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Impact of 3D printed models on quantitative surgical outcomes for patients undergoing robotic-assisted radical prostatectomy: a cohort study. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1401-1408. [PMID: 36749368 DOI: 10.1007/s00261-023-03815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Three-dimensional (3D) printed anatomic models can facilitate presurgical planning by providing surgeons with detailed knowledge of the exact location of pertinent anatomical structures. Although 3D printed anatomic models have been shown to be useful for pre-operative planning, few studies have demonstrated how these models can influence quantitative surgical metrics. OBJECTIVE To prospectively assess whether patient-specific 3D printed prostate cancer models can improve quantitative surgical metrics in patients undergoing robotic-assisted radical prostatectomy (RARP). METHODS Patients with MRI-visible prostate cancer (PI-RADS V2 ≥ 3) scheduled to undergo RARP were prospectively enrolled in our IRB approved study (n = 82). Quantitative surgical metrics included the rate of positive surgical margins (PSMs), operative times, and blood loss. A qualitative Likert scale survey to assess understanding of anatomy and confidence regarding surgical approach was also implemented. RESULTS The rate of PSMs was lower for the 3D printed model group (8.11%) compared to that with imaging only (28.6%), p = 0.128. The 3D printed model group had a 9-min reduction in operating time (213 ± 42 min vs. 222 ± 47 min) and a 5 mL reduction in average blood loss (227 ± 148 mL vs. 232 ± 114 mL). Surgeon anatomical understanding and confidence improved after reviewing the 3D printed models (3.60 ± 0.74 to 4.20 ± 0.56, p = 0.62 and 3.86 ± 0.53 to 4.20 ± 0.56, p = 0.22). CONCLUSIONS 3D printed prostate cancer models can positively impact quantitative patient outcomes such as PSMs, operative times, and blood loss in patients undergoing RARP.
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Singh M, Kathuria S, Jain S, Rasool S, Tyagi V, Gupta M, Pahwa M, Pandey H, Sharma A. Evaluation of Biochemical Recurrence and Correlation with Various Parameters After Robotic-Assisted Radical Prostatectomy: a Single Center Experience. Indian J Surg Oncol 2022; 13:661-667. [PMID: 36187532 PMCID: PMC9515285 DOI: 10.1007/s13193-022-01554-2] [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: 04/24/2021] [Accepted: 05/10/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Biochemical recurrence (BCR) is widely used as an early end point to assess treatment success and frequently prompts the initiation of secondary therapy after radical prostatectomy. We conducted an observational, ambispective study to evaluate BCR after robotic-assisted radical prostatectomy (RARP) for clinically localized prostate cancer. We also analyzed correlation of BCR with pre-operative PSA level, D'Amico classification, pathological stage, post-operative GS, and positive surgical margins after RARP. Material and Methods A total of 90 patients with clinically localized carcinoma prostate (≤ T 2), who underwent RARP between April 2012 and April 2017 at our institute with 3 year of minimum follow-up were included in our study. Patients having locally advanced disease on clinical staging or died of unrelated cause in follow up or lost to follow up were excluded from study. Patients who had persistent detectable PSA (> 0.20 ng/ml) at 6 week with a second confirmatory level of PSA greater than 0.2 ng/ml at 3rd month were excluded from study. Results The age of the patient ranges from 46 to 79 years with the mean age of 65.36 ± 6.55 years. The mean PSA was 24.36 ± 26.68 ng/ml with range between 1.8 and 126.6 ng/ml. Nine patients (10%) developed BCR at 1-year follow-up and 81 patients were BCR-free. Thus, 1-year BCRFS and BCR rate were 90% and 10%, respectively in our study. Total 17 patients (18.9%) developed BCR during a 2-year period and 73 patients were free of BCR. Thus, 2-year BCRFS and BCR rate were 81.1% and 18.9%, respectively. A total of 29 patients (32.2%) had BCR and 61 patients were free of BCR at 3 years of follow-up. Thus, overall 3-year BCR rate and 3-year BCRFS rate were 32.2% and 67.8%, respectively. There was significant correlation of BCR with pre-operative PSA level, D'Amico classification, pathological stage, post-operative GS, and positive surgical margins. Conclusions There is relative paucity of data regarding the BCR rate after RARP in the Indian scenario. The BCR rate in our study was similar to previously published Western and limited Indian data on RARP series in localized prostate cancer. There was significant correlation of BCR with PSA, post-operative GS, pathological stage, PSM, and D'Amico classification.
