 in a series of prostate tissues. One hundred and eighty prostate tissues including prostate cancer (PCa) (n = 137), high-grade prostatic intraepithelial neoplasia (HPIN) (n = 18) and benign prostatic hyperplasia (BPH) (n = 25) were immunostained for the TLR-9 and MMP-13 markers. Subsequently, the correlation between the TLR-9 and MMP-13 staining scores and clinicopathological parameters was obtained. Higher expressions of TLR-9 and MMP-13 were found in PCa and high-grade prostatic intraepithelial neoplasia compared to benign prostatic hyperplasia tissues. Among PCa samples, a positive relationship was revealed between the MMP-13 expression and Gleason score (P < 0.001). There was a significant correlation between TLR-9 expression and regional lymph node involvement (P = 0.04). The expression patterns of TLR-9 and MMP-13 markers demonstrated a reciprocal significant correlation between the two markers in the same series of prostate samples (P < 0.001). Furthermore, the Gleason score of TLR-9high /MMP-13high and TLR-9low /MMP-13low phenotypes showed a significant difference (P = 0.002). Higher expressions of TLR-9 and MMP-13 can confer aggressive behaviour to PCa. Therefore, these markers may be used as a valuable target for tailored therapy of PCa.
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Affiliation(s)
- Elham Kalantari
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Department of Pathology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Department of Pathology, Hasheminejad Urology-Nephrology Center, Iran University of Medical Sciences, Tehran, Iran
| | - Raheleh Roudi
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad M Farajollahi
- Department of Medical Biotechnology, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seif Farhad
- Department of Immunology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Madjd
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Pathology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Askarian-Amiri
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Monireh Mohsenzadegan
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
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Li W, Li J, Sarma KV, Ho KC, Shen S, Knudsen BS, Gertych A, Arnold CW. Path R-CNN for Prostate Cancer Diagnosis and Gleason Grading of Histological Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:945-954. [PMID: 30334752 PMCID: PMC6497079 DOI: 10.1109/tmi.2018.2875868] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Prostate cancer is the most common and second most deadly form of cancer in men in the United States. The classification of prostate cancers based on Gleason grading using histological images is important in risk assessment and treatment planning for patients. Here, we demonstrate a new region-based convolutional neural network framework for multi-task prediction using an epithelial network head and a grading network head. Compared with a single-task model, our multi-task model can provide complementary contextual information, which contributes to better performance. Our model is achieved a state-of-the-art performance in epithelial cells detection and Gleason grading tasks simultaneously. Using fivefold cross-validation, our model is achieved an epithelial cells detection accuracy of 99.07% with an average area under the curve of 0.998. As for Gleason grading, our model is obtained a mean intersection over union of 79.56% and an overall pixel accuracy of 89.40%.
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Kayano PP, Carneiro A, Castilho TML, Sivaraman A, Claros OR, Baroni RH, Garcia RG, Mariotti GC, Smaletz O, Filippi RZ, Lemos GC. Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer. Int Braz J Urol 2019; 44:1106-1113. [PMID: 30325600 PMCID: PMC6442175 DOI: 10.1590/s1677-5538.ibju.2017.0552] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 08/05/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) improves the detection of clinically significant prostate cancer (PCa). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa. MATERIALS AND METHODS A retrospective analysis of data that were collected prospectively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B). US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed. RESULTS In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043). The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. -0.01 [-1.42 to 1.39]). In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 - 6.28]; p=0.024). CONCLUSIONS US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, suggesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.
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Affiliation(s)
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Arjun Sivaraman
- Memorial Sloan Kettering Cancer Center - USA, New York, NY, EUA
| | | | | | | | | | - Oren Smaletz
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Bulten W, Bándi P, Hoven J, Loo RVD, Lotz J, Weiss N, Laak JVD, Ginneken BV, Hulsbergen-van de Kaa C, Litjens G. Epithelium segmentation using deep learning in H&E-stained prostate specimens with immunohistochemistry as reference standard. Sci Rep 2019; 9:864. [PMID: 30696866 PMCID: PMC6351532 DOI: 10.1038/s41598-018-37257-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/03/2018] [Indexed: 12/24/2022] Open
Abstract
Given the importance of gland morphology in grading prostate cancer (PCa), automatically differentiating between epithelium and other tissues is an important prerequisite for the development of automated methods for detecting PCa. We propose a new deep learning method to segment epithelial tissue in digitised hematoxylin and eosin (H&E) stained prostatectomy slides using immunohistochemistry (IHC) as reference standard. We used IHC to create a precise and objective ground truth compared to manual outlining on H&E slides, especially in areas with high-grade PCa. 102 tissue sections were stained with H&E and subsequently restained with P63 and CK8/18 IHC markers to highlight epithelial structures. Afterwards each pair was co-registered. First, we trained a U-Net to segment epithelial structures in IHC using a subset of the IHC slides that were preprocessed with color deconvolution. Second, this network was applied to the remaining slides to create the reference standard used to train a second U-Net on H&E. Our system accurately segmented both intact glands and individual tumour epithelial cells. The generalisation capacity of our system is shown using an independent external dataset from a different centre. We envision this segmentation as the first part of a fully automated prostate cancer grading pipeline.
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Affiliation(s)
- Wouter Bulten
- Radboud University Medical Center, Diagnostic Image Analysis Group and the Department of Pathology, 6500HB, Nijmegen, The Netherlands.
| | - Péter Bándi
- Radboud University Medical Center, Diagnostic Image Analysis Group and the Department of Pathology, 6500HB, Nijmegen, The Netherlands
| | - Jeffrey Hoven
- Radboud University Medical Center, Department of Pathology, 6500HB, Nijmegen, The Netherlands
| | - Rob van de Loo
- Radboud University Medical Center, Department of Pathology, 6500HB, Nijmegen, The Netherlands
| | | | - Nick Weiss
- Fraunhofer MEVIS, 23562, Lübeck, Germany
| | - Jeroen van der Laak
- Radboud University Medical Center, Diagnostic Image Analysis Group and the Department of Pathology, 6500HB, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Radboud University Medical Center, Diagnostic Image Analysis Group and the Department of Radiology and Nuclear Medicine, 6500HB, Nijmegen, The Netherlands
| | | | - Geert Litjens
- Radboud University Medical Center, Diagnostic Image Analysis Group and the Department of Pathology, 6500HB, Nijmegen, The Netherlands
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24
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Athanazio DA, Souza VC. Current topics on prostate and bladder pathology. SURGICAL AND EXPERIMENTAL PATHOLOGY 2018. [DOI: 10.1186/s42047-018-0015-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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25
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Mohsenzadegan M, Saebi F, Yazdani M, Abolhasani M, Saemi N, Jahanbani F, Farajollahi MM. Autoantibody against new gene expressed in prostate protein is traceable in prostate cancer patients. Biomark Med 2018; 12:1125-1138. [DOI: 10.2217/bmm-2018-0069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: We assessed an autoantibody against new gene expressed in prostate (NGEP) protein for prostate cancer (PCa) that may better diagnosis and prognosis approaches in the patients with PCa. Methods: Autoantibodies against NGEP were measured in sera of PCa patients by ELISA. Results: The autoantibody against NGEP is present in a significantly higher proportion in the sera of PCa patients as compared with healthy controls (p < 0.001). An inverse significant correlation was found between seropositive patients and Gleason score (p < 0.05) and serum prostate-specific antigen (recombinant NGEP; p < 0.05). Conclusion: The data showed that measurement of autoantibody against NGEP as a novel prostate-specific antigen in sera can be used as a potential biomarker to discriminate well-differentiated PCa patients from normal subjects.
