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Stankovic M, Wolff L. The Impact of Prostate Volume in Open Radical Prostatectomy: A Single Centre Experience. Clin Genitourin Cancer 2024; 22:7-13. [PMID: 37349164 DOI: 10.1016/j.clgc.2023.06.005] [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: 01/13/2023] [Revised: 03/24/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Even the most experienced surgeons experience technical difficulties and challenges when operating on very large prostates, regardless of surgical technique. Our goal was to determine whether preoperative prostate volume has an impact on functional and oncological outcomes after open radical prostatectomy. MATERIALS AND METHODS We reviewed the records of 909 patients who underwent open radical prostatectomy by a single surgeon at our institution. Variables were compared across quartile distributions of prostate volume as defined by preoperative transrectal ultrasound examination, including group A with prostate volume < 30ccm 3, group B with prostate volume ≥ 30ccm 3 and < 50ccm 3, group C with prostate volume ≥ 50ccm 3 and < 70ccm 3 and group D with prostate volume ≥ 70ccm3. Factors assessed in this analysis were patient age, preoperative prostate specific antigen (p-PSA), Gleason score, pathological stage, margin status, operative time, cystography leakage, early continence, biochemical recurrence (BCR)-free, and overall-survival (OS). The complication rates were classified using Clavien Dindo classification. RESULTS There were no statistically relevant differences between the groups considering preoperative factors such as age, p-PSA, Gleason score, and tumor stadium. Patients with a very large prostate had slightly higher percentage of anastomosis leakage, severe Clavien Dindo complication rates (≥ 3), longer operation time and severe early incontinence (IV°) rates, simultaneously having lower positive margin rates. Nevertheless, the early continence rates, BCR-free and OS were similar regardless of the prostate size. CONCLUSIONS open radical prostatectomy for patients with very large prostate is a viable therapy option with slightly higher urinary leakage-, early incontinence- and complication-rates that takes slightly more operation time. However, the functional and oncological outcomes are similar when compared to smaller prostates.
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Affiliation(s)
- Mladen Stankovic
- Department of Urology, Salem Hospital, Academic Hospital -University of Heidelberg, Heidelberg, Germany.
| | - Laura Wolff
- Department of Urology, Salem Hospital, Academic Hospital -University of Heidelberg, Heidelberg, Germany
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Masui K, Katayama N, Yorozu A, Kikuchi T, Higashide S, Kojima S, Saito S. The prognosis of patients with prostate cancer receiving permanent seed implantation stratified by prostate volume: Should we be reluctant to treat with brachytherapy because of a very small prostate (<15 cc)? Radiother Oncol 2023; 188:109855. [PMID: 37597804 DOI: 10.1016/j.radonc.2023.109855] [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: 06/02/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE We evaluated the treatment outcomes of different prostate volumes (PVs), <15 cc, 15-20 cc, and > 20 cc, in patients with prostate cancer who underwent permanent seed implantation (PI) ± external beam radiation therapy ± hormone therapy in a national Japanese prospective cohort study (J-POPS). METHODS AND MATERIALS Of the 6721 patients in J-POPS from 2005 to 2011, 6652 were included in the analysis population. We categorized the patients into the following three PV groups: <15 cc, 15-20 cc, and > 20 cc. We evaluated the effect of PV on biochemical freedom from failure (bFFF), prostate cancer-specific mortality (PCSM), and all-cause mortality (ACM) using the Phoenix definition and Cox proportional hazard models. RESULTS The median follow-up period was 60.0 months. Patients in each PV group was 491 (7.4%), 1118 (16.8%), and 5043 (75.8%), respectively. No difference was observed in bFFF (94.7%, 96.2%, and 95.7%, p = 0.407), PCSM (99.8%, 99.7%, and 99.8%, p = 0.682), and ACM (98.2%, 96.7%, and 97.2%, p = 0.119) at 5 years for each PV group. In univariate and multivariate analyses, PV was not associated with bFFF, PCSM, ACM, or grade 2 toxicity. The percentage of positive biopsies was the single most significant predictor for all treatment outcomes. CONCLUSIONS Our results obtained by analyzing a very large Japanese prospective database showed no difference in treatment outcomes according to PV (<15 cc, 15-20 cc, and ˃20 cc). Our study confirmed that PI in small prostates (even < 15 cc) remains an effective treatment option.
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Affiliation(s)
- Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Norihisa Katayama
- Department of Radiology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | | | | | | | - Shiro Saito
- Department of Urology, Ofuna Chuo Hospital, Kanagawa, Japan
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Ruan X, Huang D, Huang J, Tsu JHL, Na R. Genetic risk assessment of lethal prostate cancer using polygenic risk score and hereditary cancer susceptibility genes. J Transl Med 2023; 21:446. [PMID: 37415201 PMCID: PMC10327136 DOI: 10.1186/s12967-023-04316-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The genetic risk of aggressive prostate cancer (PCa) is hard to be assessed due to the lack of aggressiveness-related single-nucleotide polymorphisms (SNPs). Prostate volume (PV) is a potential well-established risk factor for aggressive PCa, we hypothesize that polygenic risk score (PRS) based on benign prostate hyperplasia (BPH) or PV-related SNPs may also predict the risk of aggressive PCa or PCa death. METHODS We evaluated a PRS using 21 BPH/PV-associated SNPs, two established PCa risk-related PRS and 10 guideline-recommended hereditary cancer risk genes in the population-based UK Biobank cohort (N = 209,502). RESULTS The BPH/PV PRS was significantly inversely associated with the incidence of lethal PCa as well as the natural progress in PCa patients (hazard ratio, HR = 0.92, 95% confidence interval [CI]: 0.87-0.98, P = 0.02; HR = 0.92, 95% CI 0.86-0.98, P = 0.01). Compared with men at the top 25th PRS, PCa patients with bottom 25th PRS would have a 1.41-fold (HR, 95% CI 1.16-1.69, P = 0.001) increased PCa fatal risk and shorter survival time at 0.37 yr (95% CI 0.14-0.61, P = 0.002). In addition, patients with BRCA2 or PALB2 pathogenic mutations would also have a high risk of PCa death (HR = 3.90, 95% CI 2.34-6.51, P = 1.79 × 10-7; HR = 4.29, 95% CI 1.36-13.50, P = 0.01, respectively). However, no interactive but independent effects were detected between this PRS and pathogenic mutations. CONCLUSIONS Our findings provide a new measurement of PCa patients' natural disease outcomes via genetic risk ways.