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Affiliation(s)
| | | | - Saurabh Jain
- Department of Urology, Apex Hospital, Jaipur, India
| | | | - Vipin Tyagi
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
| | - Manu Gupta
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
| | - Mrinal Pahwa
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
| | | | - Ajay Sharma
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
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Covas Moschovas M, Kind S, Bhat SK, Noel J, Sandri M, Rogers TP, Moser D, Brady I, Patel V. Implementing the da Vinci SP® without increasing positive surgical margins: experience and pathological outcomes of a prostate cancer referral center. J Endourol 2021; 36:493-498. [DOI: 10.1089/end.2021.0656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marcio Covas Moschovas
- AdventHealth Global Robotics Institute, Urology, Celebration, Florida, United States
- University of Central Florida, 6243, UCF, Orlando, Florida, United States
| | - Sarah Kind
- Johns Hopkins University, 1466, Baltimore, Maryland, United States
| | - Seetharam K Bhat
- AdventHealth Global Robotics Institute, Urology, Celebration, Florida, United States
| | - Jonathan Noel
- AdventHealth Global Robotics Institute, Urology, 40 Celebration Pl, Celebration, Florida, United States, 34747
| | - Marco Sandri
- Big and Open Data Innovation Laboratory (BODaI-Lab), Research, Milan, Italy
| | - Travis Phillip Rogers
- AdventHealth Global Robotics Institute, Urology, Celebration, Florida, United States
| | - Daniel Moser
- Hospital Brasil, Urology, Sao Paulo, Sao Paulo, Brazil
| | - Isabella Brady
- AdventHealth Global Robotics Institute, Urology, Celebration, Florida, United States
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Urology, Celebration, Florida, United States
- University of Central Florida, 6243, UCF, Orlando, Florida, United States
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Covas Moschovas M, Chew C, Bhat S, Sandri M, Rogers T, Dell'Oglio P, Roof S, Reddy S, Sighinolfi MC, Rocco B, Patel V. Association Between Oncotype DX Genomic Prostate Score and Adverse Tumor Pathology After Radical Prostatectomy. Eur Urol Focus 2021; 8:418-424. [PMID: 33757735 DOI: 10.1016/j.euf.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 03/09/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Oncotype DX assay is a clinically validated 17-gene genomic assay that provides a genomic prostate score (GPS; scale 0-100) measuring the heterogeneous nature of prostate tumors. The test is performed on prostate tissue collected during biopsy. There is a lack of data on the association between the GPS and tumor pathology after radical prostatectomy (RP). OBJECTIVE To investigate the association between GPS and final pathology, including extraprostatic extension (EPE), positive surgical margin (PSM), and seminal vesicle invasion (SVI). DESIGN, SETTING, AND PARTICIPANTS Data for the 749 patients who underwent Oncotype DX assay and RP at a referral prostate cancer center between 2015 and 2019 were retrospectively assessed to evaluate the association between GPS and unfavorable pathology parameters. INTERVENTION After a GPS genetic test, patients underwent robotic RP performed by the same surgeon. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable logistic regression analyses were performed to assess the association between GPS and EPE, PSM, and SVI. The models were adjusted for age, clinical stage, prostate-specific antigen (PSA) level, Gleason score, and time between the genomic assay and surgery. The median time between Oncotype DX assay and surgery was 176 d (interquartile range [IQR] 141-226). The median age was 63 yr (IQR 58-68), median GPS was 29 (IQR 21-39), and median PSA was 5.7 ng/ml (IQR 4.6-7.7). In multivariable analyses assessing the odds ratio (OR) per 20-point change in GPS, GPS was an independent predictor of EPE (OR 1.8, 95% confidence interval [CI] 1.4-2.3) and SVI (OR 2.1, 95% CI 1.3-3.4). In addition, when patients were grouped by GPS quartile, the percentage of cases with EPE and SVI increased with the GPS quartile. CONCLUSIONS We provide evidence that the Oncotype DX GPS is significantly associated with adverse pathology after RP. Specifically, the risk of EPE and SVI increases with the GPS. Therefore, use of the Oncotype DX GPS may help clinicians to improve preoperative patient counseling and develop surgical strategies for patients with a higher chance of EPE or unfavorable pathological features. PATIENT SUMMARY We studied whether the score for a prostate genetic test was associated with prostate cancer pathology findings for patients who had their prostate removed. We found that the risk of prostate cancer spread outside the gland and to the seminal vesicle increases with higher test scores. These findings may help surgeons in counseling patients on surgical options for prostate cancer.
