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Singh V, Sharma K, Singh M, Tripathi SS, Bhirud DP, Jena R, Navriya SC, Choudhary GR, Sandhu AS. Discrepancies in Gleason score between needle core biopsy and radical prostatectomy specimens with correlation between clinical and pathological staging. Urologia 2024:3915603241244942. [PMID: 38578052 DOI: 10.1177/03915603241244942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND The studies have shown that GS given after assessment of the entire prostate gland on the radical prostatectomy specimen may differ from GS given after examination of a small sample from needle core biopsy. We conducted this study to assess discrepancies in the Gleason score between NCB and RP specimens and to find out the correlation between the clinical stage and pathological stage. METHODS The study included 174 patients with carcinoma prostate which underwent robotic-assisted radical prostatectomy (RARP). Pre-operative Gleason score was determined on 12-core biopsy samples under trans-rectal ultrasound (TRUS) guidance. The Gleason score obtained from the radical prostatectomy specimen was compared with that of the NCB Gleason score to find out differences. RESULTS The preoperative Gleason score (GS) ranges from 6 to 9 with a mean GS of 6.97 ± 1.02. The post-operative GS ranges between 6 and 10 with mean and GS of 7.5 ± 1.10. On the pre-operative assessment of biopsy specimens, 70 (43.2%) patients had a GS of 6, while 44 patients had a GS of 7 (27.1%) and 48 (29.8%) patients had a GS of more than 7. On the postoperative assessment of specimens, 31 (19.1%) patients had post-operative GS of 6, while 66 (41%) patients had GS of 7 and 74 (41.1%) patients had GS of more than 7. When pre-operative GS and post-operative GS were compared, no changes were observed in the GS of 79 patients, whereas 83 patients showed the difference in GS, with 75 patients showing up-gradation and eight patients marked as down-graded. CONCLUSION concordance between biopsy and the pathology results directly affects the prognosis of the patient. The results of our study demonstrated the rate of discordance between Gleason scores obtained from transrectal prostate biopsy and RP surgical specimens. This rate brings into question the accuracy of the chosen treatment.
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Affiliation(s)
- Vikram Singh
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kartik Sharma
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Singh
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Deepak Prakash Bhirud
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Jena
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shiv Charan Navriya
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gautam Ram Choudhary
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Singh Sandhu
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Zhou J, Yu M, Ding J, Qi J. Does the Gleason Score 7 Upgrading Always Predict Worse Prognosis? Clin Genitourin Cancer 2023; 21:e412-e421. [PMID: 37248147 DOI: 10.1016/j.clgc.2023.05.002] [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: 02/08/2022] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine the clinical significance of Gleason score(GS) 7 upgraded on radical prostatectomy(RP) and its impact on the prognosis of patients. PATIENTS AND METHODS We used the Surveillance, Epidemiology, and End Results (SEER) database to study 8832 men diagnosed with M0 GS 3+4/4+3 prostate cancer (PCa) from 2010 to 2015 treated by RP. Logistic regression was used to analyze the effect of clinicopathological characteristics on the Gleason sore upgraded. Cox hazards regression analysis was performed to find significant factors of overall survival (OS). RESULTS A total of 6237 (70.6%) biopsy GS 3+4 patients and 2595(29.4%) biopsy GS 4+3 patients were included in the study. Univariate and multivariate logistic regression analysis found that prostate-specific antigen (PSA)>20ng/ml, T stage 3-4, lymph node metastasis are independent risk factors in predicting the incidence of GS upgraded after RP (all P<0.05). Through multivariate analysis, we found that black race, GS upgraded, chemotherapy played significant roles in predicting poor OS (all P<0.05). It was surprising to find that the biopsy GS upgraded in patients with PSA 0-4ng/ml and 4.1-10ng/ml had a significant association with poor OS (all P<0.05). Multivariate analysis showed that only in patients with PSA 4-10ng/ml, biopsy GS upgrade had a statistically important relationship with poor OS (P=0.046). CONCLUSIONS Not all patients with GS 7 upgraded had a worse prognosis than those without GS upgraded. Only in patients with PSA 4.1-10ng/ml, biopsy GS 7 upgraded was an independent risk factor affecting OS.
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Affiliation(s)
- Jiatong Zhou
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Minghao Yu
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie Ding
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Jun Qi
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Tomioka M, Saigo C, Kawashima K, Suzui N, Miyazaki T, Takeuchi S, Kawase M, Kawase K, Kato D, Takai M, Iinuma K, Nakane K, Takeuchi T, Koie T. Clinical Predictors of Grade Group Upgrading for Radical Prostatectomy Specimens Compared to Those of Preoperative Needle Biopsy Specimens. Diagnostics (Basel) 2022; 12:diagnostics12112760. [PMID: 36428820 PMCID: PMC9689294 DOI: 10.3390/diagnostics12112760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Decision-making and selection of treatment modalities for newly diagnosed prostate cancer (PCa) are often determined by risk stratification using grade group (GG), prostate-specific antigen (PSA), and clinical stage. The discrepancies between needle biopsy (NB) and radical prostatectomy (RP) specimens often occur because of the sampling errors in NB or multifocal features of PCa. Thus, we aimed to estimate the preoperative clinical factors for predicting GG upgrading after robot-assisted RP (RARP). METHODS In this retrospective study, we reviewed the clinical and pathological records of patients who underwent RARP at Gifu University Hospital. We focused on patients with organ-confined PCa who had not received neoadjuvant therapy prior to RARP. The primary endpoint was identified as the predictive factor of GG upgrading for RARP specimens compared to those of NB specimens. RESULTS Eighty-one patients were included in this study. The enrolled patients were divided into two groups: those who had GG upgrading for RARP specimens (the NB upgrade group) or those who did not have GG upgrading (the no upgrade group). The median age of all patients was 70 years, and the median body mass index (BMI) was 22.9 kg/m2. The median neutrophil count was 3720/μL, lymphocyte count was 1543/μL, and neutrophil-to-lymphocyte ratio (NLR) was 2.24. In univariate analysis, BMI, PSA, neutrophil count, and NLR were significantly associated with GG upgrading in RARP specimens compared to NB specimens. BMI and NLR were identified as strong predictive factors for GG upgrading in RARP specimens in the multivariate analysis. CONCLUSIONS Although this study's small number of enrolled patients was a vital weakness, BMI and NLR might have been significantly correlated with GG upgrading for RP specimens compared with NB specimens. Therefore, BMI and NLR may have potential benefits for newly diagnosed patients with PCa in terms of decision-making and the selection of treatment modalities.