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Affiliation(s)
- Xiaohao Ruan
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jingyi Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - James Hok-Leung Tsu
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Rong Na
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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4
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Detection of clinically significant prostate cancer by transperineal multiparametric magnetic resonance imaging-ultrasound fusion targeted prostate biopsy in smaller prostates. Urol Oncol 2022; 40:451.e9-451.e14. [DOI: 10.1016/j.urolonc.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/20/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
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5
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Sellers J, Ward E, Weaver P, Garza J, Brandi L, de Riese WTW. Association of prostate size with capsule thickness and glandular epithelial cell density: The possible clinical implications on prostate cancer development. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221086399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the two most common urologic diseases in aging males. The negative association between prostate/BPH size and incidence of PCa is well documented in the literature. However, the exact mechanism is not well understood. This study aims to further investigate the possible effect of prostate volume on prostate capsule thickness and glandular cell density in the prostatic peripheral zone (PZ). Materials and Methods: A total of 100 patients were selected that had undergone radical prostatectomy with prostate sizes ranging from 20 to 160 mL. Quantitative measurements of capsule thickness and density of epithelial glands within the peripheral zone not affected by cancer were analysed and calculated on histo-anatomical slides using computer-based imaging software. Associations between the different variables were calculated using Spearman correlation with 95% confidence intervals (CIs). Results: In the non-cancerous areas of the PZ, prostate volume and average capsule thickness are positively associated ( rs = +0.6526, 95% CI +0.5233 to +0.7526, p < 0.0001), while prostate volume and average glandular epithelial cell density of the PZ are negatively associated ( rs = −0.6011, 95% CI −0.7133 to −0.4589, p < 0.0001). These associations remain consistent on subgroup analysis. Conclusion: The findings of this study support the hypothesis that transition zone (TZ) growth in large BPH prostates may cause pressure on the outer PZ, leading to fibrosis and atrophy of the glandular tissue. This may provide a protective effect against PCa, as most PCa originates in the PZ of the prostate. Level of evidence: Not applicable
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Affiliation(s)
- Jake Sellers
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, USA
| | - Ellen Ward
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, USA
| | - Preston Weaver
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, USA
| | - John Garza
- Department of Mathematics, The University of Texas Permian Basin, USA
| | - Luis Brandi
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, USA
| | - Werner TW de Riese
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, USA
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Yang L, Li M, Zhang MN, Yao J, Song B. Association of prostate zonal volume with location and aggressiveness of clinically significant prostate cancer: A multiparametric MRI study according to PI-RADS version 2.1. Eur J Radiol 2022; 150:110268. [PMID: 35344914 DOI: 10.1016/j.ejrad.2022.110268] [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: 01/23/2022] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The relationship between prostate cancer (PCa) and benign prostatic hyperplasia (BPH) remains unclear. This study aimed to determine whether prostate zonal volume was associated with the location and aggressiveness of PCa. METHODS 412 PCa patients were retrospectively enrolled. The volumes of the whole prostate (V) and transition zone (Vtz) were calculated by the prolate ellipsoid formula, and volume of the peripheral zone (Vpz) was calculated by their subtraction. Locations of PCa were divided into three categories, including peripheral zone (PZ), transition zone (Vtz) and mixed zone group. The mixed zone group was further divided into PZ-dominated, TZ-dominated and equally distributed subgroups. RESULTS The Vtz of Gleason score (GS) 3 + 4 group was the largest, while the Vpz of GS 9 group was the largest. Tumor diameters of the PZ and TZ groups were weakly correlated with their corresponding zonal volume (r = 0.261, p < 0.001; r = 0.311, p = 0.009, respectively). There was no significant difference in the zonal volumes and GS distribution among the location groups. The proportion of tumors with high-grade GS of 8 and 9 was higher in the PZ than that in the TZ group (38.5 vs 24.3%, p = 0.041). For tumors located in the TZ, the V and Vpz of tumors with high-grade GS were larger than those in the low-grade GS of 7 group (p = 0.033 and 0.039, respectively). Among the subgroups of mixed zone group, the Vtz of the TZ-dominated group was larger than those of PZ-dominated and equally distributed groups (p = 0.016 and 0.001, respectively). CONCLUSION PCa with high-grade GS is more likely to have a relatively larger Vpz and involve PZ, while PCa with a larger Vtz is more likely to be with low-grade GS, which support the theoretical model that pressure exerted by increasing prostate size/mechanical deformation may inhibit PCa growth from the clinical point. However, the increase in zonal volume might not be the direct cause of tumorigenesis and aggressiveness.
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Affiliation(s)
- Ling Yang
- Department of Radiology, West China Hospital of Sichuan University, 37# Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, China
| | - Mou Li
- Department of Radiology, West China Hospital of Sichuan University, 37# Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, China
| | - Meng-Ni Zhang
- Department of Pathology, West China Hospital of Sichuan University, 37# Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, China
| | - Jin Yao
- Department of Radiology, West China Hospital of Sichuan University, 37# Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, China.
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, 37# Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, China.
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Barlow SK, Oyekunle T, Janes JL, De Hoedt AM, Aronson WJ, Kane CJ, Amling CL, Cooperberg MR, Klaassen ZW, Terris MK, Freedland SJ, Csizmadi I. Prostate weight and prostate cancer outcomes after radical prostatectomy: Results from the SEARCH cohort study. Prostate 2022; 82:366-372. [PMID: 34905632 DOI: 10.1002/pros.24283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/16/2021] [Accepted: 12/03/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Smaller prostates have been linked to unfavorable clinical characteristics and poor short-term outcomes following radical prostatectomy (RP). We examined the relation between prostate weight at RP and prostate cancer (PC) outcomes post-RP. METHODS Men in the SEARCH cohort undergoing RP between 1988 and 2017 (N = 6242) were studied for PC-specific mortality (PCSM) as the primary outcome, and for biochemical recurrence (BCR), castration-resistant PC (CRPC) and metastasis as secondary outcomes. Hazard ratios (HR) and 95% confidence intervals (CI) were determined for associations between prostate weight and outcomes using Fine-Gray competing risk regression multivariable analyses. Sensitivity analyses were also carried out following exclusion of: (i) men with extreme prostate weights (<20 g and ≥100 g); and (ii) men with elevated prostate specific antigen (PSA) levels. RESULTS Median values for age, pre-RP PSA and prostate weight were 63 years, 6.6 ng/ml, and 42.0 g, respectively. During a median follow-up of 7.9 years, 153 (3%) died from PC, 2103 (34%) had BCR, 203 (3%) developed CRPC, and 289 (5%) developed metastases. Prostate weight was not associated with PCSM in the main analyses (multivariable HR = 1.43; 95% CI: 0.87-2.34) or in sensitivity analyses. Prostate weight was inversely associated with BCR in the main analyses (multivariable HR = 0.70; 95%CI: 0.61-0.79) which was unchanged in sensitivity analyses. HRs for prostate weight and CRPC and metastasis were elevated but statistical significance was not attained. Similar results were observed in sensitivity analyses. CONCLUSIONS Inconsistent results for prostate weight and short-term vs longer-term outcomes highlight the need to better understand the complex biology leading to prostate size and the relevance of prostate size as a predictor of PC outcomes.
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Affiliation(s)
- Sean Kennedy Barlow
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Taofik Oyekunle
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute Biostatistics Shared Resource, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jessica L Janes
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Amanda M De Hoedt
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - William J Aronson
- Department of Urology, University of California Los Angeles Medical Center, Los Angeles, California, USA
- Division of Urology, Wadsworth Veterans Affairs Medical Center, Los Angeles, California, USA
| | - Christopher J Kane
- Department of Urology, University of California San Diego Health System, San Diego, California, USA
- Division of Urology, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Christopher L Amling
- Department of Urology, Oregon Health and Science University, Portland, Oregon, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California San Francisco Medical Center, San Francisco, California, USA
- Division of Urology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Zachary W Klaassen
- Department of Surgery, Augusta University, Augusta, Georgia, USA
- Division of Urology, Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Martha K Terris
- Department of Surgery, Augusta University, Augusta, Georgia, USA
- Division of Urology, Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Stephen J Freedland
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, USA
| | - Ilona Csizmadi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, USA
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8
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Yamashiro JR, de Riese WTW. Any Correlation Between Prostate Volume and Incidence of Prostate Cancer: A Review of Reported Data for the Last Thirty Years. Res Rep Urol 2021; 13:749-757. [PMID: 34676178 PMCID: PMC8518471 DOI: 10.2147/rru.s331506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/30/2021] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Prostate cancer (PCa) is the most common non-skin cancer in men worldwide and more than 80% of men with PCa also have histo-anatomical findings of benign prostate hyperplasia (BPH). It is well documented that BPH develops in the transition zone (TZ), whereas 80-85% of PCa originates in the peripheral zone (PZ) of the prostate. Possible causal links between both disease entities are controversially discussed in the current literature. Some studies have reported that larger prostates have a decreased incidence of PCa compared to smaller prostates. The purpose of this systematic review is to comprehensively summarize studies analyzing any association between prostate gland volume and incidence of PCa. METHODS A thorough literature review was performed between 01.01.1990 through 02.28.2020 using PubMed and applying the "PRISMA" guidelines. Inclusion and exclusion criteria were defined. RESULTS Our systematic review found 41 articles reporting an inverse (negative) relationship between prostate gland volume and incidence of prostate cancer. Sample sizes ranged from 114 to 6692 patients in these single institutional and multi-institutional studies. Thirty-nine (95%) of the 41 articles showed a statistically significant inverse relationship. In our search, no study was found showing a positive correlation between BPH size and the incidence of PCa. CONCLUSION To our knowledge, this is the first systematic review on the important clinical question of interaction between prostate size and the incidence of PCa. The results are demonstrating an inverse relationship, and therefore reveal strong evidence that large prostates may be protective of PCa when compared to smaller prostates.