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Affiliation(s)
| | - Christopher Chew
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Seetharam Bhat
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Marco Sandri
- Big and Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Travis Rogers
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Shannon Roof
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Sunil Reddy
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | | | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
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5
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Albisinni S, De Groote A, Deneft F, Thoma P, Catteau X, Roumeguère T, Wildschutz T. [Can preoperative prostate MRI before radical prostatectomy predict extracapsular extension and the side of the index lesion?]. Prog Urol 2016; 26:281-6. [PMID: 26996453 DOI: 10.1016/j.purol.2016.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/28/2016] [Accepted: 02/18/2016] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the role of preoperative multi-parametric magnetic resonance imaging (MP-MRI) in patients undergoing radical prostatectomy. Specifically, the accuracy of MP-MRI in detecting extracapsular extension (ECE) and individuating the side of the index lesion have been explored. METHODS Thirty-five consecutive patients undergoing radical prostatectomy have been retrospectively analyzed. The MRI exam incorporated T2-weighted imaging, diffusion-weighted imaging and dynamic contrast enhancement in all patients. χ(2) test was performed to assess an association between an MP-MRI suggestive of ECE and pathologic ECE; similar tests were performed to study the association between the MRI-detected side of the index lesion and its true localization on final pathology. Univariate logistic regression models were constructed to evaluate possible predictors of ECE, including MP-MRI suspected ECE. RESULTS Seventeen percent (6/35) of men presented ECE on final pathology. MP-MRI was predictive of pathologic ECE with a negative predictive value and specificity of 93% and 90%, respectively. Global accuracy of MP-MRI in predicting ECE was 86%. MRI-detected ECE was significantly predictive of pathologic ECE on logistic regression (OR: 17.3, 95% CI: 2.2-138.2, P=0.007). Moreover, MRI significantly predicted the side of the index lesion (P=0.012). CONCLUSIONS In this single center cohort, preoperative MP-MRI was significantly predictive of ECE and side of the index lesion. Further studies are necessary to individuate patients who can benefit from preoperative MP-MRI. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- S Albisinni
- Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique; Département d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme, université libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique.
| | - A De Groote
- Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
| | - F Deneft
- Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
| | - P Thoma
- Département de radiologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
| | - X Catteau
- Département d'anatomopathologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
| | - T Roumeguère
- Département d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme, université libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique
| | - T Wildschutz
- Département d'urologie, CHU Tivoli, université libre de Bruxelles, Bruxelles, Belgique
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Maxeiner A, Magheli A, Jöhrens K, Kilic E, Braun TL, Kempkensteffen C, Hinz S, Stephan C, Miller K, Busch J. Significant reduction in positive surgical margin rate after laparoscopic radical prostatectomy by application of the modified surgical margin recommendations of the 2009 International Society of Urological Pathology consensus. BJU Int 2016; 118:750-757. [PMID: 26915345 DOI: 10.1111/bju.13451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To verify retrospectively the margin status and analyse the location and characteristics of positive surgical margins (PSMs) in patients undergoing radical prostatectomy (RP), by a central pathology review, based on the consensus conference 2009 updated margin criteria from the International Society of Urological Pathology (ISUP). PATIENTS AND METHODS The detailed PSM characteristics of 441 patients who underwent laparoscopic RP (LRP) between 1999 and 2007 were centrally reviewed with regard to location, number, Gleason score at the PSM and tumour width. Predictors of PSMs and the impact of several PSM characteristics on clinical outcomes were examined. Patient characteristics were compared using the chi-squared test. Differences in recurrence-free survival (RFS) rates were analysed using the log-rank test and presented as Kaplan-Meier survival curves. Univariable and multivariable Cox regression analysis for the prediction of RFS was performed. RESULTS Central pathology review using the updated PSM definition according to ISUP 2009, resulted in reclassification of a substantial number of patients with PSMs (n = 113, 26.6%) as R0. Several PSM characteristics with a higher risk of biochemical recurrence (BCR) were identified as the strongest independent predictors of RFS: pathological stage; Gleason score; and the presence of multiple PSMs (hazard ratio [HR] 1.78; 95% confidence interval [CI] 1.08-2.96; P = 0.025). Further analysis replacing the location of PSM by the width categories of PSM showed that a PSM >3 mm was an independent predictor of RFS (HR 1.72; 95% CI 1.08-2.72; P = 0.022). CONCLUSIONS The impact of PSMs after LRP for prostate cancer remains unclear. PSMs in the present cohort of patients undergoing LRP had different characteristics and conferred different risks of BCR. A better understanding of PSM characteristics and a careful standardized pathological evaluation is needed to adequately counsel patients with respect to prognosis and adjuvant therapy after LRP.