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Affiliation(s)
- Masayuki Tomioka
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Chiemi Saigo
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Keisuke Kawashima
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, Gifu 5011194, Japan
| | | | - Shinichi Takeuchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Tamotsu Takeuchi
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
- Correspondence: ; Tel.: +81-582306000
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Wei C, Zhang Y, Zhang X, Ageeli W, Szewczyk-Bieda M, Serhan J, Wilson J, Li C, Nabi G. Prostate Cancer Gleason Score From Biopsy to Radical Surgery: Can Ultrasound Shear Wave Elastography and Multiparametric Magnetic Resonance Imaging Narrow the Gap? Front Oncol 2021; 11:740724. [PMID: 34888237 PMCID: PMC8649692 DOI: 10.3389/fonc.2021.740724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives To investigate the impact of ultrasound shear wave elastography (USWE) and multiparametric magnetic resonance imaging (mpMRI) in predicting a change in biopsy-assigned Gleason Score (GS) after radical surgery for localised prostate cancer (PCa). Method A total of 212 men opting for laparoscopic radical prostatectomy (LRP) between September 2013 and June 2017 were recruited into this study. All the participants had 12-core transrectal ultrasound (TRUS) biopsies and imaging using USWE and mpMRI before radical surgery. The predictive accuracy for imaging modalities was assessed in relation to upgrading and downgrading of PCa GS between the biopsies and radical prostatectomy using Student's t-test and multivariable logistic regression analyses. A decision analysis curve was constructed assessing the impact of nomogram on clinical situations using different thresholds of upgrading probabilities. Results Most GS 6 diseases on biopsies were upgraded on radical surgery (37/42, 88.1%). Major downgrading was seen in GS 8 category of disease (14/35; 37.1%), whereas no alteration was observed in GS 7 on biopsies in most men (55/75; 73.3%). In univariate analysis, higher preoperative prostate-specific antigen (PSA) (p = 0.001), higher prostate-specific antigen density (PSAD) (p = 0.002), stiffer USWE lesions (p = 0.009), and higher prostate imaging-reporting and data system (PIRADS) (p = 0.002) on mpMRI were significant predictors of upgrading. In multivariate logistic regression analyses, only PSA (p = 0.016) and USWE-measured tissue stiffness (p = 0.029) showed statistical significance in predicting upgrading. Conclusions Measurement of tissue stiffness using USWE in clinically localised PCa can predict upgrading of GS and has the potential to improve patient management options.
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Affiliation(s)
- Cheng Wei
- Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Yilong Zhang
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Xinyu Zhang
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Wael Ageeli
- Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom.,Diagnostic Radiology Department, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | | | - Jonathan Serhan
- Department of Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom
| | - Jennifer Wilson
- Department of Pathology, Ninewells Hospital, Dundee, United Kingdom
| | - Chunhui Li
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Ghulam Nabi
- Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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Apfelbeck M, Tritschler S, Clevert DA, Buchner A, Chaloupka M, Kretschmer A, Herlemann A, Stief C, Schlenker B. Postoperative change in Gleason score of prostate cancer in fusion targeted biopsy: a matched pair analysis. Scand J Urol 2020; 55:27-32. [PMID: 33380254 DOI: 10.1080/21681805.2020.1849390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate if MRI/ultrasound fusion based targeted biopsy (FBx) leads to a reduced rate of change in Gleason score (GS) compared to prostatectomy specimen. METHODS The histopathological findings of the biopsy of the prostate and the radical prostatectomy (RP) specimen of 210 patients who were referred to our hospital between 2012 and 2017 were compared retrospectively in this study. One hundred and five patients who underwent FBx combined with ultrasound-guided 12-core biopsy of the prostate (SBx) were matched with 105 patients who underwent SBx only. This study evaluated the rate of up- or downgrading in the RP specimen in both groups and compared the results via matched pair analysis. RESULTS Concordance in Gleason grade group (GGG) was found in 52/105 patients (49.5%) in SBx and in 49/105 patients (46.7%) with FBx (p = 0.679). The rate of downgrading was statistically significant (p = 0.014) and was higher in the FBx group (14/105 patients, 13.3%) than in the SBx group (4/105 patients, 3.8%). A higher rate of upgrading was seen in SBx (49/105 patients; 46.7%) compared to FBx (42/105 patients; 40%), with no statistical significance (p = 0.331). The change in GGG from biopsy to final pathology in patients with GGG 1 and 2 at biopsy level was not statistically significant (p = 0.168). CONCLUSION FBx does not decrease the rate of upgrading between biopsy and final pathology in RP specimens. Our results indicate that FBx tends to overestimate the final GGG compared to SBx.
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Affiliation(s)
- M Apfelbeck
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - S Tritschler
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Urology, Loretto Hospital, Freiburg, Germany
| | - D-A Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - A Buchner
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M Chaloupka
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - A Kretschmer
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - A Herlemann
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - C Stief
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - B Schlenker
- Department of Urology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
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Haberal HB, Artykov M, Hazir B, Citamak B, Altan M, Yazici S, Akdogan B, Ozen H. Predictors of ISUP score upgrade in patients with low-risk prostate cancer. TUMORI JOURNAL 2020; 107:254-260. [PMID: 32727308 DOI: 10.1177/0300891620943953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The literature contains few studies that focus on the relationship between International Society of Urological Pathology (ISUP) score upgrade and complete blood count (CBC) parameters for patients with low-risk prostate cancer and studies achieved inconclusive results. METHODS We retrospectively analyzed our institutional database for patients with prostate cancer who underwent radical prostatectomy (RP) between 1994 and 2017. In total, we included 633 patients with low-risk prostate cancer in the study. We investigated the effects of clinicopathologic factors on ISUP score upgrade. Moreover, we compared RP pathologic outcomes between the patients with and without ISUP score upgrade. RESULTS The mean age and follow-up periods were 61.09±6.61 years and 41.9±1.8 months, respectively. ISUP score upgrade was observed in 207 patients (32.7%). In multivariate analysis, high prostate-specific antigen (PSA) density and percentage of positive cores were found to be significantly associated with ISUP score upgrade (p = 0.003 and p = 0.003, respectively). The neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and eosinophil-lymphocyte ratio were found to have no effect on ISUP score upgrade (p = 0.856, p = 0.353, p = 0.128, and p = 0.074, respectively). The percentage of tumors, surgical margin positivity, seminal vesicle invasion rate, and extraprostatic extension rate in RP pathology were higher in patients with ISUP score upgrade (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSIONS Approximately one-third of the patients in our series had ISUP score upgrade in RP pathology. PSA density and the percentage of positive cores were found to be the factors significantly associated with ISUP score upgrade. CBC-related factors had no effect on ISUP score upgrade.
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Affiliation(s)
| | - Meylis Artykov
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Berk Hazir
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Burak Citamak
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mesut Altan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sertac Yazici
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Bulent Akdogan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Haluk Ozen
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
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Su ZT, Patel HD, Epstein JI, Pavlovich CP, Allaf ME. Downgrading of grade group 2 intermediate-risk prostate cancer from biopsy to radical prostatectomy: Comparison of outcomes and predictors to identify potential candidates for active surveillance. Cancer 2020; 126:1632-1639. [PMID: 32031685 DOI: 10.1002/cncr.32709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/27/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND A proportion of men with grade group (GG) 2 intermediate risk (IR) prostate cancer are downgraded to GG1 or harbor favorable pathology (FP, defined as GG1 or GG2 with <5% Gleason pattern 4) at radical prostatectomy (RP). Prediction of downgrading or FP may help identify potential active surveillance candidates within this group that have outcomes similar to biopsy low-risk (LR) disease. METHODS We performed a comparative cohort study of biopsy LR and IR men who underwent RP at The Johns Hopkins Hospital and Bayview Medical Center between 2005 and 2018. We evaluated pathological outcomes at RP and recurrence-free survival (RFS). Multivariable logistic regression and Cox proportional hazards regression were applied and individual predicted probabilities were calculated. RESULTS Among 2943 biopsy GG2 IR patients, 223 (7.6%) were downgraded to GG1, while 525 (17.8%) had FP; 730 of 1325 biopsy LR patients (55.1%) were upgraded (GG >1). Concordance statistics for final predictive regression models were 0.76 for downgrading and 0.70 for upgrading. Biopsy GG2 IR patients downgrading to GG1 or harboring FP had similar RFS to biopsy LR patients. A cutoff of >10% predicted probability of downgrading (24.7% of patients; hazard ratio [HR], 1.55; 95% CI, 0.89-2.68) or >20% predicted probability of FP (37.0% of patients; HR, 1.35; 95% CI, 0.81-2.24) led to similar RFS to biopsy LR patients. CONCLUSION GG2 IR patients who experience downgrading or harbor FP had similar oncologic outcomes as LR patients. The developed models may serve as tools to inform patients about the risks of pathological downgrading/upgrading and help identify a segment of GG2 IR patients who would consider pursuing active surveillance based on predicted probability cutoffs.