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Affiliation(s)
- Justine R Yamashiro
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Werner T W de Riese
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Nandalur KR, Colvin R, Walker D, Nandalur SR, Seifman B, Gangwish D, Hafron J. Benign prostate hyperplasia as a potential protective factor against prostate cancer: Insights from a magnetic resonance imaging study of compositional characteristics. Prostate 2021; 81:1097-1104. [PMID: 34375453 DOI: 10.1002/pros.24207] [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] [Received: 06/29/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE The structural relationship between benign prostate hyperplasia (BPH) and prostate cancer (Pca) is controversial. The purpose of our study was to examine the association between quantitative prostate compositional metrics by magnetic resonance imaging (MRI) and Pca. METHODS We identified 405 patients who underwent prostate MRI and biopsy and/or prostatectomy from January 2019 to January 2021 at our institution. Segmentation volumetric methods were used to assess central gland (CG) and peripheral zone (PZ) volume. PZ mean thickness and mean apparent diffusion coefficient (ADC), marker of underlying histologic components, were measured. Multivariable logistic regression was performed with outcomes of ≥Grade Group (GG) 2 Pca and for multifocal disease. RESULTS On multivariable analysis, higher CG volumes were at lower odds of ≥GG2 disease (n = 227) (OR: 0.97, 95% CI 0.96-0.98, p < 0.0001), taking into account PZ volume (p = 0.18) and thickness (p = 0.70). For every one cc increase in CG volume, there was an approximately 3% decrease in odds of ≥GG2 disease. Similar findings were noted for multifocal disease (n = 180) (OR: 0.97, 95% CI 0.96-0.98, p < 0.0001). Notably, ADC of the normal PZ was not significantly associated with CG volume (p = 0.21) nor a predictor of disease (p = 0.49). CONCLUSIONS Increasing central gland volume, driven by BPH, is associated with lower odds of significant Pca, including multifocal disease, while PZ anatomic and histologic surrogate changes were noncontributory. Findings support BPH impediment of global tumor growth predicted by theoretical mechanobiological model. This potential stabilizing factor should be further studied for risk stratification and in consideration for BPH therapy.
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Affiliation(s)
- Kiran R Nandalur
- Department of Radiology and Molecular Imaging, Oakland University William Beaumont Hospital School of Medicine, Royal Oak, Michigan, USA
| | - Robert Colvin
- Department of Radiology and Molecular Imaging, Oakland University William Beaumont Hospital School of Medicine, Royal Oak, Michigan, USA
| | - David Walker
- Department of Radiology and Molecular Imaging, Oakland University William Beaumont Hospital School of Medicine, Royal Oak, Michigan, USA
| | - Sirisha R Nandalur
- Department of Radiation Oncology, Oakland University William Beaumont Hospital School of Medicine, Royal Oak, Michigan, USA
| | - Brian Seifman
- Department of Urology, Oakland University William Beaumont Hospital School of Medicine, Royal Oak, Michigan, USA
| | - David Gangwish
- Department of Urology, Oakland University William Beaumont Hospital School of Medicine, Royal Oak, Michigan, USA
| | - Jason Hafron
- Department of Urology, Oakland University William Beaumont Hospital School of Medicine, Royal Oak, Michigan, USA
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Sellers J, Wagstaff RG, Helo N, de Riese WTW. Quantitative measurements of prostatic zones by MRI and their dependence on prostate size: possible clinical implications in prostate cancer. Ther Adv Urol 2021; 13:17562872211000852. [PMID: 33868460 PMCID: PMC8020739 DOI: 10.1177/17562872211000852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022] Open
Abstract
AIM Many studies support an inverse relationship between benign prostate hypertrophy (BPH) size and incidence of prostate cancer (PCa), but the causal link between these conditions is poorly understood. Recent studies suggest that a growing transition zone (TZ) in the prostate may induce pressure on the outer peripheral zone (PZ), leading to atrophy of the glandular tissue where PCa often originates, providing a possible explanation for this interaction. To further investigate this phenomenon, our pilot study uses magnetic resonance imaging (MRI) to examine quantitative zonal changes in a consecutive cohort of prostates. METHODS MRI scans of male patients [n = 204, 61.57 ± 13.90 years, average body mass index (BMI) 29.05 kg/m2] with various prostate sizes were analyzed statistically to identify possible associations between prostate parameters, such as total prostate volume (TPV) and peripheral zone thickness (PZT). RESULTS TPV and PZT demonstrated a weak, inverse correlation (r = -0.21, p = 0.002). However, when examining the plotted data, the relationship between TPV and PZT was significantly different when the cohort was divided into two groups; lower TPV: ⩽87.5 ml (n = 188, TPV x- = 36.01 ± 18.18 ml), and higher TPV: >87.5 ml (n = 17, TPV x- = 125.69 ± 41.13 ml). Average PZT differed significantly between these groups (z = -3.5554, p = 0.0004). CONCLUSIONS PZT was significantly different for patients with lower versus higher TPVs, suggesting that, above a certain point of BPH growth, the PZ is unable to withstand pressure from an expanding TZ, supporting the notion that growing BPH causes compression of the PZ glandular tissue, and, therefore, BPH may be protective against PCa.
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Affiliation(s)
- Jake Sellers
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rachel G. Wagstaff
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Naseem Helo
- Department of Radiology, University Medical Center, Lubbock, TX, USA
| | - Werner T. W. de Riese
- Department of Urology, Texas Tech University Health Sciences Center – School of Medicine, 3601 4th Street, Lubbock, TX 79430-7260, USA
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Comparison of Transabdominal and Transrectal Ultrasound for Sizing of the Prostate. Urology 2020; 141:125-129. [PMID: 32333985 DOI: 10.1016/j.urology.2020.04.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the accuracy of prostate sizing between pelvic abdominal (PUS) and transrectal (TRUS) ultrasound in a large, diverse cohort of men at our institution. Prostate volume plays a vital role in all types of prostate disease. American Urological Association guidelines (2018) for surgical management of benign prostatic hyperplasia now include consideration of prostate volume measurement prior to surgical intervention. Ultrasound is a quick and radiation-free imaging modality. METHODS We performed a single-center, retrospective study of 299 patients with prostate sizing between January 1, 2012 and August 31, 2017. Prostate volume was derived from ellipsoid volume calculation using dimensions measured on ultrasound. PUS and TRUS were compared by calculating the Pearson correlation coefficient and intraclass correlation coefficient, and agreement between modalities assessed using the Bland Altman analysis. This analysis was done for the whole sample population as well as for specific groupings according to body mass index, prostate size, and time between exams. RESULTS A total of 236 patients had PUS followed by TRUS and met study inclusion criteria. Median age was 63, median prostate specific antigen value prior to PUS was 7.6 ng/mL, and only 20% were white. Mean volume differences between the two modalities for the data (volPUS - volTRUS) were (-0.3 ± 1.1) cm3. Bland-Altman analysis showed agreement between PUS and TRUS only for prostates ≤ 30 cm3. CONCLUSION For prostates less than 30 cc, we found that PUS is interchangeable with TRUS in estimating prostate volume. However, for larger prostates where size may alter surgical management, we would recommend TRUS or cross-sectional imaging.