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Affiliation(s)
- Andreas Maxeiner
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
| | - Ahmed Magheli
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Korinna Jöhrens
- Department of Pathology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Ergin Kilic
- Department of Pathology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Tom Lukas Braun
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Stefan Hinz
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Carsten Stephan
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Jonas Busch
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
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7
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Fischer S, Lin D, Simon RM, Howard LE, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, Freedland SJ, Vidal AC. Do all men with pathological Gleason score 8-10 prostate cancer have poor outcomes? Results from the SEARCH database. BJU Int 2015; 118:250-7. [PMID: 26351095 DOI: 10.1111/bju.13319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine whether there are subsets of men with pathological high grade prostate cancer (Gleason score 8-10) with particularly high or low 2-year biochemical recurrence (BCR) risk after radical prostatectomy (RP) when stratified into groups based on combinations of pathological features, such as surgical margin status, extracapsular extension (ECE) and seminal vesicle invasion (SVI). MATERIALS AND METHODS We identified 459 men treated with RP with pathological Gleason score 8-10 prostate cancer in the SEARCH database. The men were stratified into five groups based on pathological characteristics: group 1, men with negative surgical margins (NSMs) and no ECE; group 2, men with positive surgical margin (PSMs) and no ECE; group 3, men with NSMs and ECE; group 4, men with PSMs and ECE; and group 5, men with SVI. Cox proportional hazards models and the log-rank test were used to compare BCR among the groups. RESULTS At 2 years after RP, pathological group was significantly correlated with BCR (log-rank, P < 0.001) with patients in group 5 (+SVI) having the highest BCR risk (66%) and those in group 1 (NSMs and no ECE) having the lowest risk (14%). When we compared groups 2, 3, and 4, with each other, there was no significant difference in BCR among the groups (~50% 2-year BCR risk; log-rank P = 0.28). Results were similar when adjusting for prostate-specific antigen, age, pathological Gleason sum and clinical stage, or after excluding men who received adjuvant therapy. CONCLUSIONS In patients with high grade (Gleason score 8-10) prostate cancer after RP, the presence of either PSMs, ECE or SVI was associated with an increased risk of early BCR, with a 2-year BCR risk of ≥50%. Conversely, men with organ-confined margin-negative disease had a very low risk of early BCR despite Gleason score 8-10 disease.
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Affiliation(s)
- Sean Fischer
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.,Urology Section, Veterans Affairs Medical Center, Durham, NC, USA
| | - Daniel Lin
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Ross M Simon
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.,Urology Section, Veterans Affairs Medical Center, Durham, NC, USA
| | - Lauren E Howard
- Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - William J Aronson
- Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA
| | - Martha K Terris
- Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, GA, USA.,Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Christopher J Kane
- Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA
| | | | - Matt R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.,Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Stephen J Freedland
- Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adriana C Vidal
- Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Simon RM, Howard LE, Freedland SJ, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, Vidal AC. Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy: is adjuvant radiation warranted? BJU Int 2015; 117:897-903. [PMID: 26010251 DOI: 10.1111/bju.13182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine if men with adverse pathology but undetectable ultrasensitive (<0.01 ng/mL) PSA are at high-risk for biochemical recurrence (BCR), or if there is a subset of patients at low-risk for whom the benefit of adjuvant radiation therapy might be limited. PATIENTS AND METHODS We evaluated 411 patients treated with RP from 2001 to 2013 without adjuvant radiation who had an undetectable (<0.01 ng/mL) PSA level after RP but with adverse pathology [positive surgical margins (PSMs), extraprostatic extension (EPE), and/or seminal vesicle invasion (SVI)]. Multivariable Cox regression analyses tested the relationship between pathological characteristics and BCR to identify groups of men at highest risk of early BCR. RESULTS On multivariable analysis, only pathological Gleason 7 (4 + 3), Gleason ≥8, and SVI independently predicted BCR (P = 0.019, P < 0.001, and P = 0.001, respectively), although on two-way analysis men with Gleason 7 (4 + 3) did not have significantly higher rates of BCR compared with patients with Gleason ≤6 (log-rank, P = 0.074). Men with either Gleason ≥8 (with PSMs or EPE) or SVI (15% of the cohort) defined a high-risk group vs men without these characteristics (3-year BCR risk of 50.4% vs 11.9%, log-rank, P < 0.001). CONCLUSIONS Among men with adverse pathology but an undetectable (<0.01 ng/mL) PSA level after RP, the benefits of adjuvant radiation are probably limited except for men with Gleason 8-10 (with PSMs or EPE) or SVI who are at high-risk of early BCR.