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Affiliation(s)
- Zhuo T Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan I Epstein
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Erdem S, Verep S, Bagbudar S, Ozluk Y, Sanli O, Ozcan F. The clinical predictive factors and postoperative histopathological parameters associated with upgrading after radical prostatectomy: A contemporary analysis with grade groups. Prostate 2020; 80:225-234. [PMID: 31794085 DOI: 10.1002/pros.23936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIM Upgrading after radical prostatectomy (RP) is an ongoing problem since first description of Gleason score. In this retrospective study, our aim is to investigate upgrading after RP in grade groups (GG) and clinical predictive, and postoperative histopathological factors associated with GG upgrading (GGU). PATIENTS AND METHODS A total of 753 patients undergoing RP between January 2006 and June 2019 at our institution were investigated. Overall cohort were divided into two groups according to GGU status after RP as nonupgrading and upgrading. Retrospectively documented preoperative clinical and postoperative histopathological parameters were compared between two groups. Furthermore, we investigated a subgroup of institutional cohort (n = 398) whose prostate biopsy (Pbx) and RP were performed in our institution and we also divided this cohort into two groups according to GGU status. χ2 and Mann-Whitney U tests were used for comparative analyses. The independent preoperative predictive and postoperative histopathological factors associated with GGU were investigated using multivariate logistic regression analysis. RESULTS The total GGU was 55.8% in overall cohort and 45.2% in institutional cohort. The GGU was found as the most common in bioptic GG1 group in both overall (64.0%), and institutional (54.5%) cohorts. In multivariate analyses, the noninstitutional Pbx (odds ratio [OR] = 2.56; 95% confidence interval [CI]: 1.86-3.51; P < .001), tumor positive core numbers in Pbx (OR = 1.11; 95%CI: 1.04-1.19; P = .003), increased prostate specific antigen (PSA) density (OR = 3.59; 95%CI: 1.03-12.52, P = .045) and age (OR = 1.03; 95%CI: 1.00-1.05, P = .046) were independent clinical predictors of GGU in overall cohort whereas only increased PSA density (OR = 5.94; 95%CI: 1.28-27.50; P = .023) was independent predictor in institutional cohort. Among postoperative histopathological factors, perineural invasion (OR = 1.57; 95%CI: 1.70-3.87; P < .001 and OR = 2.53; 95%CI: 1.46-4.40; P = .001, respectively), increased maximum tumor diameter (OR = 1.46; 95%CI: 1.23-1.73; P < .001 and OR = 1.33; 95%CI: 1.07-1.66; P = .010, respectively), and high-grade prostatic intraepithelial neoplasia (HGPIN) existence at tumor surrounding tissue (OR = 1.96; 95%CI: 1.32-2.90; P = .001 and OR = 1.87; 95%CI: 1.10-3.21; P = .022, respectively) were independently associated with GGU after RP, in both of overall and institutional cohorts. CONCLUSIONS Noninstitutional prostate biopsy, increased PSA density, higher tumor positive cores in Pbx and older age are the clinical predictors of upgrading after RP in contemporary GG. Perineural invasion, increased maximum tumor diameter, and HGPIN existence at tumor surrounding tissue are postoperative histopathological factors associated with GGU.
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Affiliation(s)
- Selcuk Erdem
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Samed Verep
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sidar Bagbudar
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Oner Sanli
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Faruk Ozcan
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Eggener S, Karsh LI, Richardson T, Shindel AW, Lu R, Rosenberg S, Goldfischer E, Korman H, Bennett J, Newmark J, Denes BS. A 17-gene Panel for Prediction of Adverse Prostate Cancer Pathologic Features: Prospective Clinical Validation and Utility. Urology 2019; 126:76-82. [DOI: 10.1016/j.urology.2018.11.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/11/2018] [Indexed: 11/26/2022]
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10
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Camtosun A, Gökçe H. Comparison of prostate biopsy pathology and radical prostatectomy pathologies. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.534851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Beksac AT, Sobotka S, Xu P, Gupta A, Treacy PJ, Weil R, Mahajan K, Prasad S, Cumarasamy S, Martini A, Falagario U, Rastinehad A, Tewari AK. Downgrading of Grade Group After Radical Prostatectomy: Comparison of Multiparametric Magnetic Resonance Imaging Guided Fusion Biopsy and Standard 12-Core Biopsy. Urology 2019; 127:80-85. [PMID: 30759371 DOI: 10.1016/j.urology.2019.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To analyze the factors associated with Grade group (GG) downgrading post-radical prostatectomy. PATIENTS AND METHODS We performed a retrospective analysis of 536 patients who underwent robot-assisted laparoscopic radical prostatectomy from February 2014 to October 2015. We have analyzed the clinical, radiological, and pathologic factors associated with GG downgrading in final pathology. Downgrading was defined as those patients who downgraded from GG 3, 4, or 5 on biopsy to GG 1 or 2 on final pathology as well as patients who downgraded from GG 2 on biopsy to GG 1 on final pathology. Categorical values were compared with chi-square and Fischer's exact tests. Mann-Whitney U and Kruskal-Wallis were used for analysis of independent variables associated with GG downgrading. RESULTS Ninety-three patients underwent fusion biopsy (FB) and 443 underwent the standard 12 core biopsy. Baseline clinical characteristics were similar between the 2 groups except for race (P = .009). Downgrading was observed in 76 patients (14.1%). Rate of downgrading was higher in the FB group (n = 22, 23.7% vs n = 54, 12.2%, P = .008). In multivariable logistic regression analysis, FB (OR:2.39, P = .004) and maximum percentage of core involvement (OR:1.01, P = .013) were associated with downgrading after robot-assisted laparoscopic radical prostatectomy. After 1:2 propensity score matching, FB was still associated with an increased rate of downgrading (P = .034). Downgrading had no significant effect on pathologic outcome. CONCLUSION FB and maximum percentage of core involvement are the only factors associated with GG downgrading in final pathology. However, downgrading did not influence surgical outcome.