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Olde Heuvel J, de Wit-van der Veen BJ, Vyas KN, Tuch DS, Grootendorst MR, Stokkel MPM, Slump CH. Performance evaluation of Cerenkov luminescence imaging: a comparison of 68Ga with 18F. EJNMMI Phys 2019; 6:17. [PMID: 31650365 PMCID: PMC6813407 DOI: 10.1186/s40658-019-0255-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/27/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cerenkov Luminescence Imaging (CLI) is an emerging technology for intraoperative margin assessment. Previous research only evaluated radionuclide 18-Fluorine (18F); however, for future applications in prostate cancer, 68-Gallium (68Ga) seems more suitable, given its higher positron energy. Theoretical calculations predict that 68Ga should offer a higher signal-to-noise ratio than 18F; this is the first experimental confirmation. The aim of this study is to investigate the technical performance of CLI by comparing 68Ga to 18F. RESULTS The linearity of the system, detection limit, spatial resolution, and uniformity were determined with the LightPath imaging system. All experiments were conducted with clinically relevant activity levels in vitro, using dedicated phantoms. For both radionuclides, a linear relationship between the activity concentration and detected light yield was observed (R2 = 0.99). 68Ga showed approximately 22 times more detectable Cerenkov signal compared to 18F. The detectable activity concentration after a 120 s exposure time and 2 × 2 binning of 18F was 23.7 kBq/mL and 1.2 kBq/mL for 68Ga. The spatial resolution was 1.31 mm for 18F and 1.40 mm for 68Ga. The coefficient of variance of the uniformity phantom was 0.07 for the central field of view. CONCLUSION 68Ga was superior over 18F in terms of light yield and minimal detection limit. However, as could be expected, the resolution was 0.1 mm less for 68Ga. Given the clinical constraints of an acquisition time less than 120 s and a spatial resolution < 2 mm, CLI for intraoperative margin assessment using 68Ga could be feasible.
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Affiliation(s)
- J Olde Heuvel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands. .,Robotics and Mechatronics , Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | | | - K N Vyas
- Lightpoint Medical Ltd, Misbourne Works, Waterside, Chesham, HP5 1PE, UK
| | - D S Tuch
- Lightpoint Medical Ltd, Misbourne Works, Waterside, Chesham, HP5 1PE, UK
| | - M R Grootendorst
- Lightpoint Medical Ltd, Misbourne Works, Waterside, Chesham, HP5 1PE, UK
| | - M P M Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C H Slump
- Robotics and Mechatronics , Technical Medical Centre, University of Twente, Enschede, The Netherlands
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13
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Computer simulations suggest that prostate enlargement due to benign prostatic hyperplasia mechanically impedes prostate cancer growth. Proc Natl Acad Sci U S A 2019; 116:1152-1161. [PMID: 30617074 DOI: 10.1073/pnas.1815735116] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Prostate cancer and benign prostatic hyperplasia are common genitourinary diseases in aging men. Both pathologies may coexist and share numerous similarities, which have suggested several connections or some interplay between them. However, solid evidence confirming their existence is lacking. Recent studies on extensive series of prostatectomy specimens have shown that tumors originating in larger prostates present favorable pathological features. Hence, large prostates may exert a protective effect against prostate cancer. In this work, we propose a mechanical explanation for this phenomenon. The mechanical stress fields that originate as tumors enlarge have been shown to slow down their dynamics. Benign prostatic hyperplasia contributes to these mechanical stress fields, hence further restraining prostate cancer growth. We derived a tissue-scale, patient-specific mechanically coupled mathematical model to qualitatively investigate the mechanical interaction of prostate cancer and benign prostatic hyperplasia. This model was calibrated by studying the deformation caused by each disease independently. Our simulations show that a history of benign prostatic hyperplasia creates mechanical stress fields in the prostate that impede prostatic tumor growth and limit its invasiveness. The technology presented herein may assist physicians in the clinical management of benign prostate hyperplasia and prostate cancer by predicting pathological outcomes on a tissue-scale, patient-specific basis.
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14
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An JY, Harmon SA, Mehralivand S, Czarniecki M, Smith CP, Peretti JA, Wood BJ, Pinto PA, Choyke PL, Shih JH, Turkbey B. Evaluating the size criterion for PI-RADSv2 category 5 upgrade: is 15 mm the best threshold? Abdom Radiol (NY) 2018; 43:3436-3444. [PMID: 29752491 PMCID: PMC7983163 DOI: 10.1007/s00261-018-1631-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was to determine if the ≥ 15 mm threshold currently used to define PIRADS 5 lesions is the optimal size threshold for predicting high likelihood of clinically significant (CS) cancers. MATERIALS Three hundred and fifty-eight lesions that may be changed from category 4 to 5 or vice versa on the basis of the size criterion (category 4: n = 288, category 5: n = 70) from 255 patients were evaluated. Kendall's tau-b statistic accounting for inter-lesion correlation, generalized estimation equation logistic regression, and receiver operating curve analysis evaluated two lesion size-metrics (lesion diameter and relative lesion diameter-defined as lesion diameter/prostate volume) for ability to identify CS (Gleason grade ≥ 3 + 4) cancer at targeted biopsy. Optimal cut-points were identified using the Youden index. Analyses were performed for the whole prostate (WP) and zone-specific sub-cohorts of lesions in the peripheral and transition zones (PZ and TZ). RESULTS Lesion diameter showed a modest correlation with Gleason grade (WP: τB = 0.21, p < 0.0001; PZ: τB = 0.13, p = 0.02; TZ: τB = 0.32, p = 0.001), and association with CS cancer detection (WP: AUC = 0.63, PZ: AUC = 0.59, TZ: AUC = 0.74). Empirically derived thresholds (WP: 14 mm, PZ: 13 mm, TZ: 16 mm) performed similarly to the current ≥ 15 mm standard. Lesion relative lesion diameter improved identification of CS cancers compared to lesion diameter alone (WP: τB = 0.30, PZ: τB = 0.24, TZ: τB = 0.42, all p < 0.0001). AUC also improved for WP and PZ lesions (WP: AUC = 0.70, PZ: AUC = 0.68, and TZ: AUC = 0.74). CONCLUSIONS The current ≥ 15 mm diameter threshold is a reasonable delineator of PI-RADS category 4 and category 5 lesions in the absence of extraprostatic extension to predict CS cancers. Additionally, relative lesion diameter can improve identification of CS cancers and may serve as another option for distinguishing category 4 and 5 lesions.
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Affiliation(s)
- Julie Y An
- Center for Interventional Oncology, NIH Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Stephanie A Harmon
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc, NCI Campus at Frederick, 1050 Boyle Street, Frederick, MD, USA
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
| | - Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA
| | - Clayton P Smith
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA
| | - Julie A Peretti
- Center for Interventional Oncology, NIH Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, NIH Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA
| | - Joanna H Shih
- Biometric Research Program, National Cancer Institute, National Institutes of Health, 6130 Executive Plaza, Rockville, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA.