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Affiliation(s)
- Ross M Simon
- Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC, USA.,Urology Section, Veterans Affairs Medical Center, Durham, NC, USA
| | - Lauren E Howard
- Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Stephen J Freedland
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William J Aronson
- Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA
| | - Martha K Terris
- Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, GA, USA.,Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Christopher J Kane
- Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA
| | | | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.,Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Adriana C Vidal
- Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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9
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Sanchís-Bonet A, Arribas-Gómez I, Sánchez-Rodríguez C, Sánchez-Chapado M. Evolution of the patient characteristics of candidates for radical prostatectomy and the results obtained with the technique. Actas Urol Esp 2015; 39:78-84. [PMID: 24909335 DOI: 10.1016/j.acuro.2014.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the oncological profile and risk of biochemical recurrence of patients with prostate cancer who underwent radical prostatectomy based on the time period in which the patients were operated. To evaluate the differences in prostate-specific antigen (PSA) at diagnosis of patients with or without biochemical recurrence based on these time periods. MATERIAL AND METHODS Observation carried forward study of a cohort of 972 radical prostatectomies performed during 3 time periods (1994-2000, 2001-2006, 2007-2011). The importance of PSA at diagnosis on the time periods and on biochemical recurrence was assessed using a generalized linear model. The independent predictive behavior of biochemical recurrence was analyzed using Cox regression. RESULTS The median follow-up was 38 (16-76) months. PSA levels at diagnosis were higher in the period 1994-2000 (12.97ng/mL, P<.001). Seventy-two percent of the patients from the period 2007-2011 were diagnosed as clinical stage T1c (P<.001), compared with 55% from the period 1994-2000. The percentage of extracapsular extension in the specimen decreased from 27% to 18% from the period 1994-2000 to the period 2007-2011 (p<.001). The percentage of patients with biochemical recurrence went from 38% to 14% from the first to the third period (P>.001). The difference between PSA levels at diagnosis for the patients with or without biochemical recurrence was independent of the period (P=.84). The period during which surgery was performed was not an independent predictive factor for biochemical recurrence (P=.09). CONCLUSIONS Patients from the 2007-2011 period had less extracapsular disease in the radical prostatectomy. The period was not an independent predictive factor for biochemical recurrence.
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Affiliation(s)
- A Sanchís-Bonet
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - I Arribas-Gómez
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Fundación para la Investigación Biomédica del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - C Sánchez-Rodríguez
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M Sánchez-Chapado
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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10
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Silberstein JL, Eastham JA. Significance and management of positive surgical margins at the time of radical prostatectomy. Indian J Urol 2014; 30:423-8. [PMID: 25378825 PMCID: PMC4220383 DOI: 10.4103/0970-1591.134240] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique.
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Affiliation(s)
| | - James A Eastham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Eisenberg MS, Karnes RJ, Kaushik D, Rangel L, Bergstralh EJ, Boorjian SA. Risk Stratification of Patients with Extraprostatic Extension and Negative Lymph Nodes at Radical Prostatectomy: Identifying Optimal Candidates for Adjuvant Therapy. J Urol 2013; 190:1735-41. [DOI: 10.1016/j.juro.2013.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Manuel S. Eisenberg
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - R. Jeffrey Karnes
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - Dharam Kaushik
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - Laureano Rangel
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - Eric J. Bergstralh
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - Stephen A. Boorjian
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
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12
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Swanson GP, Lerner SP. Positive margins after radical prostatectomy: Implications for failure and role of adjuvant treatment. Urol Oncol 2013; 31:531-41. [DOI: 10.1016/j.urolonc.2011.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 05/20/2011] [Accepted: 06/13/2011] [Indexed: 11/29/2022]
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13
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Fontenot PA, Mansour AM. Reporting positive surgical margins after radical prostatectomy: time for standardization. BJU Int 2013; 111:E290-9. [DOI: 10.1111/j.1464-410x.2012.11640.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Philip A. Fontenot
- Department of Urology; University of Miami Miller School of Medicine; Miami; FL; USA
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14
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Indications for postoperative radiotherapy in patients with prostate cancer after surgery with positive surgical margins. Contemp Oncol (Pozn) 2013; 17:383-8. [PMID: 24592127 PMCID: PMC3934049 DOI: 10.5114/wo.2013.37217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/15/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Prostate cancer is the second most prevalent cancer among men in Poland. The main methods of radical treatment are radical prostatectomy and radiotherapy. In patients who have been correctly qualified for surgery, a positive surgical margin is always an unexpected and undesirable factor. The aim of this prospective study was to evaluate the incidence of positive margins in more than 100 consecutive patients with prostate cancer undergoing radical prostatectomy. MATERIAL AND METHODS The study included 114 patients aged 44-78 years (mean 61.5 years) who underwent surgery for prostate cancer in stage cT1-3N0/M0 (according to the TNM staging system) in the years 2010-2011 in the Clinical Department of Oncological Urology in the Center of Oncology in Bydgoszcz. RESULTS The presence of positive surgical margins was found in 45 (39.47%) patients, and in 20 (17.54%) margins were assessed as close (1-2 mm). Among the patients with positive surgical margins about 22% had biochemical recurrence. Among patients with negative surgical margins 13% of pT2c and 12.5% of pT3a had biochemical recurrence. Patients with positive surgical margins, along with patients diagnosed with tumor extending beyond the prostate (pT3a) or invading seminal vesicles (pT3b), are at an increased risk of recurrence and progression, reaching up to 30-50% over 10 years. The risk is 2-4 times higher than in patients without positive operating margins.