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Affiliation(s)
- Monireh Mohsenzadegan
- Cellular & Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Saebi
- Cellular & Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yazdani
- Hasheminejad Kidney Center Laboratory, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Hasheminejad Kidney Center Laboratory, Iran University of Medical Sciences, Tehran, Iran
- Oncopathology Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nazanin Saemi
- Department of Medical Biotechnology, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jahanbani
- Department of Genetic, Standford University School of Medicine, CA, USA
| | - Mohammad M Farajollahi
- Cellular & Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Medical Biotechnology, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
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26
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Development and External Validation of Nomograms To Predict Adverse Pathological Characteristics After Robotic Prostatectomy: Results of a Prospective, Multi-institutional, Nationwide series. Eur Urol Oncol 2018; 1:338-345. [DOI: 10.1016/j.euo.2018.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/23/2018] [Accepted: 04/11/2018] [Indexed: 01/10/2023]
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27
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Junker D, Steinkohl F, Fritz V, Bektic J, Tokas T, Aigner F, Herrmann TRW, Rieger M, Nagele U. Comparison of multiparametric and biparametric MRI of the prostate: are gadolinium-based contrast agents needed for routine examinations? World J Urol 2018; 37:691-699. [PMID: 30078170 DOI: 10.1007/s00345-018-2428-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/31/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To investigate, if and how omitting gadolinium-based contrast agents (GBCA) and dynamic contrast-enhanced imaging (DCE) influences diagnostic accuracy and tumor detection rates of prostate MRI. METHODS In this retrospective study, 236 patients were included. The results of biparametric (bpMRI) and multiparametric magnetic resonance imaging (mpMRI) were compared using the PI-RADS version 2 scoring system. The distribution of lesions to PIRADS score levels, tumor detection rates, diagnostic accuracy and RoC analysis were calculated and compared to the results of histopathological analysis or 5-year follow-up for benign findings. RESULTS Omitting DCE changed PI-RADS scores in 9.75% of patients, increasing the number of PI-RADS 3 scores by 8.89% when compared to mpMRI. No change of more than one score level was observed. BpMRI did not show significant differences in diagnostic accuracy or tumor detection rates. (AuC of 0.914 vs 0.917 in ROC analysis). Of 135 prostate carcinomas (PCa), 94.07% were scored identically, and 5.93% were downgraded only from PI-RADS 4 to PI-RADS 3 by bpMRI. All of them were low-grade PCa with Gleason Score 6 or 7a. No changes were observed for PCa ≥ 7b. CONCLUSION Omitting DCE did not lead to significant differences in diagnostic accuracy or tumor detection rates when using the PI-RADS 2 scoring system. According to these data, it seems reasonable to use a biparametric approach for initial routine prostate MRI. This could decrease examination time and reduce costs without significantly lowering the diagnostic accuracy.
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Affiliation(s)
- Daniel Junker
- Department of Radiology, Community Hospital Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria. .,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Fabian Steinkohl
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Veronika Fritz
- Department of Urology, Community Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.,Department of Urology, Community Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.,Department of Urology, Klinik für Urologie, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Michael Rieger
- Department of Radiology, Community Hospital Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Udo Nagele
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.,Department of Urology, Community Hospital Hall in Tirol, Hall in Tirol, Austria
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28
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Sauter G, Clauditz T, Steurer S, Wittmer C, Büscheck F, Krech T, Lutz F, Lennartz M, Harms L, Lawrenz L, Möller-Koop C, Simon R, Jacobsen F, Wilczak W, Minner S, Tsourlakis MC, Chirico V, Weidemann S, Haese A, Steuber T, Salomon G, Matiu M, Vettorazzi E, Michl U, Budäus L, Tilki D, Thederan I, Pehrke D, Beyer B, Fraune C, Göbel C, Heinrich M, Juhnke M, Möller K, Bawahab AAA, Uhlig R, Huland H, Heinzer H, Graefen M, Schlomm T. Integrating Tertiary Gleason 5 Patterns into Quantitative Gleason Grading in Prostate Biopsies and Prostatectomy Specimens. Eur Urol 2018; 73:674-683. [DOI: 10.1016/j.eururo.2017.01.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/05/2017] [Indexed: 11/27/2022]
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29
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Gansler T, Fedewa SA, Lin CC, Amin MB, Jemal A, Ward EM. Trends in Diagnosis of Gleason Score 2 Through 4 Prostate Cancer in the National Cancer Database, 1990–2013. Arch Pathol Lab Med 2017; 141:1686-1696. [DOI: 10.5858/arpa.2016-0611-oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
The incidence of prostate cancer with Gleason scores 2 through 4 has been decreasing for decades, largely because of evolving criteria for Gleason scores, including the 2005 International Society of Urological Pathology recommendation that scores of 2 through 4 should rarely, if ever, be diagnosed based on needle biopsy. Whether trends in assigning Gleason scores 2 through 4 vary by facility type and patient characteristics is unknown.
Objective.—
To assess trends in prostate cancer grading among various categories of treatment facilities.
Design.—
Analyses of National Cancer Database records from 1990 through 2013 for 434 612 prostate cancers diagnosed by core needle biopsy, including multivariable regression for 106 331 patients with clinical T1c disease diagnosed from 2004 through 2013.
Results.—
The proportion of prostate core needle biopsies with Gleason scores 2 through 4 declined from 11 476 of 53 850 (21.3%) (1990–1994) to 96 of 43 566 (0.2%) (2010–2013). The proportions of American Joint Committee on Cancer category T1c needle biopsies assigned Gleason scores 2 through 4 were 416 of 12 796 (3.3%) and 9 of 7194 (0.1%) during 2004 and 2013, respectively. Declines occurred earliest at National Cancer Institute–designated programs and latest at community programs. A multivariable logistic model adjusting for patient demographic and clinical variables and restricted to T1c cancers diagnosed in needle biopsies from 2004 through 2013 showed that facility type is independently associated with the likelihood of cancers in such specimens being assigned Gleason scores of 2 through 4, with community centers having a statistically significant odds ratio of 5.99 relative to National Cancer Institute–designated centers.