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Affiliation(s)
- Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paige Xu
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Akriti Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Rachel Weil
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kanika Mahajan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sonya Prasad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shivaram Cumarasamy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ugo Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ardeshir Rastinehad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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12
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Porcaro AB, Inverardi D, Corsi P, Sebben M, Cacciamani G, Tafuri A, Processali T, Pirozzi M, Mattevi D, De Marchi D, Amigoni N, Rizzetto R, Cerruto MA, Brunelli M, Siracusano S, Artibani W. Prostate-specific antigen levels and proportion of biopsy positive cores are independent predictors of upgrading patterns in low-risk prostate cancer. MINERVA UROL NEFROL 2018; 72:66-71. [PMID: 30298710 DOI: 10.23736/s0393-2249.18.03172-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study is to evaluate clinical factors associated with the risk of tumor upgrading patterns in low risk prostate cancer (PCA) patients undergoing radical prostatectomy. METHODS In a period running from January 2013 to December 2016, 245 low risk patients underwent RP. Patients were classified into three groups, which included case with pathology grade group one (no upgrading pattern), two-three (intermediate upgrading pattern), and four-five (high upgrading pattern). The association of factors with the upgrading risk was evaluated by the multinomial logistic regression model. It was used a receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis to assess the efficacy of predictors. RESULTS Overall, tumor upgrading was detected in 158 patients (67.3%). Tumor upgrading patterns were absent in 80 patients (32.7%), intermediate in 152 cases (62%) and high in 13 subjects (5.3%). Median prostate specific (PSA) levels and proportion of biopsy positive core (BPC) were higher in patients with intermediate (PSA=6 ng/mL; BPC=0.28) and high (PSA=8.9 ng/mL; BPC=0.33) than those without (PSA=5.7 ng/mL; BPC=0.17) and the difference was significant (PSA: P=0.002; BPC: P=0.001). When compared to not upgraded cases, higher BPC proportions were independent predictors of intermediate upgrading patterns (odds ratio, OR=36.711; P<0.0001; AUC=0.613) while higher PSA values were independent predictors of high upgrading patterns (OR=2.033, P<0.0001; AUC=0.779). CONCLUSIONS PSA and BPC were both independent predictors of tumor upgrading in low risk PCA. BPC associated with the risk of intermediate tumor upgrading patterns, but showed a low discrimination power. PSA associated with high upgrading patterns and showed a fair discrimination power in the model. Tumor upgrading risk patterns should be evaluated in low risk PCA patients before treatment.
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Affiliation(s)
- Antonio B Porcaro
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy -
| | - Davide Inverardi
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Paolo Corsi
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Marco Sebben
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Giovanni Cacciamani
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Alessandro Tafuri
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Tania Processali
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Marco Pirozzi
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Daniele Mattevi
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Davide De Marchi
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Nelia Amigoni
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Riccardo Rizzetto
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Maria A Cerruto
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, Verona University Hospital, Verona, Italy
| | - Salvatore Siracusano
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
| | - Walter Artibani
- Clinic of Urology, Department of Surgery and Oncology, Verona University Hospital, Verona, Italy
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13
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Gandaglia G, van den Bergh RC, Tilki D, Fossati N, Ost P, Surcel CI, Sooriakumaran P, Tsaur I, Valerio M, Kretschmer A, Zaffuto E, Salomon L, Montorsi F, Graefen M, van der Poel H, de la Taille A, Briganti A, Ploussard G. How can we expand active surveillance criteria in patients with low- and intermediate-risk prostate cancer without increasing the risk of misclassification? Development of a novel risk calculator. BJU Int 2018; 122:823-830. [DOI: 10.1111/bju.14391] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | | | - Derya Tilki
- Martini-Klinik Prostate Cancer Center; University-Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University-Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Nicola Fossati
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Piet Ost
- Department of Radiotherapy; Ghent University Hospital; Ghent Belgium
| | - Christian I. Surcel
- Centre of Urological Surgery; Dialysis and Renal Transplantation; Fundeni Clinical Institute; Bucharest Romania
| | | | - Igor Tsaur
- Department of Urology; University Medicine Mainz; Mainz Germany
| | - Massimo Valerio
- Department of Urology; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - Alexander Kretschmer
- Urologische Klinik und Poliklinik; Campus Großhadern; Ludwig-Maximilians-Universität; Munich Germany
| | - Emanuele Zaffuto
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Laurent Salomon
- Department of Urology; Henri Mondor Hospital; Assistance-Publique Hopitaux de Paris; Creteil France
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele; Milan Italy
- Vita-Salute San Raffaele University; Milan Italy
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center; University-Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Henk van der Poel
- Department of Urology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Alexandre de la Taille
- Department of Urology; Henri Mondor Hospital; Assistance-Publique Hopitaux de Paris; Creteil France
| | - Alberto Briganti
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele; Milan Italy
- Vita-Salute San Raffaele University; Milan Italy
| | - Guillaume Ploussard
- Department of Urology; Henri Mondor Hospital; Assistance-Publique Hopitaux de Paris; Creteil France
- Department of Urology; Saint Jean Languedoc Hospital; Toulouse France
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14
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Clinical factors stratifying the risk of tumor upgrading to high-grade disease in low-risk prostate cancer. TUMORI JOURNAL 2018; 104:111-115. [PMID: 27791231 DOI: 10.5301/tj.5000580] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To identify clinical factors stratifying the risk of tumor upgrading to increasing patterns of the tumor grading system in low-risk prostate cancer (PCa). METHODS We evaluated the records of 438 patients who underwent radical prostatectomy. Associations between clinical factors and tumor upgrading were assessed by the univariate and multivariate multinomial logistic regression model. RESULTS Low-risk PCa included 170 cases (38.8%) and tumor upgrading was detected in 111 patients (65.3%): 72 (42.4%) had pathology Gleason pattern (pGP) 3 + 4, 27 (15.9%) pGP 4 + 3, and 12 (7.1%) pGP 4 + 4. Prostate- specific antigen (PSA) and proportion of positive cores (P+) were independent predictors of upgrading to high-risk disease. These factors also stratified the risk of tumor upgrading to the increasing patterns of the tumor grading system. The model allowed the identification of pGP 4 + 4. The main difference between high-risk PCa and other upgraded tumors related to PSA load (odds ratio 2.4) that associated with high volume disease in the specimen. CONCLUSIONS Low-risk PCa is a heterogeneous population with significant rates of tumor upgrading. Significant clinical predictors stratifying the risk of tumor upgrading to increasing patterns of the grading system included PSA and P+. These factors allowed the identification of the subset hiding high-grade disease requiring further investigations before delivering active treatments.
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15
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He B, Chen R, Gao X, Ren S, Yang B, Hou J, Wang L, Yang Q, Zhou T, Zhao L, Xu C, Sun Y. Nomograms for predicting Gleason upgrading in a contemporary Chinese cohort receiving radical prostatectomy after extended prostate biopsy: development and internal validation. Oncotarget 2017; 7:17275-85. [PMID: 26943768 PMCID: PMC4941387 DOI: 10.18632/oncotarget.7787] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/09/2016] [Indexed: 11/25/2022] Open
Abstract
The current strategy for the histological assessment of prostate cancer (PCa) is mainly based on the Gleason score (GS). However, 30-40% of patients who undergo radical prostatectomy (RP) are misclassified at biopsy pathologically. Thus, we developed and validated nomograms for the prediction of Gleason score upgrading (GSU) in patients who underwent radical prostatectomy after extended prostate biopsy in a Chinese population. This retrospective study included a total of 411 patients who underwent radical prostatectomy at our institute after having prostate biopsies between 2011 and 2015. The final pathologic GS was upgraded in 151 (36.74%) of the cases in all patients and 92 (60.13%) cases in men with GS=6. In multivariate analyses, the primary biopsy GS, secondary biopsy GS and obesity were predictive of GSU in the patient cohort assessed. In patients with GS=6, the significant predictors of GSU included the body mass index (BMI), prostate-specific antigen density(PSAD) and percentage of positive cores. The area under the curve (AUC) of the prediction models was 0.753 for the entire patient population and 0.727 for the patients with GS=6. Both nomograms were well calibrated, and decision curve analysis demonstrated a high net benefit across a wide range of threshold probabilities. This study may be relevant for improved risk assessment and clinical decision-making in PCa patients.