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15
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Prognostic Importance of Small Prostate Size in Men Receiving Definitive Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2012; 84:396-401. [DOI: 10.1016/j.ijrobp.2011.11.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/16/2011] [Accepted: 11/21/2011] [Indexed: 11/24/2022]
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16
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SEER Coding Standards Result in Underestimation of Positive Surgical Margin Incidence at Radical Prostatectomy: Results of a Systematic Audit. J Urol 2011; 186:855-9. [DOI: 10.1016/j.juro.2011.04.079] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Indexed: 11/22/2022]
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17
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Boorjian SA, Tollefson MK, Rangel LJ, Bergstralh EJ, Karnes RJ. Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy. Prostate Cancer Prostatic Dis 2011; 15:56-62. [DOI: 10.1038/pcan.2011.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Affiliation(s)
- M Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
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19
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Somford DM, van Oort IM, Cosyns JP, Witjes JA, Kiemeney LALM, Tombal B. Prognostic relevance of number and bilaterality of positive surgical margins after radical prostatectomy. World J Urol 2011; 30:105-10. [PMID: 21240506 PMCID: PMC3264849 DOI: 10.1007/s00345-010-0641-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 12/29/2010] [Indexed: 11/25/2022] Open
Abstract
Purpose Positive surgical margin (PSM) status following radical prostatectomy (RP) is a well-established prognostic factor. The aim of the present study is to evaluate whether number of PSMs or bilaterality of PSMs might have prognostic significance for biochemical recurrence (BCR) in the population with a PSM status following RP. Methods We evaluated 1,395 RP pathology reports from our center between 1980 and 2006. All patients who underwent (neo)-adjuvant therapy were excluded, leaving a cohort of 1,009 patients, with 249 (24.7%) subjects having a PSM at RP of whom 29.4% had multiple PSMs (≥ 2 sites), while 13.6% had bilateral PSMs. Median follow-up was 40 months (range 0–258 months). We used BCR-free survival as the primary study outcome. BCR was defined as any rise in PSA above or equal to 0.2 ng/ml. Results Of patients with a PSM status, 41% (95% CI: 33–49%) developed BCR within 5 years, compared to 12% (95% CI: 9–15%) in the population without a PSM. Multivariable analysis identified PSA at diagnosis and RP Gleason score as independent predictive factors for BCR. Increasing number and/or bilaterality of PSM did not lead to significant higher rates of BCR. Conclusion In patients with a PSM, the number of positive sites or bilaterality of PSM status does not add prognostic information for risk of BCR. Survival curve slopes were different for patients with bilateral PSM, showing a significant tendency to progress to BCR earlier during follow-up than patients with unilateral PSM.
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Affiliation(s)
- Diederik M Somford
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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20
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Swanson GP, Basler JW. Prognostic factors for failure after prostatectomy. J Cancer 2010; 2:1-19. [PMID: 21197260 PMCID: PMC3005550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 12/06/2010] [Indexed: 11/24/2022] Open
Abstract
Several randomized studies have been completed in prostate cancer that show a benefit to immediate postoperative treatment in patients undergoing prostatectomy. In one of the studies, there was even a survival advantage. In spite of those positive findings, there has been some reluctance to uniformly offer adjuvant treatment to patients. The perception is that the risk is not really high enough to warrant the risk of toxicity that comes with treatment. There are clearly factors that can help predict who is at the highest risk. Our purpose is to review those factors and identify patients that have a high enough risk justifying immediate treatment.