Conclusions.—
These results strongly suggest differences in Gleason grading by pathologists practicing in different facility categories and variations in their promptness of adopting International Society of Urological Pathology recommendations.
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30
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Scialpi M, D'Andrea A, Martorana E, Malaspina CM, Aisa MC, Napoletano M, Orlandi E, Rondoni V, Scialpi P, Pacchiarini D, Palladino D, Dragone M, Di Renzo G, Simeone A, Bianchi G, Brunese L. Biparametric MRI of the prostate. Turk J Urol 2017; 43:401-409. [PMID: 29201499 DOI: 10.5152/tud.2017.06978] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/27/2017] [Indexed: 12/13/2022]
Abstract
Biparametric Magnetic Resonance Imaging (bpMRI) of the prostate combining both morphologic T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) is emerging as an alternative to multiparametric MRI (mpMRI) to detect, to localize and to guide prostatic targeted biopsy in patients with suspicious prostate cancer (PCa). BpMRI overcomes some limitations of mpMRI such as the costs, the time required to perform the study, the use of gadolinium-based contrast agents and the lack of a guidance for management of score 3 lesions equivocal for significant PCa. In our experience the optimal and similar clinical results of the bpMRI in comparison to mpMRI are essentially related to the DWI that we consider the dominant sequence for detection suspicious PCa both in transition and in peripheral zone. In clinical practice, the adoption of bpMRI standardized scoring system, indicating the likelihood to diagnose a clinically significant PCa and establishing the management of each suspicious category (from 1 to 4), could represent the rationale to simplify and to improve the current interpretation of mpMRI based on Prostate Imaging and Reporting Archiving Data System version 2 (PI-RADS v2). In this review article we report and describe the current knowledge about bpMRI in the detection of suspicious PCa and a simplified PI-RADS based on bpMRI for management of each suspicious PCa categories to facilitate the communication between radiologists and urologists.
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Affiliation(s)
- Michele Scialpi
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, Santa Maria della Misericordia Hospital, Perugia University, Sant' Andrea delle Fratte, Perugia, Italy
| | - Alfredo D'Andrea
- Department of Experimental Medicine, Magrassi Lanzara, Luigi Vanvitelli, Second University of Naples, Naples, Italy
| | | | - Corrado Maria Malaspina
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, Santa Maria della Misericordia Hospital, Perugia University, Sant' Andrea delle Fratte, Perugia, Italy
| | - Maria Cristina Aisa
- Department of Surgical and Biomedical Sciences, Division of Gynaecology, Santa Maria della Misericordia Hospital, Perugia University, Sant' Andrea delle Fratte, Perugia, Italy
| | - Maria Napoletano
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, Santa Maria della Misericordia Hospital, Perugia University, Sant' Andrea delle Fratte, Perugia, Italy
| | - Emanuele Orlandi
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, Santa Maria della Misericordia Hospital, Perugia University, Sant' Andrea delle Fratte, Perugia, Italy
| | - Valeria Rondoni
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, Santa Maria della Misericordia Hospital, Perugia University, Sant' Andrea delle Fratte, Perugia, Italy
| | - Pietro Scialpi
- Division of Urology, Portogruaro Hospital, Venice, Italy
| | - Diamante Pacchiarini
- Health Management, S. Maria della Misericordia Hospital, Sant' Andrea delle Fratte, Perugia, Italy
| | - Diego Palladino
- Department of Radiology, Casa Sollievo della Sofferenza Hospital, Foggia, Italy
| | - Michele Dragone
- Department of Radiology, Casa Sollievo della Sofferenza Hospital, Foggia, Italy
| | - Giancarlo Di Renzo
- Department of Surgical and Biomedical Sciences, Division of Gynaecology, Santa Maria della Misericordia Hospital, Perugia University, Sant' Andrea delle Fratte, Perugia, Italy.,3DIFIC, Medical Area, University of Perugia, Perugia, Italy
| | - Annalisa Simeone
- Department of Radiology, Casa Sollievo della Sofferenza Hospital, Foggia, Italy
| | | | - Luca Brunese
- Department of Radiology, Campobasso University, C.da Tappino, Campobasso, Italy
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31
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Liu H, Zhou H, Yan L, Ye T, Lu H, Sun X, Ye Z, Xu H. Prognostic significance of six clinicopathological features for biochemical recurrence after radical prostatectomy: a systematic review and meta-analysis. Oncotarget 2017; 9:32238-32249. [PMID: 30181813 PMCID: PMC6114957 DOI: 10.18632/oncotarget.22459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 10/11/2017] [Indexed: 11/25/2022] Open
Abstract
Identifying patients with high risk of biochemical recurrence after radical prostatectomy is of immense value in clinical practice. Assessment of prognostic significance of specific clinicopathological features plays an important role in surgical management after prostatectomy. The purpose of our meta-analysis was to investigate the association between the six pathological characteristics and the prognosis of prostate cancer. We carried out a systematic document retrieval in electronic databases to sort out appropriate studies. Outcomes of interest were gathered from studies comparing biochemical recurrence-free survival (BCFS) in patients with the six pathological traits. Studies results were pooled, and hazard ratios (HRs) combined with corresponding 95% confidence intervals (CIs) for survival were used to estimate the effect size. 29 studies (21,683 patients) were enrolled in our meta-analysis. All the six predictors were statistically significant for BCFS with regard to seminal vesicle invasion (HR = 1.97, 95% CI = 1.79–2.18, p < 0.00001), positive surgical margin (HR = 1.79, 95% CI = 1.56–2.06, p < 0.00001), extracapsular extension (HR = 2.03, 95% CI = 1.65–2.50, p < 0.0001), lymphovascular invasion (HR = 1.85, 95% CI = 1.54–2.22, p < 0.00001), lymph node involvement (HR = 1.88, 95% CI = 1.37–2.60, p = 0.0001) and perineural invasion (HR = 1.59, 95% CI = 1.33–1.91, p < 0.00001). Subgroup analysis showed that all the six predictors had significantly relationship with poor BCFS. The pooled results demonstrated that the six clinical findings indicated a worse prognosis in patients with prostate cancer. In conclusion, our results show several clinicopathological characteristics can predict the risk of biochemical recurrence after radical prostatectomy. Prospective studies are needed to further confirm the predictive value of these features for the prognosis of prostate cancer patients after radical prostatectomy.