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Affiliation(s)
- Biming He
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rui Chen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xu Gao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shancheng Ren
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bo Yang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianguo Hou
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Linhui Wang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing Yang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Tie Zhou
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lin Zhao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chuanliang Xu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
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16
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Faiella E, Santucci D, Greco F, Frauenfelder G, Giacobbe V, Muto G, Zobel BB, Grasso RF. Analysis of histological findings obtained combining US/mp-MRI fusion-guided biopsies with systematic US biopsies: mp-MRI role in prostate cancer detection and false negative. Radiol Med 2017; 123:143-152. [PMID: 29019021 DOI: 10.1007/s11547-017-0814-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/13/2017] [Indexed: 02/02/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the diagnostic accuracy of mp-MRI correlating US/mp-MRI fusion-guided biopsy with systematic random US-guided biopsy in prostate cancer diagnosis. MATERIALS AND METHODS 137 suspected prostatic abnormalities were identified on mp-MRI (1.5T) in 96 patients and classified according to PI-RADS score v2. All target lesions underwent US/mp-MRI fusion biopsy and prostatic sampling was completed by US-guided systematic random 12-core biopsies. Histological analysis and Gleason score were established for all the samples, both target lesions defined by mp-MRI, and random biopsies. PI-RADS score was correlated with the histological results, divided in three groups (benign tissue, atypia and carcinoma) and with Gleason groups, divided in four categories considering the new Grading system of the ISUP 2014, using t test. Multivariate analysis was used to correlate PI-RADS and Gleason categories to PSA level and abnormalities axial diameter. When the random core biopsies showed carcinoma (mp-MRI false-negatives), PSA value and lesions Gleason median value were compared with those of carcinomas identified by mp-MRI (true-positives), using t test. RESULTS There was statistically significant difference between PI-RADS score in carcinoma, atypia and benign lesions groups (4.41, 3.61 and 3.24, respectively) and between PI-RADS score in Gleason < 7 group and Gleason > 7 group (4.14 and 4.79, respectively). mp-MRI performance was more accurate for lesions > 15 mm and in patients with PSA > 6 ng/ml. In systematic sampling, 130 (11.25%) mp-MRI false-negative were identified. There was no statistic difference in Gleason median value (7.0 vs 7.06) between this group and the mp-MRI true-positives, but a significant lower PSA median value was demonstrated (7.08 vs 7.53 ng/ml). CONCLUSION mp-MRI remains the imaging modality of choice to identify PCa lesions. Integrating US-guided random sampling with US/mp-MRI fusion target lesions sampling, 3.49% of false-negative were identified.
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Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy.
| | - Domiziana Santucci
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Federico Greco
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Giulia Frauenfelder
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Viola Giacobbe
- Department of Bio-Engineering, University of Rome "Gemelli", Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Giovanni Muto
- Department of Urology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Bruno Beomonte Zobel
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Rosario Francesco Grasso
- Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21-00128, Rome, Italy
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17
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Use of a 17-Gene Prognostic Assay in Contemporary Urologic Practice: Results of an Interim Analysis in an Observational Cohort. Urology 2017; 107:67-75. [DOI: 10.1016/j.urology.2017.02.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/06/2017] [Accepted: 02/15/2017] [Indexed: 11/22/2022]
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18
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Porcaro AB, Siracusano S, de Luyk N, Corsi P, Sebben M, Tafuri A, Mattevi D, Bizzotto L, Tamanini I, Cerruto MA, Martignoni G, Brunelli M, Artibani W. Low-Risk Prostate Cancer and Tumor Upgrading in the Surgical Specimen: Analysis of Clinical Factors Predicting Tumor Upgrading in a Contemporary Series of Patients Who were Evaluated According to the Modified Gleason Score Grading System. Curr Urol 2017; 10:118-125. [PMID: 28878593 DOI: 10.1159/000447164] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To identify significant clinical factors associated with prostate cancer (PCa) upgrading the low-risk PCa patients graded according to the modified Gleason score system. MATERIALS AND METHODS The logistic regression model was used to evaluate the records of 438 patients. RESULTS There were 170 cases (38.8%) of low-risk PCa and tumors were upgraded in 111 patients (65.3%). Only prostate specific antigen (PSA) and the proportion of positive cores (P+) were independent predictors of tumor upgrading. Further exploration was investigated by categorizing and regressing PSA (≤ 5.0 vs. > 5.0 ng/ml) and P+ (≤ 0.20 vs. > 0.20). The odds ratio of PSA > 5 ng/ml was 1.32 and of P+ > 0.20 was 2.71. The population was stratified into very low-risk with PSA ≤ 5 ng/ml and P+ ≤ 0.20 (class A), low-risk with PSA > 5 ng/ml and P+ ≤ 0.20 (class B), intermediate risk with PSA ≤ 5 ng/ml and P+ > 0.20 (class C), and high risk with PSA > 5 ng/ml and P+ 0.20 (class D). Upgrading rates were extremely low in class A (9%), extremely high in D (50.5%), and moderate (20%) in B and C. CONCLUSION Patients diagnosed with low-risk PCa at biopsy are a heterogeneous population because they include subsets with undetected high-grade disease. Significant clinical predictors of upgrading include the PSA value and P+. In low-risk PCa, we identified a high-risk upgrading subgroup that needed repeat biopsies in order to reclassify the tumor grade and to reassess the clinical risk category.