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Affiliation(s)
- Gregory P. Swanson
- 1. Departments of Radiation Oncology, Radiology and Urology, UT Health Science Center San Antonio, San Antonio, TX 78229, USA.,✉ Corresponding author: Gregory P. Swanson, MD, Associate Professor of Radiation Oncology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive MC7889, San Antonio, TX 78229, USA. Tel: 210-450-1109; Fax: 210-450-5085;
| | - Joseph W. Basler
- 2. Department of Urology, UT Health Science Center San Antonio, San Antonio, TX 78229, USA
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21
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Anastasiou I, Tyritzis SI, Adamakis I, Mitropoulos D, Stravodimos KG, Katafigiotis I, Balangas A, Kollias A, Pavlakis K, Constantinides CA. Prognostic factors identifying biochemical recurrence in patients with positive margins after radical prostatectomy. Int Urol Nephrol 2010; 43:715-20. [DOI: 10.1007/s11255-010-9859-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 09/29/2010] [Indexed: 11/29/2022]
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22
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Freedland SJ. Screening, risk assessment, and the approach to therapy in patients with prostate cancer. Cancer 2010; 117:1123-35. [PMID: 20960523 DOI: 10.1002/cncr.25477] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 05/06/2010] [Accepted: 05/10/2010] [Indexed: 12/22/2022]
Abstract
The major challenge in prostate cancer is to identify patients at higher risk of death and to distinguish them from those more likely to die from other causes. Stratification of patients into risk groups can be used to guide management decisions at each disease stage. This review discusses the measures, tools, and nomograms available for risk assessment in prostate cancer. For patients with localized hormone-sensitive disease, the choice is between active surveillance and radical treatment, with focal therapy an emerging option. Current guidelines recommend treatment of patients with a life expectancy ≥10 years, although active surveillance is being used with increasing frequency for low-risk patients, even with a long life expectancy. A number of risk stratification methods have been devised to assess the risk of biochemical recurrence (BCR) after treatment, with prostate-specific antigen (PSA) level, Gleason score, clinical stage, and tumor mass/volume all shown to be predictive of BCR. Among men with BCR after treatment, PSA doubling time (PSADT) was the best predictor of further progression. Although studies in patients with castration-resistant prostate cancer have shown that PSA level and PSADT are associated with a risk of developing metastatic disease, there is currently no clear surrogate for disease progression or overall survival for this patient group and no standard second- or third-line therapy after progression on first-line chemotherapy. The use of newly developed risk-stratification models and markers of disease progression should assist in the earlier identification of disease progression, allowing the optimal treatment of such patients.
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Affiliation(s)
- Stephen J Freedland
- Department of Surgery, Durham VA Medical Center, Duke Prostate Center, Durham, North Carolina 27710, USA.
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23
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Moreira DM, Presti JC, Aronson WJ, Terris MK, Kane CJ, Amling CL, Freedland SJ. Definition and preoperative predictors of persistently elevated prostate-specific antigen after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU Int 2009; 105:1541-7. [PMID: 19912191 DOI: 10.1111/j.1464-410x.2009.09016.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To define a level of persistently elevated prostate-specific antigen (PSA) after radical prostatectomy (RP) that equates with high-risk for disease progression, and to identify preoperative predictors of PSA persistence among men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. PATIENTS AND METHODS A total of 901 men treated with RP between 2001 and 2008 were separated into groups based upon PSA nadir within 6 months after RP. We explored the association between nadir groups and time to biochemical recurrence (BCR) using multivariate Cox proportional hazards and determined the preoperative predictors of PSA persistence using logistic regression. RESULTS Relative to men with undetectable PSA levels, those with a PSA nadir of 0.03 (hazard ratio [HR] 3.88, P < 0.001), 0.04 (HR 4.87, P < 0.001), 0.05-0.09 (HR 12.69, P < 0.001), 0.1-0.19 (HR 13.17, P < 0.001), and 0.2 ng/mL (HR 13.23, P < 0.001) were at increased risk of BCR while men with a nadir of 0.01 (HR 1.36, P = 0.400) and 0.02 (HR 1.64, P = 0.180) were not. Using the PSA persistence definition of a PSA nadir > or = 0.03 ng/mL, 230 men (26%) had persistence. The independent preoperative predictors of PSA persistence were higher body mass index (BMI, P = 0.002), pathological Gleason score (relative to 2-6: 4 + 3-10, P = 0.001) and preoperative PSA level (P < 0.001). CONCLUSIONS Men with a PSA nadir > or = 0.03 ng/mL after RP were at higher risk for BCR. Using a PSA persistence definition of a PSA nadir > or = 0.03 ng/mL, persistence was predicted by known factors associated with aggressive disease (tumour grade, PSA level and BMI). Validation of the present definition in different populations using later end-points remains necessary to assess its prognostic usefulness.