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Affiliation(s)
- Haoran Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hui Zhou
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Libin Yan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tao Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hongyan Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xifeng Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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32
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Kuhl CK, Bruhn R, Krämer N, Nebelung S, Heidenreich A, Schrading S. Abbreviated Biparametric Prostate MR Imaging in Men with Elevated Prostate-specific Antigen. Radiology 2017; 285:493-505. [DOI: 10.1148/radiol.2017170129] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Christiane K. Kuhl
- From the Department of Diagnostic and Interventional Radiology (C.K.K., R.B., N.K., S.N., S.S.) and Department of Urology (A.H.), University of Aachen, RWTH, Pauwelsstr. 30, Aachen 52074, Germany; and Department of Urology, Uro-oncology, Robot-assisted and Special Urological Surgery, University of Cologne, Cologne, Germany (A.H.)
| | - Robin Bruhn
- From the Department of Diagnostic and Interventional Radiology (C.K.K., R.B., N.K., S.N., S.S.) and Department of Urology (A.H.), University of Aachen, RWTH, Pauwelsstr. 30, Aachen 52074, Germany; and Department of Urology, Uro-oncology, Robot-assisted and Special Urological Surgery, University of Cologne, Cologne, Germany (A.H.)
| | - Nils Krämer
- From the Department of Diagnostic and Interventional Radiology (C.K.K., R.B., N.K., S.N., S.S.) and Department of Urology (A.H.), University of Aachen, RWTH, Pauwelsstr. 30, Aachen 52074, Germany; and Department of Urology, Uro-oncology, Robot-assisted and Special Urological Surgery, University of Cologne, Cologne, Germany (A.H.)
| | - Sven Nebelung
- From the Department of Diagnostic and Interventional Radiology (C.K.K., R.B., N.K., S.N., S.S.) and Department of Urology (A.H.), University of Aachen, RWTH, Pauwelsstr. 30, Aachen 52074, Germany; and Department of Urology, Uro-oncology, Robot-assisted and Special Urological Surgery, University of Cologne, Cologne, Germany (A.H.)
| | - Axel Heidenreich
- From the Department of Diagnostic and Interventional Radiology (C.K.K., R.B., N.K., S.N., S.S.) and Department of Urology (A.H.), University of Aachen, RWTH, Pauwelsstr. 30, Aachen 52074, Germany; and Department of Urology, Uro-oncology, Robot-assisted and Special Urological Surgery, University of Cologne, Cologne, Germany (A.H.)
| | - Simone Schrading
- From the Department of Diagnostic and Interventional Radiology (C.K.K., R.B., N.K., S.N., S.S.) and Department of Urology (A.H.), University of Aachen, RWTH, Pauwelsstr. 30, Aachen 52074, Germany; and Department of Urology, Uro-oncology, Robot-assisted and Special Urological Surgery, University of Cologne, Cologne, Germany (A.H.)
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33
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McGinley KF, Sun X, Howard LE, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, Freedland SJ. Characterization of a "low-risk" cohort of grade group 2 prostate cancer patients: Results from the Shared Equal Access Regional Cancer Hospital database. Int J Urol 2017; 24:611-617. [PMID: 28589550 DOI: 10.1111/iju.13387] [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: 12/01/2016] [Accepted: 05/01/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine if there is a subset of men with grade group 2 prostate cancer who could be potential candidates for active surveillance. METHODS We used the Shared Equal Access Regional Cancer Hospital database to identify 776 men undergoing radical prostatectomy from 2006 to 2015 with >8 biopsy cores obtained and complete information. We compared men who fulfilled low-risk disease criteria (clinical stage T1c/T2a; grade group 1; prostate-specific antigen ≤10 ng/mL) with the exception of grade group 2 versus men who met all three low-risk criteria. Logistic regression was used to test the association between grade group and radical prostatectomy pathological features. Biochemical recurrence was examined using Cox models. To examine whether there was a subset of men with low-volume grade group 2 with comparable outcomes to low-risk men, we repeated all analyses limiting the percentage of positive cores in the grade group 2 group to ≤33%, and positive cores to ≤4, ≤3 or ≤2. RESULTS Grade group 2 low-risk men had increased risk of pathological grade group 3 or higher (P < 0.001), extraprostatic extension (P < 0.001), seminal vesicle invasion (P < 0.001) and higher risk of biochemical recurrence (hazard ratio = 1.76, P = 0.006). Using increasingly strict definitions of low-volume disease, at ≤2 positive cores there was no difference in adverse pathology between groups (all P > 0.2), except higher pathological grade group (P = 0.006). Biochemical recurrence was similar in men in grade group 1 and grade group 2 (hazard ratio = 1.24; P = 0.529). CONCLUSIONS Among men with prostate-specific antigen ≤10 ng/mL and clinical stage T1c/T2a, those in grade group 2 with ≤2 total positive cores have similar rates of adverse pathology and biochemical recurrence as men with grade group 1.
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Affiliation(s)
- Kathleen F McGinley
- Division of Urology, Department of Surgery, Duke University, Durham, North Carolina, USA.,Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Xizi Sun
- Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Lauren E Howard
- Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - William J Aronson
- Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Urology, UCLA School of Medicine, Los Angeles, California, USA
| | - Martha K Terris
- Section of Urology, Veterans Affairs Medical Center, Augusta, Georgia, USA.,Department of Urology, Georgia Regents University, Augusta, Georgia, USA
| | - Christopher J Kane
- Urology Department, University of California San Diego Health System, San Diego, California, USA
| | | | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Stephen J Freedland
- Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA.,Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
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34
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Sharif A, Malhotra NR, Acosta AM, Kajdacsy-Balla AA, Bosland M, Guzman G, Prins GS, Abern MR. The Development of Prostate Adenocarcinoma in a Transgender Male to Female Patient: Could Estrogen Therapy Have Played a Role? Prostate 2017; 77:824-828. [PMID: 28191651 DOI: 10.1002/pros.23322] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/24/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate adenocarcinoma (PCa) is a rare diagnosis in the male to female transgender (MtFT) population with only a few case reports published in the current medical literature. Long standing beliefs of androgen suppression conferring a protective effect against prostate cancer development have been challenged by the literature citing adenocarcinoma development in the prostate of rodent models following combined estrogen and testosterone treatment. MATERIALS AND METHODS We herein present a MtFT patient who presented with high grade PCa following 20 years of exogenous estrogen therapy. RESULTS Immunohistochemical (IHC) localization of estrogen receptor alpha (ER-α) and progesterone receptor (PR) demonstrated positive staining in stromal cells; while, androgen receptor (AR) demonstrated positive staining in malignant glands and weak scattered staining in adjacent stroma. CONCLUSION This pattern of staining raises concern for a possible contributing role of exogenous estrogen therapy in tumorigenesis. As awareness of gender dysphoria and acceptance of gender reassignment surgery has seen a recent increase, the unique needs of this population must be recognized. Prostate 77:824-828, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Asma Sharif
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Neha R Malhotra
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | - Andres M Acosta