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Affiliation(s)
- Antonio B Porcaro
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Siracusano
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nicolò de Luyk
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Paolo Corsi
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Sebben
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Tafuri
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Daniele Mattevi
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Leonardo Bizzotto
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Irene Tamanini
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria A Cerruto
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Guido Martignoni
- Department of Patholog, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Department of Patholog, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Walter Artibani
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Population-based study of grade progression in patients who harboured Gleason 3 + 3. World J Urol 2017; 35:1689-1699. [PMID: 28500489 DOI: 10.1007/s00345-017-2047-z] [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: 02/06/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE This study aimed to evaluate (1) the time interval between a decision to commence on active surveillance (AS) and grade progression in community practice; (2) factors predicting grade progression in localised prostate cancer (CaP) patients apparently undergoing AS. METHODS Data from the Prostate Cancer Outcomes Registry-Victoria were used to analyze men with Gleason 3 + 3 CaP or less who had at least one repeat biopsy. Unadjusted and adjusted 5-year Kaplan-Meier survival curves were used to assess the time to grade progression. Both univariate and multivariate analyses for grade progression were performed using Cox proportional hazards. RESULTS The cohort included 951 men. Overall, 39% of men had Gleason grade reclassified to a higher risk disease state with median of 2.2 years [IQR 1.2-3.7 years]. Men who harboured cT2 disease were 30% more likely to have upgrading compared to men with cT1 disease (adjusted HR: 1.3, 95% CI 1.0-1.6, p = 0.048). Half of the men with cT2 in our cohort had their Gleason grade reclassified within 1.6 years from diagnosis as compared with 2.7 years for the cT1 group. The presence of percentage of core involvement >25.0% and a PSA velocity of >1.01 ng/mL/year remained significant for a higher progression rate. The adjusted HR: 1.6; 95% CI [1.2-2.3], p = 0.004; adjusted HR: 1.6, 95% CI [1.2-2.4], p = 0.021, for percent of core involvement of 25.1-37.5%, and ≥37.6%, respectively. The adjusted HRs and p value associated with PSA velocity were 1.5; 95% CI [1.1-2.1], p = 0.016 and 1.6; 95% CI [1.2-2.3], p = 0.003 for PSA velocity values of 1.01-2 ng/mL per year and >2 ng/mL per year, respectively. Men who were diagnosed in regional hospital and subsequently had biopsy in metropolitan hospital were twice at risk of having Gleason upgrade compared to those whom both diagnostic and surveillance biopsies were carried out in metropolitan hospitals (adjusted HR: 1.9; 95% CI 1.1-3.3, p = 0.029). CONCLUSIONS When placing men on AS and considering time to histologic progression, clinicians should pay particular attention to the likely accuracy of the diagnostic specimen, their tumour stage, volume of tumour (percent of core involvement), and rising PSA. Those diagnosed with T2 disease and had >25.0% of core involvement, and a PSA velocity greater than 1 ng/mL per year is at particular risk for more rapid disease progression and, for this reason, should be counselled on the importance of following the recommended surveillance regimen. For half of these men, their disease will have 'progressed' according to biopsy results in 2 years.
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20
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Herlemann A, Buchner A, Kretschmer A, Apfelbeck M, Stief CG, Gratzke C, Tritschler S. Postoperative upgrading of prostate cancer in men ≥75 years: a propensity score-matched analysis. World J Urol 2017; 35:1517-1524. [PMID: 28493044 DOI: 10.1007/s00345-017-2045-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/02/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Gleason score upgrading should be considered when indicating surgery in prostate cancer (PCa) patients. In elderly patients, definitive treatment of low-risk PCa must be weighed with the risks of overtreatment. Our aim was to evaluate rates of Gleason score upgrading in patients ≥75 years undergoing radical prostatectomy (RP) for localized PCa and to identify predictors associated with upgrading. METHODS 3296 patients undergoing RP were retrospectively evaluated and categorized into age groups: <70 years (n = 2971) vs. ≥75 years (n = 325). We analyzed prostate-specific antigen (PSA), biopsy counts, Gleason score, pathologic T- and N-stage, and surgical margin. Propensity score matching was performed to compare rates of up- and downgrading on surgical specimen using the new five-tier pathologic grading system. Logistic regression was used to identify independent predictors of upgrading. RESULTS Preoperatively, patients ≥75 years had higher PSA (8.8 vs. 7.3 ng/mL) and lower proportion of grade group 1 (Gleason score 6) at biopsy (29.2 vs. 47.9%; both p < 0.001) compared to patients <70 years. At RP, patients ≥75 years were more likely to have extraprostatic disease (50 vs. 30%) and lower rates of grade group 1 (14.1 vs. 34.8%; both p < 0.001). Postoperative downgrading was similar (15.1 vs. 19.5%). However, patients ≥75 years had higher rates of postoperative upgrading (46.6 vs. 27.9%; p < 0.001). Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were associated with upgrading. CONCLUSIONS Patients ≥75 years not only demonstrated higher rates of advanced disease but more frequent upgrading on RP specimen. Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were predictive for upgrading. The increased risk of upgrading should be taken into consideration when discussing optimal treatment for this specific cohort.
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Affiliation(s)
- Annika Herlemann
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Maria Apfelbeck
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefan Tritschler
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2017. [DOI: 10.17517/ksutfd.205510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Xu H, Bai P, Hu M, Mao S, Zhu W, Hu J, Liu S, Yang T, Hou J, Hu Y, Ding Q, Jiang H. Gleason sum upgrading between biopsy and radical prostatectomy in Chinese population: Updated nomograms. Actas Urol Esp 2017; 41:162-171. [PMID: 27522521 DOI: 10.1016/j.acuro.2016.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION To assess the risk factors of Gleason sum upgrading between biopsy and radical prostatectomy (RP) and update the nomogram for the prediction of Gleason sum upgrading. METHODS The study cohort consisted of 237 Chinese prostate adenocarcinoma patients who underwent 10-core prostate biopsy and subsequently received RP in Huashan Hospital from February 2011 to May 2015. The main outcome of our study was Gleason sum upgrading between biopsy and RP pathology. Univariate and multivariate logistic regression models were conducted to explore the potential predictors, and ultimately to build the nomograms. The prediction model was further evaluated for its ability to predict significant upgrading in patients with biopsy Gleason sum<8. RESULTS In the main cohort of all the patients, Gleason sum upgrading was observed in 62 (26.16%) patients. The pre-operative prostate-specific antigen (PSA) level, biopsy Gleason sum, and digital rectal examination were used in building the nomogram, which was validated internally with a bootstrap-corrected concordance index of 0.787. In the sub-cohort of 115 patients with standardized biopsy details, Gleason sum upgrading was observed in 31 (26.96%) patients. The pre-operative PSA level, biopsy Gleason sum, and number of positive cores were used in the nomogram, which was also validated internally with a bootstrap-corrected concordance index of 0.833. These two nomograms both demonstrated satisfactory statistical performance for predicting significant upgrading. CONCLUSIONS Updated nomograms to predict Gleason sum upgrading in Chinese population between biopsy and RP were developed, demonstrating good statistical performance upon internal validation.