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Affiliation(s)
- Daniel M Moreira
- Division of Urologic Surgery, Department of Surgery, and the Duke Prostate Center, Durham, NC, USA
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Resnick MJ, Canter DJ, Guzzo TJ, Magerfleisch L, Tomaszewski JE, Brucker BM, Bergey MR, Sonnad SS, Wein AJ, Malkowicz SB. Defining pathological variables to predict biochemical failure in patients with positive surgical margins at radical prostatectomy: implications for adjuvant radiotherapy. BJU Int 2009; 105:1377-80. [DOI: 10.1111/j.1464-410x.2009.08953.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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25
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Caire AA, Sun L, Ode O, Stackhouse DA, Maloney K, Donatucci C, Mouraviev V, Polascik TJ, Robertson CN, Albala DM, Moul JW. Delayed Prostate-specific Antigen Recurrence After Radical Prostatectomy: How to Identify and What Are Their Clinical Outcomes? Urology 2009; 74:643-7. [DOI: 10.1016/j.urology.2009.02.049] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 01/30/2009] [Accepted: 02/09/2009] [Indexed: 11/28/2022]
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26
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Jayachandran J, Schroeck F, Sun L, Gerber L, Moreira DM, Moul JW, Freedland SJ. The Shared Equal Access Regional Cancer Hospital (SEARCH) nomogram for risk stratification in intermediate risk group of men with prostate cancer: validation in the Duke Prostate Center database. BJU Int 2009; 105:180-4. [PMID: 19709074 DOI: 10.1111/j.1464-410x.2009.08728.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To validate the Shared Equal Access Regional Cancer Hospital (SEARCH) nomogram to better risk stratify men with intermediate-risk pathology after prostatectomy (positive surgical margins, PSM, and/or extracapsular disease, ECE, without seminal vesicle or lymph node involvement) in a tertiary referral centre (the Duke Prostate Center, DPC). PATIENTS AND METHODS We retrospectively analysed 485 men in the DPC cohort with PSM and/or ECE but without seminal vesicle or lymph node involvement. The predicted risk of biochemical progression-free probability at 1, 3 and 5 years was estimated by the SEARCH and updated Kattan postoperative nomograms. Calibration plots were generated and accuracy assessed with the concordance index. RESULTS The SEARCH nomogram appeared to be well calibrated, with the highest-risk quartile having a predicted <60% progression-free probability at 5 years, vs >80% for the lowest risk. In comparison, overall external calibration appeared to be similar for the updated Kattan nomogram, although there was less separation between the highest- and lowest-risk quartiles. The SEARCH model had an overall predictive accuracy of 0.65, which compared favourably with the updated Kattan nomogram (0.57). CONCLUSION In an external dataset, the SEARCH nomogram to predict progression-free probability for men at intermediate risk after prostatectomy was well calibrated and performed better than the updated postoperative Kattan nomogram.
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Affiliation(s)
- Jayakrishnan Jayachandran
- Division of Urologic Surgery, Department of Surgery, Duke Prostate Center, Duke University School of Medicine, Durham, NC 27710, USA
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Blum DL, Koyama T, M’Koma AE, Iturregui JM, Martinez-Ferrer M, Uwamariya C, Smith JA, Clark PE, Bhowmick NA. Chemokine markers predict biochemical recurrence of prostate cancer following prostatectomy. Clin Cancer Res 2008; 14:7790-7. [PMID: 19047106 PMCID: PMC3050736 DOI: 10.1158/1078-0432.ccr-08-1716] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Stratifying patients who have a high risk of prostate cancer recurrence following prostatectomy can potentiate the use of adjuvant therapy at an early stage. Inflammation has emerged as a mediator of prostate cancer metastatic progression. We hypothesized that chemokines can be biomarkers for distinguishing patients with high risk for biochemical recurrence of prostate cancer. EXPERIMENTAL DESIGN In a nested case-control study, 82 subjects developed biochemical recurrence within 5 years of prostatectomy. Prostate tissues from 98 age-matched subjects who were recurrence-free following prostatectomy in the same period were the controls. A high-throughput lectin-based enrichment of prostate tissue enabled multiplex ELISA to identify the expression of three chemokines to discriminate the two patient populations. RESULTS The expression of CX3CL1 and IL-15 in prostate tissue was associated with 5-year biochemical recurrence-free survival following prostatectomy. However, the expression of chemokine ligand 4 (CCL4) was associated with biochemical recurrence. Multivariable logistic regression model combining preoperative prostate-specific antigen, Gleason score, surgical margin, and seminal vesicle status with the three chemokines doubled the specificity of prediction at 90% sensitivity compared with use of the clinicopathologic variables alone (P < 0.0001). Survival analysis yielded a nomogram that supported the use of CX3CL1, IL-15, and CCL4 in predicting 1-, 3-, and 5-year recurrence-free survival after prostatectomy. CONCLUSIONS Each of the three chemokines can serve as independent predictors of biochemical recurrence. However, the combination of chemokine biomarkers plus clinicopathologic variables discriminated prostatectomy subjects for the probability of biochemical recurrence significantly better than clinicopathologic variables alone.
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Affiliation(s)
- David L. Blum
- Department of Urologic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville TN 37232-2765
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville TN 37232-2765
| | - Amosy E. M’Koma
- Department of Urologic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville TN 37232-2765
| | - Juan M. Iturregui
- Department of Pathology, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville TN 37232-2765
| | - Magaly Martinez-Ferrer
- Department of Urologic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville TN 37232-2765
| | - Consolate Uwamariya
- Department of Urologic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville TN 37232-2765
| | - Joseph A. Smith
- Department of Urologic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville TN 37232-2765
| | - Peter E. Clark
- Department of Urologic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville TN 37232-2765
| | - Neil A. Bhowmick
- Department of Urologic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville TN 37232-2765
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