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15
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Yang R, Cao K, Han T, Zhang YF, Zhang GT, Xu LF, Lian HB, Li XG, Guo HQ. Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy. Asian J Androl 2018; 19:468-472. [PMID: 27004537 PMCID: PMC5507095 DOI: 10.4103/1008-682x.173444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study was designed to define possible preoperative predictors of positive surgical margin after laparoscopic radical prostatectomy. We retrospectively analyzed the records of 296 patients with prostate cancer diagnosed by prostate biopsy, and eventually treated with laparoscopic radical prostatectomy. The prognostic impact of age, prostate volume, preoperative prostate-specific antigen, biopsy Gleason score, maximum percentage tumor per core, number of positive cores, biopsy perineural invasion, capsule invasion on imaging, and tumor laterality on surgical margin was assessed. The overall positive surgical margin rate was 29.1%. Gleason score, number of positive cores, perineural invasion, tumor laterality in the biopsy specimen, and prostate volume significantly correlated with risk of positive surgical margin by univariate analysis (P < 0.05). Gleason score (odds ratio [OR] = 2.286, 95% confidence interval [95% CI] = 1.431–3.653, P = 0.001), perineural invasion (OR = 4.961, 95% CI = 2.656–9.270, P < 0.001), and number of positive cores (OR = 4.403, 95% CI = 1.878–10.325, P = 0.001) were independent predictors of positive surgical margin at the multivariable logistic regression analysis. Patients with perineural invasion, higher biopsy Gleason scores and/or a large number of positive cores in biopsy pathology had more possibility of capsule invasion. The positive surgical margin rate in patients with capsule invasion (49.5%) was much higher than that with localized disease (17.8%). In contrast, prostate volume showed a protective effect against positive surgical margin (OR = 0.572, 95% CI = 0.346–0.945, P = 0.029). Gleason score, perineural invasion, and number of positive cores in the biopsy specimen were preoperative independent predictors of positive surgical margin after laparoscopic radical prostatectomy while prostate volume was a protective factor against positive surgical margin.
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Affiliation(s)
- Rong Yang
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Kai Cao
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Tao Han
- Department of Urology, Nanjing Children's Hospital, Nanjing 210008, China
| | - Yi-Feng Zhang
- Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Gu-Tian Zhang
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Lin-Feng Xu
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Hui-Bo Lian
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xiao-Gong Li
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Hong-Qian Guo
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
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Boibessot C, Toren P. Sex steroids in the tumor microenvironment and prostate cancer progression. Endocr Relat Cancer 2018; 25:R179-R196. [PMID: 29317479 DOI: 10.1530/erc-17-0493] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/08/2018] [Indexed: 12/30/2022]
Abstract
Prostate cancer is uniquely dependent on androgens. Despite years of research on the relationship between androgens and prostate cancer, many questions remain as to the biological effects of androgens and other sex steroids during prostate cancer progression. This article reviews the clinical and basic research on the influence of sex steroids such as androgens, estrogens and progesterone within the prostate tumor microenvironment on the progression of prostate cancer. We review clinical studies to date evaluating serum sex steroids as prognostic biomarkers and discuss their respective biological effects within the prostate tumor microenvironment. We also review the link between genomic alterations and sex steroid levels within prostate tumors. Finally, we highlight the links between sex steroid levels and the function of the immune system within the tumor microenvironment. As the context of treatment of lethal prostate cancer evolves over time, an understanding of this underlying biology remains central to developing optimal treatment approaches.
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Affiliation(s)
- Clovis Boibessot
- Department of SurgeryLaval University, Quebec City, Quebec, Canada
| | - Paul Toren
- Department of SurgeryLaval University, Quebec City, Quebec, Canada
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17
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Demura T, Takada T, Shimoda N, Hioka T, Iwaguchi Y, Ichihara S, Gotoda H. Mechanism underlying the negative effect of prostate volume on the outcome of extensive transperineal ultrasound-guided template prostate biopsy. Cancer Med 2018; 7:336-343. [PMID: 29341453 PMCID: PMC5806096 DOI: 10.1002/cam4.1300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 12/29/2022] Open
Abstract
Previous studies have indicated a possible relationship between increased prostate volume (PV) and decreased biopsy yield, although the mechanism involved is unclear. We evaluated 1650 patients who underwent template biopsy. The distribution of 993 cancer lesions in 302 prostatectomy specimens was compared with the biopsy data to determine whether each lesion was detected. A receiver operating characteristic (ROC) model was used to determine the diagnostic accuracy of prostate-specific antigen (PSA) and related markers. A medical record number (MRN) was used as a negative control. The cancer positive rate did not change as PSA increased in patients with PV ≥50 mL (P = 0.466), although it increased as PSA increased in patients with PV<50 mL (P = 0.001). The detection rate of cancer lesions decreased as the diameter of the lesions decreased (P = 0.018), but remained unchanged with respect to PV. The diameters of the maximum lesions in patients with PV ≥ 50 mL were significantly smaller than those in patients with PV<50 mL (P = 0.003). In patients with PV ≥ 50 mL, the areas under the ROC curves for PSA-related markers did not differ significantly from that for MRN, although they were significantly greater than that for MRN in patients with PV<50 mL (P < 0.001). These results suggest that an increase in PV is associated with a decrease in size and detectability of cancer lesions resulting in a decrease in biopsy yield. Loss of diagnostic accuracy of markers in patients with PV ≥ 50 mL indicates a decrease in serum levels of PSA produced by prostate cancer, which suggests growth inhibition of the cancer.
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Affiliation(s)
| | - Takenori Takada
- Terrestrial EcologyGraduate School of Environmental Earth ScienceHokkaido UniversitySapporoJapan
| | - Naohiko Shimoda
- Department of UrologySapporo Kosei General HospitalSapporoJapan
| | - Takaya Hioka
- Department of UrologySapporo Kosei General HospitalSapporoJapan
| | - Yoshihumi Iwaguchi
- Department of Clinical PathologySapporo Kosei General HospitalSapporoJapan
| | - Shin Ichihara
- Department of Clinical PathologySapporo Kosei General HospitalSapporoJapan
| | - Hiroko Gotoda
- Department of Clinical PathologySapporo Kosei General HospitalSapporoJapan
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18
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Yang T, Zhang L, Chen Y, Cai Y, Jiang H, Ding Q. The predictive efficacy of hypoechoic lesion in ultrasound for prostate cancer in Chinese people: five-year experience in a moderated 10-core transperineal prostate biopsy procedure. Oncotarget 2017; 8:79433-79440. [PMID: 29108322 PMCID: PMC5668055 DOI: 10.18632/oncotarget.18342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/21/2017] [Indexed: 11/25/2022] Open
Abstract
We aim to investigate the predictive efficacy of hypoechoic lesion for prostate cancer at different levels of serum PSA in the procedure of transrectal ultrasound guided 10-core trans-perineal prostate biopsy (TP-PBx). In this study, we collected clinical parameters involving age, digital rectal examination (DRE), PSA, prostate volume, pathological diagnosis, Gleason score, novel Gleason group, and numbers of positive cores from 856 patients who had elevated level of PSA above 4 ng/ml or susceptible nodule of prostate gland in DRE received the moderated 10-core TP-PBx procedure. There were 481 cases (56.2%) with no visible lesion of hypoechoic nodule in transrectal ultrasound (TRUS) and 375 cases (43.8%) with the hypoechoic lesion. The total cancer detection rate is 45.56%. The predictive efficacy of hypoechoic lesion for prostate cancer varies among different PSA intervals. For PSA groups of 0-4, 4-10, 10-20, 20-100, > 100 ng/ml, the Youden's indexes are 0.3483, 0.3506, 0.3941, 0.2795 and 0.8667, respectively. Besides, the visible lesions are inclined to be detected in patients with higher Gleason score. We concluded that the hypoechoic lesions in TRUS could improve the predictive accuracy for diagnosing prostate cancer and present different predictive efficacy in the respective PSA intervals. Besides, it was probably associated with more aggressive clinical significance.