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Athanazio D, Gotto G, Shea-Budgell M, Yilmaz A, Trpkov K. Global Gleason grade groups in prostate cancer: concordance of biopsy and radical prostatectomy grades and predictors of upgrade and downgrade. Histopathology 2017; 70:1098-1106. [DOI: 10.1111/his.13179] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/03/2017] [Accepted: 01/30/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Daniel Athanazio
- Department of Pathology and Laboratory Medicine; Calgary Laboratory Services and University of Calgary; Calgary Alberta Canada
| | - Geoffrey Gotto
- Division of Urology; University of Calgary; Calgary Alberta Canada
| | - Melissa Shea-Budgell
- Cancer Strategic Clinical Network, Research Innovation and Analytics; Alberta Health Services; University of Calgary; Calgary Alberta Canada
- Department of Oncology; University of Calgary; Calgary Alberta Canada
| | - Asli Yilmaz
- Department of Pathology and Laboratory Medicine; Calgary Laboratory Services and University of Calgary; Calgary Alberta Canada
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine; Calgary Laboratory Services and University of Calgary; Calgary Alberta Canada
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Genomic and Biological Markers to Select Treatment for Patients with Prostate Cancer: Choose Wisely, My Friend. J Urol 2017; 197:8-9. [DOI: 10.1016/j.juro.2016.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 11/24/2022]
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Biomarkers of Outcome in Patients With Localized Prostate Cancer Treated With Radiotherapy. Semin Radiat Oncol 2017; 27:11-20. [DOI: 10.1016/j.semradonc.2016.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Leyh-Bannurah SR, Dell’Oglio P, Tian Z, Schiffmann J, Shariat SF, Suardi N, Francesco M, Alberto B, Heinzer H, Huland H, Graefen M, Budäus L, Karakiewicz PI. A proposal of a new nomogram for predicting upstaging in contemporary D’Amico low-risk prostate cancer patients. World J Urol 2016; 35:189-197. [DOI: 10.1007/s00345-016-1863-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/21/2016] [Indexed: 12/28/2022] Open
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Hwang I, Lim D, Jeong YB, Park SC, Noh JH, Kwon DD, Kang TW. Upgrading and upstaging of low-risk prostate cancer among Korean patients: a multicenter study. Asian J Androl 2016; 17:811-4. [PMID: 25578934 PMCID: PMC4577596 DOI: 10.4103/1008-682x.143751] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Only 54% of prostate cancer cases in Korea are localized compared with 82% of cases in the US. Furthermore, half of Korean patients are upgraded after radical prostatectomy (41.6%–50.6%). We investigated the risk factors for upgrading and/or upstaging of low-risk prostate cancer after radical prostatectomy. We retrospectively reviewed the medical records of 1159 patients who underwent radical prostatectomy at five hospitals in Honam Province. Preoperative data on standard clinicopathological parameters were collected. The radical prostatectomy specimens were graded and staged and we defined a “worsening prognosis” as a Gleason score ≥ 7 or upstaging to ≥ pT3. Multivariate logistic regression models were used to assess factors associated with postoperative pathological upstaging. Among the 1159 patients, 324 were classified into the clinically low-risk group, and 154 (47.5%) patients were either upgraded or upstaged. The multivariable analysis revealed that the preoperative serum prostate-specific antigen level (odds ratio [OR], 1.131; 95% confidence interval [CI], 1.007–1.271; P= 0.037), percent positive biopsy core (OR: 1.018; 95% CI: 1.002–1.035; P= 0.032), and small prostate volume (≤30 ml) (OR: 2.280; 95% CI: 1.351–3.848; P= 0.002) were predictive of a worsening prognosis. Overall, 47.5% of patients with low-risk disease were upstaged postoperatively. The current risk stratification criteria may be too relaxed for our study cohort.
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Affiliation(s)
| | | | | | | | | | | | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Porcaro AB, Siracusano S, De Luyk N, Corsi P, Sebben M, Tafuri A, Bizzotto L, Tamanini I, Inverardi D, Cerruto MA, Martignoni G, Brunelli M, Artibani W. Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System. Urol Int 2016; 97:32-41. [PMID: 26998904 DOI: 10.1159/000445034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/29/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify clinical factors associated with prostate cancer (PCA) upgrading to higher patterns of the surgical specimen in low-risk PCA. MATERIALS AND METHODS We evaluated the records of 438 patients. The multinomial logistic regression model was used. RESULTS Low-risk PCA included 170 cases (38.8%) and tumor upgrading was detected in 111 patients (65.3%) of whom 72 (42.4%) had pathological Gleason patterns (pGP) = 3 + 4 and 39 (22.9%) pGP >3 + 4. Prostate-specific antigen (PSA) and proportion of positive cores (P+) were independent predictors of tumor upgrading to higher patterns. The main difference between upgraded cancers related to PSA and to P+ >0.20. The population was stratified into risk classes by PSA ≤5 μg/l and P+ ≤0.20 (class A), PSA >5 μg/l and P+ ≤0.20 (class B), PSA ≤5 μg/l and P+ >0.20 (class C) and PSA >5 μg/l and P+ 0.20 (class D). Upgrading rates to pGP >3 + 4 were extremely low in class A (5.1%), extremely high in D (53.8%). CONCLUSIONS Low-risk PCA is a heterogeneous population with significant rates of undetected high-grade disease. Significant clinical predictors of upgrading to higher patterns include PSA and P+, which identify a very high-risk class that needs repeat biopsies in order to reclassify tumor grade.
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Porcaro AB, Petroziello A, Brunelli M, De Luyk N, Cacciamani G, Corsi P, Sebben M, Tafuri A, Tamanini I, Caruso B, Ghimenton C, Monaco C, Artibani W. High Testosterone Preoperative Plasma Levels Independently Predict Biopsy Gleason Score Upgrading in Men with Prostate Cancer Undergoing Radical Prostatectomy. Urol Int 2016; 96:470-8. [DOI: 10.1159/000443742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/30/2015] [Indexed: 11/19/2022]
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Turner RM, Ristau BT, Nelson JB. Should Gleason Score 6 Still Be Called Cancer? Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cribriform morphology predicts upstaging after radical prostatectomy in patients with Gleason score 3 + 4 = 7 prostate cancer at transrectal ultrasound (TRUS)-guided needle biopsy. Virchows Arch 2015; 467:437-42. [PMID: 26229020 DOI: 10.1007/s00428-015-1809-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 06/18/2015] [Accepted: 07/09/2015] [Indexed: 01/22/2023]
Abstract
Selected patients with transrectal ultrasound (TRUS)-guided biopsies containing Gleason score 3 + 4 = 7 prostate cancer (PCa) may be considered candidates for active surveillance (AS). The purpose of this study was to determine if there are features that predict PCa upstaging and/or upgrading after radical prostatectomy (RP) in patients with Gleason score 3 + 4 = 7 PCa diagnosed on TRUS-guided biopsies. We searched our institution's database for patients with Gleason score 3 + 4 = 7 PCa diagnosed on TRUS-guided biopsy who underwent subsequent RP between January 2010 and January 2015. Two blinded genitourinary pathologists independently reviewed and assessed the following on biopsies: (a) nuclear size, nucleolar size and distribution of macronucleoli of PCa, which were subjectively graded using a semi-quantitative scale from 1 to 3, and (b) PCa with cribriform morphology and the size of cribriform disease. Patient age, serum prostate-specific antigen (PSA) and PSA density (PSAD) were also recorded. The Gleason score and stage (presence or absence of organ-confined disease (OCD)) were retrieved from RP reports. Comparisons were performed between groups using the chi-square test and Spearman correlation. One hundred and four patients were identified to have met inclusion criteria. The mean age was 63 (±6.1) years. Mean PSA and PSAD at diagnosis were 7.5 (±4.2) and 0.25 (±0.15) ng/mL, respectively. Gleason scores were upgraded to greater than 3 + 4 = 7 in 26.9 % (28/104) of patients, and 44.2 % (46/104) of patients had no OCD after RP. There was no correlation between age, PSA, PSAD or percent of biopsies with Gleason pattern 4 for either Gleason score upgrading or absence of OCD at the time of RP (p > 0.05). Thirty patients had cribriform morphology on TRUS-guided biopsy of which 60 % (18/30) had no OCD at RP (p = 0.04) while 36.7 % (11/30) were upgraded to Gleason score ≥3 + 4 = 7 after RP (p = 0.15). There was no association between nuclear size, nucleolar size and/or distribution of macronucleoli with upgrading and/or absence of OCD (p > 0.05). The size of cribriform pattern was not associated with the absence of OCD (p = 0.43) or Gleason score upgrade (p = 0.28). A proportion of patients with Gleason score 3 + 4 = 7 PCa at needle biopsy do not have OCD or are upgraded to higher Gleason scores after RP. In our study, patients with Gleason score 3 + 4 = 7 PCa with the presence of cribriform pattern 4 had a significantly increased chance of being found to have no OCD at the time of RP. There were no clinical or pathologic parameters at the time of TRUS-guided biopsy that identified risk factors for Gleason score upgrading at RP in this study. Cribriform morphology detected on biopsy in patients with Gleason score 3 + 4 = 7 PCa is associated with tumour upstaging after RP and may be considered a contraindication to active surveillance.