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Maarten Bosland
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Grace Guzman
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Gail S Prins
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | - Michael R Abern
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
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Pierconti F, Martini M, Cenci T, Petrone GL, Ricci R, Sacco E, Bassi PF, Larocca LM. SOCS3 Immunohistochemical Expression Seems to Support the 2005 and 2014 International Society of Urological Pathology (ISUP) Modified Gleason Grading System. Prostate 2017; 77:597-603. [PMID: 28144985 DOI: 10.1002/pros.23299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND In the 2014, The International Society of Urological Pathology (ISUP) consensus conference update the grading of prostate, last revised in 2005. In this study we evaluate the SOCS3 immunohistochemical protein expression in different Gleason prostatic adenocarcinoma: classical Gleason grade 3, classical Gleason grade 3 upgraded to Gleason grade 4 according to the ISUP modifications and classical and modified Gleason grade 4. The major conclusions were: (i) Cribriform glands should be assigned a Gleason pattern 4, regardless of morphology; (ii) Glomeruloid glands should be assigned a Gleason pattern 4, regardless of morphology; (iii) Grading of mucinous carcinoma of the prostate should be based on its underlying growth pattern rather than all as pattern 4; and (iv) Intraductal carcinoma of the prostate without invasive carcinoma should not assigned Gleason grade and a comment about aggressive carcinoma probably associated should be made. In a recent report we analyzed the methylathion status of cytokine signaling (SOCS) proteins 3 (SOCS3) gene and the consequences of promoter hypermethylation on mRNA and protein expression in a collection of prostate cancer and benign prostate hyperplasia (BPH) and for the first time we demonstrated that a hypermethylation of SOCS3 with a significant reduction of its mRNA and protein expression identifies a subgroup of prostate cancer with a more aggressive behavior. Moreover we demonstrated that the immunohystochemical analysis of SOCS3 protein expression in prostatic cancer biopsies may provide a useful and easier method than SOCS3 methylation analysis to individuate in cancer with intermediate-high grade Gleason score a subgroup of prostate cancer with a more aggressive behavior. METHODS A total of 148 radical prostatectomy with diagnosis of prostatic acinar adenocarcinoma were stratified into three different categories on the basis of Gleason grade: (i) Twenty-six prostatic adenocarcinoma with classical and modified Gleason grade 3; (ii) Fifty seven prostatic adenocarcinoma with classical Gleason grade 3 upgraded to Gleason grade 4 by 2005 and 2014 ISUP Consensus Conference; and (iii) Sixty five prostatic adenocarcinoma with classical and modified Gleason grade 4. Immunohistochemical analysis for SOCS3 was performed and SOCS3 staining intensity were evaluated by two pathologists in three different ways on the basis of the intensity of cytoplasmatic staining: positive (intense cytoplasmatic staining in more than 50% of neoplastic cells) (+), negative (absence of cytoplasmatic staining in more than 50% of neoplastic cells) (-), weakly positive (weak cytoplasmatic staining in more than 50% of neoplastic cells (+/-). RESULTS In the group of prostatic adenocarcinoma Gleason grade 3 we found that SOCS3 positivity (+) were observed in 19 out of 26 cases (73.1%); in 5 out of 26 prostatic adenocarcinoma the neoplastic glands showed weak intensity SOCS3 staining (+/-) (19.2%), while in only two cases we found SOCS-3 negativity (-) (7.7%); in the group of cases with prostatic adenocarcinoma with Gleason grade 4, 16 out 65 cases (24.6%) showed SOCS3 positivity (+); 18 out 65 cases (27.7%) SOCS3 weakly positive (+/-), and in 31 cases (47.7%) SOCS3 negative staining (-) were observed. Interestingly, the group of prostatic adenocarcinoma with histological Gleason 3 pattern upgraded to Gleason 4 pattern according to the 2005 and 2014 ISUP modified grading system, showed SOCS3 positivity (+) in 16 out of 57 cases (28%), in 16 out 57 cases (28%) a weakly positive for SOCS3 (+/-) were observed, while 25 cases (44%) showed negative SOCS3 staining (-). CONCLUSIONS In this study we demonstrated a significant association of SOCS3 positivity (+) with prostatic carcinoma classical Gleason pattern 3 (P < 0.0001), while SOCS3 negative pattern (-) or SOCS3 weakly positive pattern (+/-) were associated to prostatic carcinomas with Gleason pattern 3 upgraded to Gleason pattern 4 (P = 0.0002) and with classical Gleason pattern 4. The significant difference of SOCS3 immunohistochemical expression between classical Gleason grade 3 and Gleason grade 4 upgraded to grade 4 seems to support the definitions and the modifications of Gleason grade 4 of the 2005 and the 2014 International Society of Urological Pathology (ISUP). The hypoexpression of SOCS3 protein in glomeruloid glands could support the hypothesis that from molecular point of view this growth pattern could be different from classical Gleason pattern 3 and biologically more closely to Gleason pattern 4, confirming the conclusions of the 2014 ISUP Conference assigning a Gleason pattern 4 to glomeruloid glands regardless of morphology. Prostate 77: 597-603, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Maurizio Martini
- Department of Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Tonia Cenci
- Department of Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Gian Luigi Petrone
- Department of Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Riccardo Ricci
- Department of Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of Sacred Heart, Rome, Italy
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Baras AS, Nelson JB, Han M, Parwani AV, Epstein JI. The effect of limited (tertiary) Gleason pattern 5 on the new prostate cancer grade groups. Hum Pathol 2017; 63:27-32. [DOI: 10.1016/j.humpath.2016.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 11/16/2022]
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Aoun F, Albisinni S, Henriet B, Tombal B, Van Velthoven R, Roumeguère T. Predictive factors associated with biochemical recurrence following radical prostatectomy for pathological T2 prostate cancer with negative surgical margins. Scand J Urol 2016; 51:20-26. [PMID: 27910728 DOI: 10.1080/21681805.2016.1263237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to determine factors associated with the development of biochemical recurrence (BCR) following radical prostatectomy in patients with pathological T2 prostate cancer and negative surgical margins. MATERIALS AND METHODS This retrospective multicentre cohort study included 1252 consecutive patients with pT2 pN0/Nx and negative surgical margins on radical prostatectomy and without any adjuvant treatment, performed in three Belgian centres. BCR-free survival curves were estimated using the Kaplan-Meier method. Univariate and multivariate analyses using the Cox proportional hazards model were performed to determine clinical and pathological predictive factors of BCR in this group of patients. RESULTS In total, 910 patients were included. BCR occurred in 107 patients (11.8%) at a median follow-up of 108 months. Overall 5 and 10 year BCR-free survival rates were 90% and 87%, respectively. On the multivariate analyses, serum prostate-specific antigen (PSA) level (p = .001) and surgical Gleason score of 7 or above (p = .001) were significantly associated with BCR in men with pathological T2 prostate cancer with negative surgical margins. Perineural invasion and capsular infiltration were not risk factors for recurrence. CONCLUSIONS This study identified unfavourable risk factors in patients with pathological T2 and negative surgical margins following radical prostatectomy. The results suggest that patients with a surgical Gleason score of 7 or higher, unknown lymph-node status and high PSA values are at increased risk of recurrence.