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Affiliation(s)
- Tian Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Limin Zhang
- Department of Urology, Huashan North Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yixin Chen
- Department of Ultrasonography, Huashan Hospital, Fudan University, Shanghai, China
| | - Yehua Cai
- Department of Ultrasonography, Huashan Hospital, Fudan University, Shanghai, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
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Lebacle C, Roudot-Thoraval F, Moktefi A, Bouanane M, De La Taille A, Salomon L. Integration of MRI to clinical nomogram for predicting pathological stage before radical prostatectomy. World J Urol 2016; 35:1409-1415. [PMID: 27995303 DOI: 10.1007/s00345-016-1981-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 11/30/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Debate persists regarding whether MRI should be used routinely for preoperative evaluation of prostate cancer. OBJECTIVE The aim is to assess the role of prostatic magnetic resonance imaging (MRI) and other preoperative data in extra-prostatic extension (EPE) evaluation. PATIENTS AND METHODS From 2000 to 2013, 1743 patients operated for radical prostatectomy had a preoperative MRI. Age, clinical stage with digital rectal exam (DRE), PSA, prostate weight, biopsy, MRI and pathological findings of the surgical specimen were noticed. A multiparametric score of the variables independently associated with EPE was built with or without MRI on a random sample test population and internally validated. RESULTS With mean age of 62.9 years and mean PSA of 9.6 ng/ml, the population was distributed as follows: 1424 DRE T1, 254 T2, 32 T3; on biopsy 990 Gleason score = 6 and 717 ≥ 7; on MRI 1322 iT2, 290 iT3A and 131 iT3B; on prostatectomy 15 pT0, 998 pT2, 548 pT3A, 181 pT3B and 1 pT4A. In multivariate analysis, DRE, PSA, Gleason score, prostate weight and MRI were independently associated with EPE and integrated in a score with an area under curve (AUC) of 0.74 [95% CI 0.71-0.77] (0.72 without MRI, p < 0.01) a positive predictive value of 61% and a negative predictive value of 74%, internally validated. The Hosmer-Lemeshow goodness-of-fit test showed good accuracy (p = 0.77). CONCLUSIONS Integration of MRI with clinical data for predicting pathological stage before radical prostatectomy permits to exclude accurately EPE in 74% of cases.
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Affiliation(s)
- Cedric Lebacle
- Department of Urology, CHU Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est, Créteil, France.
| | - Françoise Roudot-Thoraval
- Department of Public Health, CHU Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Anissa Moktefi
- Department of Pathology, CHU Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Mohamed Bouanane
- Department of Radiology, CHU Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Alexandre De La Taille
- Department of Urology, CHU Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Laurent Salomon
- Department of Urology, CHU Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est, Créteil, France
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20
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Computational Analysis of Enhanced Circulating Tumour Cell (CTC) Separation in a Microfluidic System with an Integrated Dielectrophoretic-Magnetophorectic (DEP-MAP) Technique. CHEMOSENSORS 2016. [DOI: 10.3390/chemosensors4030014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Hirasawa Y, Ohno Y, Nakashima J, Shimodaira K, Hashimoto T, Gondo T, Ohori M, Tachibana M, Yoshioka K. Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy. Surg Endosc 2015; 30:3702-8. [DOI: 10.1007/s00464-015-4664-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
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22
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Tuliao PH, Koo KC, Komninos C, Chang CH, Choi YD, Chung BH, Hong SJ, Rha KH. Number of positive preoperative biopsy cores is a predictor of positive surgical margins (PSM) in small prostates after robot-assisted radical prostatectomy (RARP). BJU Int 2015; 116:897-904. [PMID: 25098818 DOI: 10.1111/bju.12888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the impact of prostate size on positive surgical margin (PSM) rates after robot-assisted radical prostatectomy (RARP) and the preoperative factors associated with PSM. PATIENTS AND METHODS In all, 1229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had transurethral resection of the prostate, neoadjuvant therapy, clinically advanced cancer, and the first 200 performed cases (to reduce the effect of learning curve). Included were 815 patients who were then divided into three prostate size groups: <31 g (group 1), 31-45 g (group 2), >45 g (group 3). Multivariate analysis determined predictors of PSM and biochemical recurrence (BCR). RESULTS Console time and blood loss increased with increasing prostate size. There were more high-grade tumours in group 1 (group 1 vs group 2 and group 3, 33.9% vs 25.1% and 25.6%, P = 0.003 and P = 0.005). PSM rates were higher in prostates of <45 g with preoperative PSA levels of >20 ng/dL, Gleason score ≥7, T3 tumour, and ≥3 positive biopsy cores. In group 1, preoperative stage T3 [odds ratio (OR) 3.94, P = 0.020] and ≥3 positive biopsy cores (OR 2.52, P = 0.043) were predictive of PSM, while a PSA level of >20 ng/dL predicted the occurrence of BCR (OR 5.34, P = 0.021). No preoperative factors predicted PSM or BCR for groups 2 and 3. CONCLUSION A preoperative biopsy with ≥3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA level of >20 ng/dL is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer postoperative follow-up.
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Affiliation(s)
- Patrick H Tuliao
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyo C Koo
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christos Komninos
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chien H Chang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young D Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung H Chung
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung J Hong
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Koon H Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Yilmaz H, Ustuner M, Ciftci S, Yavuz U, Ozkan TA, Dillioglugil O. Prostate volume predicts high grade prostate cancer both in digital rectal examination negative (ct1c) and positive (≥ct2) patients. Int Braz J Urol 2014; 40:613-9. [DOI: 10.1590/s1677-5538.ibju.2014.05.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/23/2014] [Indexed: 11/22/2022] Open
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24
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Calışkan S. The core of the matter: Using pathology instead of ultrasound to measure prostate volume. Can Urol Assoc J 2014; 8:232. [PMID: 25210543 DOI: 10.5489/cuaj.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Hong SK, Poon BY, Sjoberg DD, Scardino PT, Eastham JA. Prostate size and adverse pathologic features in men undergoing radical prostatectomy. Urology 2014; 84:153-7. [PMID: 24976228 DOI: 10.1016/j.urology.2014.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/09/2014] [Accepted: 04/05/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the relationship between prostate volume measured from preoperative imaging and adverse pathologic features at the time of radical prostatectomy and evaluate the potential effect of clinical stage on such relationship. METHODS In 1756 men who underwent preoperative magnetic resonance imaging and radical prostatectomy from 2000 to 2010, we examined associations of magnetic resonance imaging-measured prostate volume with pathologic outcomes using univariate logistic regression and with postoperative biochemical recurrence using Cox proportional hazards models. We also analyzed the effects of clinical stage on the relationship between prostate volume and adverse pathologic features via interaction analyses. RESULTS In univariate analyses, smaller prostate volume was significantly associated with high pathologic Gleason score (P<.0001), extracapsular extension (P<.0001), and positive surgical margins (P=.032). No significant interaction between clinical stage and prostate volume was observed in predicting adverse pathologic features (all P>.05). The association between prostate volume and recurrence was significant in a multivariable analysis adjusting for postoperative variables (P=.031) but missed statistical significance in the preoperative model (P=.053). Addition of prostate volume did not change C-Indices (0.78 and 0.83) of either model. CONCLUSION Although prostate size did not enhance the prediction of recurrence, it is associated with aggressiveness of prostate cancer. There is no evidence that this association differs depending on clinical stage. Prospective studies are warranted assessing the effect of initial method of detection on the relationship between volume and outcome.