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Affiliation(s)
- Fouad Aoun
- a Urology Department , Jules Bordet Institute, Université libre de Bruxelles , Brussels , Belgium
| | - Simone Albisinni
- b Urology Department , University Clinics of Brussels, Erasme Hospital, Université libre de Bruxelles , Brussels , Belgium
| | - Benjamin Henriet
- b Urology Department , University Clinics of Brussels, Erasme Hospital, Université libre de Bruxelles , Brussels , Belgium
| | - Bertrand Tombal
- c Urology Department , Institut de Recherche clinique (IREC), Cliniques universitaires St Luc, Université catholique de Louvain , Brussels , Belgium
| | - Roland Van Velthoven
- a Urology Department , Jules Bordet Institute, Université libre de Bruxelles , Brussels , Belgium
| | - Thierry Roumeguère
- b Urology Department , University Clinics of Brussels, Erasme Hospital, Université libre de Bruxelles , Brussels , Belgium
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Kryvenko ON, Epstein JI. Definition of Insignificant Tumor Volume of Gleason Score 3 + 3 = 6 (Grade Group 1) Prostate Cancer at Radical Prostatectomy—Is it Time to Increase the Threshold? J Urol 2016; 196:1664-1669. [DOI: 10.1016/j.juro.2016.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Oleksandr N. Kryvenko
- Department of Pathology and Laboratory Medicine, Department of Urology and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
- Departments of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions (JIE), Baltimore, Maryland
| | - Jonathan I. Epstein
- Department of Pathology and Laboratory Medicine, Department of Urology and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
- Departments of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions (JIE), Baltimore, Maryland
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de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol 2016. [DOI: 10.1016/j.eururo.2015.07.029] [Citation(s) in RCA: 366] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Fleshner K, Assel M, Benfante N, Lee J, Vickers A, Fine S, Carlsson S, Eastham J. Clinical Findings and Treatment Outcomes in Patients with Extraprostatic Extension Identified on Prostate Biopsy. J Urol 2016; 196:703-8. [PMID: 27049874 DOI: 10.1016/j.juro.2016.03.152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE We describe histopathological, clinical and imaging findings among men with extraprostatic extension on prostate biopsy. MATERIALS AND METHODS We searched our institutional pathology database between 2004 and 2015 for pathology reports detailing extraprostatic extension on prostate biopsy in untreated patients. Patient characteristics, biopsy features, imaging interpretations and outcomes were examined. RESULTS Of 19,950 patients with prostate cancer on biopsy 112 had extraprostatic extension for a prevalence of 0.6% (95% CI 0.5-0.7). Most of the 112 patients had palpable, high grade (Gleason score 9), high volume disease, which was classified as high risk in 34 (30%), locally advanced in 17 (15%) and metastatic in 39 (35%). Most patients had 1 or 2 cores with extraprostatic extension, typically at the base and with concomitant perineural invasion. Extraprostatic extension was identified by magnetic resonance imaging in 32 of 40 patients (80%). Median followup in those who did not die was 1.3 years (IQR 0.3-4.2). Outcomes in the subgroup of 24 men treated with radical prostatectomy were consistent with high risk disease, including positive margins in 14 (58%), seminal vesicle invasion in 10 (42%) and lymph node invasion in 11 (46%). In the entire cohort the 3-year risks of metastasis and overall mortality were 32% (95% CI 22-44) and 37% (95% CI 27-50), respectively. We did not find evidence to suggest that the proportion of cores with cancer that also had extraprostatic extension was associated with overall mortality (p = 0.09). CONCLUSIONS Extraprostatic extension is a rare finding on prostate biopsy. It is strongly associated with other features of aggressive prostate cancer.
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Affiliation(s)
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Justin Lee
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samson Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sigrid Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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Kang M, Oh JJ, Lee S, Hong SK, Lee SE, Byun SS. Perineural Invasion and Lymphovascular Invasion are Associated with Increased Risk of Biochemical Recurrence in Patients Undergoing Radical Prostatectomy. Ann Surg Oncol 2016; 23:2699-706. [PMID: 26965702 DOI: 10.1245/s10434-016-5153-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to determine whether perineural invasion (PNI) and lymphovascular invasion (LVI) are independent predictors for biochemical recurrence (BCR) of prostate cancer (PCa) following radical prostatectomy (RP) in the Asian population. METHODS The study population comprised 2394 PCa patients undergoing RP at our institution in Korea. After excluding 360 patients, we compared the baseline characteristics between the groups according to the presence of PNI or LVI and estimated BCR-free survival using the Kaplan-Meier survival. Multivariate Cox regression model was adopted to identify significant predictive factors of BCR following RP. RESULTS Among 2034 patients, PNI and LVI were detected in 69.3 and 12.4 % patients, respectively. Patients with PNI or LVI had higher rates of advanced biopsy and pathological Gleason score (≥7), and higher proportions of advanced clinical and pathological T stage ≥3, extraprostatic extension, seminal vesicle invasion, and surgical margin positivity. Notably, BCR-free survival was lower in patients with PNI or LVI compared with that in patients without these markers and lower in patients with both markers compared with that in other populations of patients. Moreover, PNI (hazard ratio [HR] = 2.11) and LVI (HR = 1.57) were significant predictors of BCR. The presence of the two markers was associated with a higher risk of BCR (HR = 4.60) compared with the presence of either marker alone (HR = 3.47). CONCLUSIONS PNI and LVI are adverse pathologic parameters and independent predictors for BCR, and the concurrent presence of PNI and LVI resulted in poorer outcomes for BCR in PCa patients who underwent RP.
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Affiliation(s)
- Minyong Kang
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea.
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Waliszewski P. The Quantitative Criteria Based on the Fractal Dimensions, Entropy, and Lacunarity for the Spatial Distribution of Cancer Cell Nuclei Enable Identification of Low or High Aggressive Prostate Carcinomas. Front Physiol 2016; 7:34. [PMID: 26903883 PMCID: PMC4749702 DOI: 10.3389/fphys.2016.00034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/25/2016] [Indexed: 01/17/2023] Open
Abstract
Background: Tumor grading, PSA concentration, and stage determine a risk of prostate cancer patients with accuracy of about 70%. An approach based on the fractal geometrical model was proposed to eliminate subjectivity from the evaluation of tumor aggressiveness and to improve the prediction. This study was undertaken to validate classes of equivalence for the spatial distribution of cancer cell nuclei in a larger, independent set of prostate carcinomas. Methods: The global fractal capacity D0, information D1 and correlation D2 dimension, the local fractal dimension (LFD) and the local connected fractal dimension (LCFD), Shannon entropy H and lacunarity λ were measured using computer algorithms in digitalized images of both the reference set (n = 60) and the test set (n = 208) of prostate carcinomas. Results: Prostate carcinomas were re-stratified into seven classes of equivalence. The cut-off D0-values 1.5450, 1.5820, 1.6270, 1.6490, 1.6980, 1.7640 defined the classes from C1 to C7, respectively. The other measures but the D1 failed to define the same classes of equivalence. The pairs (D0, LFD), (D0, H), (D0, λ), (D1, LFD), (D1, H), (D1, λ) characterized the spatial distribution of cancer cell nuclei in each class. The co-application of those measures enabled the subordination of prostate carcinomas to one out of three clusters associated with different tumor aggressiveness. For D0 < 1.5820, LFD < 1.3, LCFD > 1.5, H < 0.7, and λ > 0.8, the class C1 or C2 contains low complexity low aggressive carcinomas exclusively. For D0 > 1.6980, LFD > 1.7644, LCFD > 1.7051, H > 0.9, and λ < 0.7, the class C6 or C7 contains high complexity high aggressive carcinomas. Conclusions: The cut-off D0-values defining the classes of equivalence were validated in this study. The cluster analysis suggested that the number of the subjective Gleason grades and the number of the objective classes of equivalence could be decreased from seven to three without a loss of clinically relevant information. Two novel quantitative criteria based on the complexity and the diversity measures enabled the identification of low or high aggressive prostate carcinomas and should be verified in the future multicenter, randomized studies.
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Affiliation(s)
- Przemyslaw Waliszewski
- Department of Urology, Alb Fils KlinikenGoeppingen, Germany; The Bȩdlewo Institute for Complexity ResearchPoznań, Poland
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Mohsenzadegan M, Shekarabi M, Madjd Z, Asgari M, Abolhasani M, Tajik N, Farajollahi MM. Study of NGEP expression pattern in cancerous tissues provides novel insights into prognostic marker in prostate cancer. Biomark Med 2016; 9:391-401. [PMID: 25808443 DOI: 10.2217/bmm.14.106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM The aim of this study was to produce a novel polyclonal antibody against extracellular domain of NGEP protein and explore its role in prognosis of prostate cancer. MATERIALS & METHODS Polyclonal antibodies against two peptides (NGEP-p1 and NGEP-p2) derived extracellular domains of NGEP were prepared and the intensity and distribution of NGEP expression analyzed in large series of prostate tissue specimens. RESULTS We found a significant inverse correlation between NGEP expression and prognostic features such as Gleason score, pathologic tumor stage and prostate-specific antigen level using anti-NGEP-p2 antibody. CONCLUSION The results indicate that the high level of expression could be associated with good prognosis in prostate cancer. However, additional studies are required to evaluate NGEP as an independent prognostic factor for prostate carcinoma.
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Affiliation(s)
- Monireh Mohsenzadegan
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Kır G, Seneldir H, Gumus E. Outcomes of Gleason score 3 + 4 = 7 prostate cancer with minimal amounts (<6%) vs ≥6% of Gleason pattern 4 tissue in needle biopsy specimens. Ann Diagn Pathol 2015; 20:48-51. [PMID: 26750655 DOI: 10.1016/j.anndiagpath.2015.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The International Society of Urological Pathology Gleason grading system was modified in 2005. Since the modified system was introduced, many cancers that previously would have been categorized as Gleason score (GS) 6 are now categorized as GS 7 based on biopsy specimens that only contain minimal amounts (<6%) of Gleason pattern (GP) 4 tissue. However, the clinical significance of observing <6% of GP 4 tissue in biopsies of GS 7 prostate cancer has not been studied. MATERIAL AND METHODS This study was based on needle biopsy specimens that were categorized as GS 6 or GS 7 and were obtained from patients who underwent radical prostatectomy (RP) with available follow-up data. We assessed the quantity of GP 4 tissue in biopsy specimens of GS 7 prostate cancer. Further, we evaluated the correlation between the quantity of GP 4 tissue and disease progression after RP. RESULTS GP 4 comprising 26-49% of the specimen, GS 4+3 and percentage of total core tissue scored as positive were significant and independent predictors of prostate-specific antigen (PSA) failure after RP, as assessed using a multivariate Cox regression model that included the quantity of GP 4 in the prostate biopsy specimen, preoperative PSA, perineural invasion, clinical stage, number of positive cores, and percentage of core tissue scored as positive. Cases with GS 3+3 and cases in which the observed GP 4 area was <6% did not differ significantly in terms of biochemical PSA recurrence (BPR) status. In contrast, cases with 6-25% GP 4 tissue, 26-49% GP 4 tissue, and GS 4+3 showed more frequent BPR than cases with GS 3+3. CONCLUSIONS Our data suggest that the quantity of GP 4 tissue in GS 7 cancer has clinical significance. However, there is a need for larger studies of the clinical significance of biopsy specimens that include <6% GP 4 tissue. We should reconsider whether the amount of GP 4 should be included in standart pathology reports.
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Affiliation(s)
- Gozde Kır
- Umraniye Education & Research Hospital, Istanbul, Turkey.
| | | | - Eyup Gumus
- Umraniye Education & Research Hospital, Istanbul, Turkey.
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[Analysis and prognostic factors of the specimen of radical prostatectomy in prostate cancer]. Prog Urol 2015; 25:999-1009. [PMID: 26519964 DOI: 10.1016/j.purol.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Handling and pathologic analysis of radical prostatectomy specimens are crucial to confirm the diagnosis of prostate cancer and evaluate prognostic criteria. MATERIAL AND METHODS A systematic review of the scientific literature was performed in the Medline database (PubMed), using different associations of the following keywords: prostate cancer; prostatectomy; specimen; handling; pathology; tumor staging; Gleason score; surgical margin; prognosis; frozen section; lymph node; biomarkers. A particular search was done on specimen management and characterization of tissue prognostic factors. RESULTS Handling of both radical prostatectomy specimen and lymph node dissection is standardized according to international criteria. Although the main histoprognostic factors are still Gleason score, pathologic staging and margin status, these criteria have been refined these last 10 years, allowing to improve the prediction of relapse after surgical treatment. CONCLUSION The standardization of handling and pathology reporting of radical prostatectomy specimens will be mandatory for treatment uniformization according to risk stratification in prostate cancer and personalization of therapeutic approaches.