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Affiliation(s)
- Sung Kyu Hong
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Bing Ying Poon
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Peter T Scardino
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Urology, Weill Medical College of Cornell University, New York, NY
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Urology, Weill Medical College of Cornell University, New York, NY
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Noh TI, Shin YS, Shim JS, Yoon JH, Kim JH, Bae JH, Moon DG, Park JY. Are hypoechoic lesions on transrectal ultrasonography a marker for clinically significant prostate cancer? Korean J Urol 2013; 54:666-70. [PMID: 24175039 PMCID: PMC3806989 DOI: 10.4111/kju.2013.54.10.666] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/05/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the relationship of transrectal ultrasound (TRUS) findings with the pathological characteristics of prostate cancer (PCa). Materials and Methods The study was conducted retrospectively by analyzing the data for 970 patients who underwent prostate biopsies. Gleason scores and other clinical variables were compared between PCa patients with and without hypoechoic lesions on TRUS. Results Of the 970 patients, PCa was diagnosed in 291 (30%). Of these, high-grade PCa (Gleason score of 7 or more) was diagnosed in 190 (65%). The cancer detection rate was higher in patients with hypoechoic lesions (43.9%) than in those without hypoechoic lesions (21.4%, p<0.001). High-grade PCa was detected more often in patients with hypoechoic lesions than in those without hypoechoic lesions (p<0.001). Independent predictors for high-grade PCa by logistic regression analysis included hypoechoic lesions on TRUS and abnormal digital rectal examination findings. Conclusions Patients with PCa who had hypoechoic lesions on TRUS had more aggressive pathological disease than did those without lesions. Therefore, hypoechoic lesions on TRUS could be a marker for clinically significant PCa.
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Affiliation(s)
- Tae Il Noh
- Department of Urology, Korea University Ansan Hospital, Ansan, Korea
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Le H, Rojas A, Alonzi R, Hughes R, Ostler P, Lowe G, Bryant L, Hoskin P. The influence of prostate volume on outcome after high-dose-rate brachytherapy alone for localized prostate cancer. Int J Radiat Oncol Biol Phys 2013; 87:270-4. [PMID: 23849693 DOI: 10.1016/j.ijrobp.2013.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/08/2013] [Accepted: 05/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine whether late genitourinary toxicity, biochemical control of prostate cancer, and dosimetric parameters in patients with large prostate glands is different from those variables in men with smaller glands after treatment with high-dose-rate brachytherapy alone (HDR-BT). METHODS From November 2003 to July 2009, 164 patients with locally advanced prostate carcinoma were sequentially enrolled and treated with 34 or 36 Gy in 4 fractions and 31.5 Gy in 3 fractions of (192)Ir HDR-BT alone. The median follow-up time was 71 months. Gland size was not considered in the selection criteria for this study. Estimates of freedom from biochemical relapse (FFbR) and late morbidity, stratified by median clinical target volume (CTV), were obtained, and differences were compared. RESULTS The median CTV volume was 60 cc (range, 15-208 cc). Dose-volume parameters D90 and V100 (ie, minimum dose to 90% of the prostate volume and volume receiving 100% of the prescribed isodose) achieved in patients with glands ≥60 cc were not significantly different from those with glands <60 cc (P≥.2). Nonetheless, biochemical control in patients with larger CTV was significantly higher (91% vs 78% at 6 years; P=.004). In univariate and multivariate analysis, CTV was a significant predictor for risk of biochemical relapse. This was not at the expense of an increase in either moderate (P=.6) or severe (P=.3) late genitourinary toxicity. The use of hormonal therapy was 17% lower in the large gland group (P=.01). CONCLUSIONS Prostate gland size does not affect dosimetric parameters in HDR-BT assessed by D90 and V100. In patients with larger glands, a significantly higher biochemical control of disease was observed, with no difference in late toxicity. This improvement cannot be attributed to differences in dosimetry. Gland size should not be considered in the selection of patients for HDR-BT.
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Affiliation(s)
- Hien Le
- Mount Vernon Cancer Centre, Middlesex, UK.
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Kim KH, Lim SK, Shin TY, Lee JY, Chung BH, Rha KH, Hong SJ. Upgrading of Gleason score and prostate volume: a clinicopathological analysis. BJU Int 2013; 111:1310-6. [DOI: 10.1111/j.1464-410x.2013.11799.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kwang Hyun Kim
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; Korea
| | - Sey Kiat Lim
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; Korea
| | - Tae-Young Shin
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; Korea
| | - Joo Yong Lee
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; Korea
| | - Byung Ha Chung
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; Korea
| | - Koon Ho Rha
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; Korea
| | - Sung Joon Hong
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; Korea
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Shapiro RH, Johnstone PAS. Risk of Gleason grade inaccuracies in prostate cancer patients eligible for active surveillance. Urology 2012; 80:661-6. [PMID: 22925240 DOI: 10.1016/j.urology.2012.06.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 06/05/2012] [Accepted: 06/12/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate increases in Gleason grade because of sample bias after immediate rebiopsy or prostatectomy for patients considered active surveillance candidates by institutional protocol. METHODS A contemporary medical literature search was performed using PubMed. Series were included if the patients had no more than Gleason 6 prostate cancer score on initial biopsy and underwent a prostatectomy or rebiopsy within 6 months. Patient sets using neoadjuvant hormonal therapy or focal prostate treatment were excluded. RESULTS In patients who would have fallen into the D'Amico low-risk prostate cancer group, 42% were found to have an increase in the Gleason score: 32% resulting in grade ≥ 7 disease and 3% grade ≥ 8. For series that limited patients to the Epstein criteria, Gleason upgrades were 34%, 29%, and 2%, respectively. Of the 139 patients whose second tissue specimens were from a rebiopsy, 17% were found to have grade ≥ 7 disease, whereas only 1 patient had grade ≥ 8. There were no consistent multivariate analysis variables among the series to predict for an increase in Gleason score. CONCLUSION More than one third of the patients were found to have been undergraded based on their initial prostate biopsy. Therefore, 1 biopsy alone may not be sufficient to offer active surveillance as an option. Further exploration is necessary to better ensure low-risk disease before active surveillance.
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Affiliation(s)
- Ronald H Shapiro
- Indiana University School of Medicine, Department of Radiation Oncology, Indianapolis, IN 46202, USA.
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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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Koutlidis N, Mourey E, Champigneulle J, Mangin P, Cormier L. Robot-assisted or pure laparoscopic nerve-sparing radical prostatectomy: What is the optimal procedure for the surgical margins? A single center experience. Int J Urol 2012; 19:1076-81. [DOI: 10.1111/j.1442-2042.2012.03102.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nishiyama T. Androgen deprivation therapy in combination with radiotherapy for high-risk clinically localized prostate cancer. J Steroid Biochem Mol Biol 2012; 129:179-90. [PMID: 22269996 DOI: 10.1016/j.jsbmb.2011.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 12/25/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
Abstract
Androgen deprivation therapy (ADT) has remained the main therapeutic option for patients with advanced prostate cancer (PCa) for about 70 years. Several reports and our findings revealed that aggressive PCa can occur under a low dihydrotestosterone (DHT) level environment where the PCa of a low malignancy with high DHT dependency cannot easily occur. Low DHT levels in the prostate with aggressive PCa are probably sufficient to propagate the growth of the tumor, and the prostate with aggressive PCa can produce androgens from the adrenal precursors more autonomously than that with non-aggressive PCa does under the low testosterone environment with testicular suppression. In patients treated with ADT the pituitary-adrenal axis mediated by adrenocorticotropic hormone has a central role in the regulation of androgen synthesis. Several experimental studies have confirmed the potential benefits from the combination of ADT with radiotherapy (RT). A combination of external RT with short-term ADT is recommended based on the results of phase III randomized trials. In contrast, the combination of RT plus 6 months of ADT provides inferior survival as compared with RT plus 3 years of ADT in the treatment of locally advanced PCa. Notably, randomized trials included patients with diverse risk groups treated with older RT modalities, a variety of ADT scheduling and duration and, importantly, suboptimal RT doses. The use of ADT with higher doses of RT or newer RT modalities has to be properly assessed.
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Affiliation(s)
- Tsutomu Nishiyama
- Division of Urology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Niigata 951-8510, Japan.