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Prostate Biopsy and Radical Prostatectomy Gleason Score Correlation in Heterogenous Tumors. Am J Surg Pathol 2015; 39:1213-8. [DOI: 10.1097/pas.0000000000000499] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alchin DR, Murphy D, Lawrentschuk N. What Are the Predictive Factors for Gleason Score Upgrade following RP? Urol Int 2015; 96:1-4. [DOI: 10.1159/000439139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gertych A, Ing N, Ma Z, Fuchs TJ, Salman S, Mohanty S, Bhele S, Velásquez-Vacca A, Amin MB, Knudsen BS. Machine learning approaches to analyze histological images of tissues from radical prostatectomies. Comput Med Imaging Graph 2015; 46 Pt 2:197-208. [PMID: 26362074 DOI: 10.1016/j.compmedimag.2015.08.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/30/2015] [Accepted: 08/07/2015] [Indexed: 11/18/2022]
Abstract
Computerized evaluation of histological preparations of prostate tissues involves identification of tissue components such as stroma (ST), benign/normal epithelium (BN) and prostate cancer (PCa). Image classification approaches have been developed to identify and classify glandular regions in digital images of prostate tissues; however their success has been limited by difficulties in cellular segmentation and tissue heterogeneity. We hypothesized that utilizing image pixels to generate intensity histograms of hematoxylin (H) and eosin (E) stains deconvoluted from H&E images numerically captures the architectural difference between glands and stroma. In addition, we postulated that joint histograms of local binary patterns and local variance (LBPxVAR) can be used as sensitive textural features to differentiate benign/normal tissue from cancer. Here we utilized a machine learning approach comprising of a support vector machine (SVM) followed by a random forest (RF) classifier to digitally stratify prostate tissue into ST, BN and PCa areas. Two pathologists manually annotated 210 images of low- and high-grade tumors from slides that were selected from 20 radical prostatectomies and digitized at high-resolution. The 210 images were split into the training (n=19) and test (n=191) sets. Local intensity histograms of H and E were used to train a SVM classifier to separate ST from epithelium (BN+PCa). The performance of SVM prediction was evaluated by measuring the accuracy of delineating epithelial areas. The Jaccard J=59.5 ± 14.6 and Rand Ri=62.0 ± 7.5 indices reported a significantly better prediction when compared to a reference method (Chen et al., Clinical Proteomics 2013, 10:18) based on the averaged values from the test set. To distinguish BN from PCa we trained a RF classifier with LBPxVAR and local intensity histograms and obtained separate performance values for BN and PCa: JBN=35.2 ± 24.9, OBN=49.6 ± 32, JPCa=49.5 ± 18.5, OPCa=72.7 ± 14.8 and Ri=60.6 ± 7.6 in the test set. Our pixel-based classification does not rely on the detection of lumens, which is prone to errors and has limitations in high-grade cancers and has the potential to aid in clinical studies in which the quantification of tumor content is necessary to prognosticate the course of the disease. The image data set with ground truth annotation is available for public use to stimulate further research in this area.
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Affiliation(s)
- Arkadiusz Gertych
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
| | - Nathan Ing
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Zhaoxuan Ma
- Department of Biomedical Sciences Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Thomas J Fuchs
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, CA 91109, USA; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sadri Salman
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Sambit Mohanty
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Sanica Bhele
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Adriana Velásquez-Vacca
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Beatrice S Knudsen
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA; Department of Biomedical Sciences Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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49
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Hashimoto T, Yoshioka K, Horiguchi Y, Inoue R, Yoshio O, Nakashima J, Tachibana M. Clinical effect of a positive surgical margin without extraprostatic extension after robot-assisted radical prostatectomy. Urol Oncol 2015; 33:503.e1-6. [PMID: 26277617 DOI: 10.1016/j.urolonc.2015.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/28/2015] [Accepted: 07/11/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the effect of positive surgical margin (PSM) without extraprostatic extension after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS We retrospectively reviewed 837 patients who underwent RARP for clinically localized prostate cancer without neoadjuvant endocrine therapy. The pT2+category lesions were defined according to World Health Organization classification. The actuarial probabilities of biochemical recurrence-free survival (BCR-FS) were determined using Kaplan-Meier analysis. Univariate and multivariate Cox proportional hazards regression analyses were also used to identify independent predictors for BCR. RESULTS Of the 837 patients, 102 (12.2%) experienced BCR during the follow-up period. The BCR-FS rate was significantly higher in patients with pT2+category tumors than in those with pT3a category tumors, and significantly lower in patients with pT2+category tumors than that in those with pT2 category tumors without PSM. The BCR-FS rate of patients with pT2+category tumors was significantly higher than that with pT3a category tumors with PSM but not significantly different from that with pT3a category tumors without PSM. In a multivariate analysis, the pathological T category considering pT2+category was one of independent predictive factors for BCR. CONCLUSIONS This study support the hypothesis that the pT2+category disease is associated with a significantly increased risk of BCR in patients with organ-confined prostate cancer after RARP. As PSM can be avoided in some cases, urologists should continually seek to improve their operative skills and to reduce the rate of PSM, especially in patients with organ-confined prostate cancer.
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Affiliation(s)
| | | | | | - Rie Inoue
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Ohno Yoshio
- Department of Urology, Tokyo Medical University, Tokyo, Japan
| | - Jun Nakashima
- Department of Urology, Tokyo Medical University, Tokyo, Japan
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50
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Mazaheri Y, Goldman DA, Di Paolo PL, Akin O, Hricak H. Comparison of prostate volume measured by endorectal coil MRI to prostate specimen volume and mass after radical prostatectomy. Acad Radiol 2015; 22:556-62. [PMID: 25708867 DOI: 10.1016/j.acra.2015.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/06/2015] [Accepted: 01/10/2015] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To compare prostate volume measurements from 3-Tesla endorectal coil magnetic resonance imaging (ERC MRI) obtained with the prolate ellipsoid volume formula (EVF) and volumetry to pathology-based volume measurements. METHODS The institutional review board waived informed consent for this retrospective, health insurance portability and accountability act (HIPAA) compliant study, which included 195 patients who underwent 3-T ERC MRI between January 2008 and October 2011 and had pathologic prostate measurements available. Two readers in consensus measured the prostate length, height, and width on each MRI. They estimated prostate volumes using the prolate EVF (length × height × width × [π/6]) and also by performing three-dimensional volumetry. Pathologic specimen mass and dimensions were used to calculate prostate volume. Agreement was measured with Lin's concordance correlation coefficient (CCC). Volume differences were assessed using the Wilcoxon signed-rank test. Correct prostate-specific antigen (PSA) density classification rates were compared between EVF-based and volumetry-based PSA density levels using the exact McNemar test, with pathology-based PSA density as the reference standard. RESULTS Concordance was high between EVF and volumetry measurements (CCC, 0.950 [95% confidence interval, 0.935-0.962]) and between both kinds of MRI measurements and pathology (both CCC > 0.80). Based on a cut-off of ≤0.15 ng/mL/cm(3), use of EVF-based volume produced correct classification of 46 of 48 PSA density levels >15 ng/mL/cm(3) and 113 of 147 PSA density levels ≤15 ng/mL/cm(3); use of volumetry-based volume produced correct classification of 47 of 48 PSA density levels >15 ng/mL/cm(3) and 121 of 147 PSA density levels ≤15 ng/mL/cm(3). Rates of underclassification (P > .95) and overclassification (P = .10) did not differ significantly between EVF and volumetry. CONCLUSIONS EVF appears to be suitable for measuring prostate volume from ERC-MRI.
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Affiliation(s)
- Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10605; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Pier Luigi Di Paolo
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Oguz Akin
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
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