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Vela-Navarrete R. [Comment to: «Relation between prostate gland volume and some histological markers of malignancy»]. Actas Urol Esp 2012; 36:91-2. [PMID: 22178348 DOI: 10.1016/j.acuro.2011.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 10/11/2011] [Indexed: 10/26/2022]
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Re: Guillaume Ploussard, Alexandre de la Taille, Younes Bayoud, et al. The Risk of Upstaged Disease Increases with Body Mass Index in Low-Risk Prostate Cancer Patients Eligible for Active Surveillance. Eur Urol 2012;61:356–62. Eur Urol 2012; 61:e8; author reply e9-10. [DOI: 10.1016/j.eururo.2011.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 10/26/2011] [Indexed: 11/23/2022]
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Ngo TC, Conti SL, Shinghal R, Presti JC. Prostate Size Does Not Predict High Grade Cancer. J Urol 2012; 187:477-80. [DOI: 10.1016/j.juro.2011.10.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Tin C. Ngo
- Department of Urology, Stanford University School of Medicine, Stanford and Division of Urology, Santa Clara Valley Medical Center (RS), San Jose, California
| | - Simon L. Conti
- Department of Urology, Stanford University School of Medicine, Stanford and Division of Urology, Santa Clara Valley Medical Center (RS), San Jose, California
| | - Rajesh Shinghal
- Department of Urology, Stanford University School of Medicine, Stanford and Division of Urology, Santa Clara Valley Medical Center (RS), San Jose, California
| | - Joseph C. Presti
- Department of Urology, Stanford University School of Medicine, Stanford and Division of Urology, Santa Clara Valley Medical Center (RS), San Jose, California
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González-Enguita C, Fernández-Aceñero M, García-Cardoso J, López-Pérez L, Manzarbeitia F, Vela-Navarrete R. [Relation between prostate gland volume and some histological markers of malignancy]. Actas Urol Esp 2012; 36:86-90. [PMID: 22188751 DOI: 10.1016/j.acuro.2011.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The relationship between the total volume of the prostate gland or its weight after radical prostatectomy and the histological markers of malignancy in cases of prostate cancer is a controversial subject. We have analyzed 100 consecutive radical prostatectomy specimens in order to determine the relationship between volume or weight of the prostate gland and the biological aggressiveness of the tumor process by different histological markers. MATERIAL AND METHODS One hundred consecutive radical prostatectomy specimens in patients who had not received pre-operative hormone treatment were retrospectively reviewed. These surgical samples were processed according to a standardized protocol. In a subsequent evaluation, the following were studied with greater detail: Gleason grade, tumor volume, multimodality, neural or vascular invasion, put stage, and presence of PIN foci. The histological findings were compared with the prostate gland weight using Windows SPAS, 13.0 statistical package with a significance value of p<0.05. According to the prostate gland weight, three groups were established: <40 g (33%), 40 - 90 g (61%), and >90 g (6%). RESULTS A statistically significant association (p=0.001) was found between the prostate gland weight and tumor volume since 15 of the 33 glands with weight under 40 g accounted for more than 50% of the glands affected by tumor compared to none of the 6 patients with total weight over 90 g. A significant relationship was also found between the multimodality and weight. (P=0.03), so that 24 of the 33 glands under 40 g had bilateral multimodality compared to only 1 out of the 6 glands over 90 g. The neural invasion, number of PIN foci and the highest combined Gleason grade were frequent in low volume prostates, but the difference did not reach statistical significance. CONCLUSIONS Our study indicates that large volume prostate glands have tumors with lower malignancy (tumor volume, bilateralism). This finding justifies the adequacy of using total volume of the prostate gland for diagnostic decision (indication of prostatic biopsy and their repetition) and the prognostic determination.
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Calışkan S. Re: Small prostate size and high grade disease--biology or artifact?: J. J. Liu, J. D. Brooks, M. Ferrari, R. Nolley and J. C. Presti, Jr. J Urol 2011; 185: 2108-2111. J Urol 2011; 186:2504; author reply 2504-5. [PMID: 22019038 DOI: 10.1016/j.juro.2011.07.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Indexed: 10/16/2022]
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Davies JD, Aghazadeh MA, Phillips S, Salem S, Chang SS, Clark PE, Cookson MS, Davis R, Herrell SD, Penson DF, Smith JA, Barocas DA. Prostate size as a predictor of Gleason score upgrading in patients with low risk prostate cancer. J Urol 2011; 186:2221-7. [PMID: 22014803 DOI: 10.1016/j.juro.2011.07.104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Gleason score upgrading between biopsy and surgical pathological specimens occurs in 30% to 50% of cases. Predicting upgrading in men with low risk prostate cancer may be particularly important since high grade disease influences management decisions and impacts prognosis. We determined whether prostate size predicts Gleason score upgrading in patients with low risk prostate cancer. MATERIALS AND METHODS A total of 1,251 consecutive patients with D'Amico low risk disease and complete data available underwent radical prostatectomy at our institution between January 2000 and June 2008. Patients were divided into 3 groups by pathological Gleason score, including no, minor (3 + 4 = 7) and major (4 + 3 = 7 or greater) Gleason score upgrading. We developed bivariate and multivariate models to determine whether prostate size was an important predictor of upgrading while controlling for clinical and biopsy characteristics. RESULTS Of 1,251 cases 387 (31.0%) were upgraded, including 324 (26%) and 63 (5%) with minor and major upgrading, respectively. As expected, Gleason score upgrading was associated with worse pathological and cancer control outcomes. On multivariate analysis smaller prostate size was an independent predictor of any and major upgrading (OR 0.58, 95% CI 0.48-0.69, p <0.01 and OR 0.67, 95% CI 0.49-0.96, p = 0.03, respectively). Men with prostate volume at the 25th percentile (36 cm(3)) were 50% more likely to experience upgrading than men with prostate volume at the 75th percentile (58 cm(3)). CONCLUSIONS Of low risk cases 31% were upgraded at final pathology. Smaller prostate size predicts Gleason score upgrading in men with clinically low risk prostate cancer. This is important information when counseling patients on management and prognosis.
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Affiliation(s)
- Judson D Davies
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA
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[Prostate cancer: Gleason scores correlation between biopsies and surgical gross specimen]. Prog Urol 2011; 21:615-8. [PMID: 21943657 DOI: 10.1016/j.purol.2011.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 12/10/2010] [Accepted: 03/25/2011] [Indexed: 11/21/2022]
Abstract
UNLABELLED The Gleason score is a histopronostic criterion which gives an appraisal of prostate cancer aggressiveness and outcomes. OBJECTIVE The goal of this retrospective study was to assess the relationship between Gleason scores appreciated on biopsies and later on surgical gross specimen. RESULTS During the period of the study, 123 patients benefit of a histological diagnosis of prostate cancer recording Gleason score on biopsies and postsurgical intervention on gross specimen. After analysis of biopsies and for gross specimen the reported Gleason scores vary from 3 to 9 and the mean was 5.9 and 6.1 respectively. There was a good concordance between the Gleason scores for biopsies and gross specimen in about 32.5% of cases. We noted a difference of score of one point in 37.3% of patients and a difference of two points and more in 30% of cases. In 28.4% the Gleason scores were overestimated while in 39% they were underestimated. More than half of the patients' cohort was classified in the group of histologically moderately differentiated cancer. When grouping the patients according to the histological types well, moderately or less differentiated cancers, the Gleason scores concordance for biopsies and for gross specimen change from 32.5% up to 74.8%. The correlation can be considered good for the less differentiated cancers. CONCLUSION Gleason score showed some limits in the appreciation of the prediction. The grouping of patients according to the three distinct histological differentiation groups increases the concordance between the score of Gleason on biopsy specimen and gross specimen but it seems less powerful for cancers well and moderately differentiated cancers.
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