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Caster JM, Falchook AD, Hendrix LH, Chen RC. Risk of Pathologic Upgrading or Locally Advanced Disease in Early Prostate Cancer Patients Based on Biopsy Gleason Score and PSA: A Population-Based Study of Modern Patients. Int J Radiat Oncol Biol Phys 2015; 92:244-51. [DOI: 10.1016/j.ijrobp.2015.01.051] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/31/2014] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
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Mandel P, Steuber T, Ahyai S, Kriegmair M, Schiffmann J, Boehm K, Heinzer H, Michl U, Schlomm T, Haese A, Huland H, Graefen M, Tilki D. Salvage radical prostatectomy for recurrent prostate cancer: verification of European Association of Urology guideline criteria. BJU Int 2015; 117:55-61. [DOI: 10.1111/bju.13103] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Philipp Mandel
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Thomas Steuber
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Sascha Ahyai
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | | | - Jonas Schiffmann
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Katharina Boehm
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Hans Heinzer
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Uwe Michl
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Thorsten Schlomm
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Alexander Haese
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Hartwig Huland
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Derya Tilki
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
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Jung JW, Lee JK, Hong SK, Byun SS, Lee SE. Stratification of patients with intermediate-risk prostate cancer. BJU Int 2015; 115:907-12. [PMID: 24612460 DOI: 10.1111/bju.12703] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To identify an appropriate risk stratification system for intermediate-risk prostate cancer (PCa). PATIENTS AND METHODS We reviewed the data on 1559 patients who were treated with radical prostatectomy (RP) at our institution between 2005 and 2013 and classified them according to National Comprehensive Cancer Network (NCCN) risk groups. For our analyses, intermediate-risk PCa was designated as unfavourable intermediate-risk PCa if it met at least one of the following two criteria: biopsy Gleason score 4 + 3 and/or presence of ≥ 2 intermediate-risk criteria. All other men with intermediate-risk PCa were designated as having favourable intermediate-risk disease. Postoperative outcomes, including biochemical recurrence (BCR)-free survival, were calculated and compared using the log-rank test and Cox proportional hazards model. RESULTS In multivariable analysis, biopsy Gleason score 4 + 3 and multiple (≥ 2) intermediate-risk criteria were observed to be independent predictors of BCR risk among men in the intermediate-risk group undergoing RP. The favourable intermediate-risk group had a significantly higher 5-year BCR-free survival compared with the unfavourable intermediate-risk group (87.5 vs 66.5%; P < 0.001). The unfavourable intermediate-risk group had significantly higher 5-year BCR-free survival than the high-risk group (66.5 vs 47.9%; P < 0.001) while the favourable intermediate-risk group had significantly lower 5-year BCR-free survival than the low-risk group (87.5 vs 93.5%; P = 0.002). CONCLUSIONS A marked heterogeneity exists in the biochemical outcomes of contemporary patients with intermediate-risk PCa who undergo definitive RP. According to biopsy Gleason score and number of intermediate-risk criteria present, the intermediate-risk group should be sub-divided into those with favourable and unfavourable intermediate-risk disease.
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Affiliation(s)
- Jin-Woo Jung
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Keun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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da Silva RD, Fernando J. Focal Cryotherapy in Low-Risk Prostate Cancer: Are We Treating the Cancer or the Mind? - The Cancer. Int Braz J Urol 2015; 41:5-9. [PMID: 25928504 PMCID: PMC4752050 DOI: 10.1590/s1677-5538.ibju.2015.01.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Affiliation(s)
- Rodrigo Donalisio da Silva
- Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver CO, USA
| | - J Fernando
- Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver CO, USA
- University of Colorado Cancer Center, UC Denver. Denver CO, USA
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Vourganti S, Donaldson J, Johnson L, Turkbey B, Bratslavsky G, Kotula L. Defining the radiobiology of prostate cancer progression: An important question in translational prostate cancer research. Exp Biol Med (Maywood) 2014; 239:805-812. [PMID: 24879423 DOI: 10.1177/1535370214536669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer is one of the most common malignancies affecting men worldwide. High mortality rates from advanced and metastatic prostate cancer in the United States are contrasted by a relatively indolent course in the majority of cases. This gives hope for finding methods that could direct personalized diagnostic, preventative, and treatment approaches to patients with prostate cancer. Recent advances in multiparametric magnetic resonance imaging (MP-MRI) offer a noninvasive diagnostic intervention which allows correlation of prostate tumor image characteristics with underlying biologic evidence of tumor progression. The power of MP-MRI includes examination of both local invasion and nodal disease and might overcome the challenges of analyzing the multifocal nature of prostate cancer. Future directions include a careful analysis of the genomic signature of individual prostatic lesions utilizing image-guided biopsies. This review examines the diagnostic potential of MRI in prostate cancer.
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Affiliation(s)
- Srinivas Vourganti
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Jeffrey Donaldson
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Linda Johnson
- Molecular Imaging Program, Urologic Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Baris Turkbey
- Molecular Imaging Program, Urologic Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Gennady Bratslavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Leszek Kotula
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY 13210, USA Department of Biochemistry and Molecular Biology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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Yashi M, Mizuno T, Yuki H, Masuda A, Kambara T, Betsunoh H, Abe H, Fukabori Y, Muraishi O, Suzuki K, Nakazato Y, Kamai T. Prostate volume and biopsy tumor length are significant predictors for classical and redefined insignificant cancer on prostatectomy specimens in Japanese men with favorable pathologic features on biopsy. BMC Urol 2014; 14:43. [PMID: 24886065 PMCID: PMC4047262 DOI: 10.1186/1471-2490-14-43] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/21/2014] [Indexed: 12/17/2022] Open
Abstract
Background Gleason pattern 3 less often has molecular abnormalities and often behaves indolent. It is controversial whether low grade small foci of prostate cancer (PCa) on biopsy could avoid immediate treatment or not, because substantial cases harbor unfavorable pathologic results on prostatectomy specimens. This study was designed to identify clinical predictors for classical and redefined insignificant cancer on prostatectomy specimens in Japanese men with favorable pathologic features on biopsy. Methods Retrospective review of 1040 PCa Japanese patients underwent radical prostatectomy between 2006 and 2013. Of those, 170 patients (16.3%) met the inclusion criteria of clinical stage ≤ cT2a, Gleason score (GS) ≤ 6, up to two positive biopsies, and no more than 50% of cancer involvement in any core. The associations between preoperative data and unfavorable pathologic results of prostatectomy specimens, and oncological outcome were analyzed. The definition of insignificant cancer consisted of pathologic stage ≤ pT2, GS ≤ 6, and an index tumor volume < 0.5 mL (classical) or 1.3 mL (redefined). Results Pathologic stage ≥ pT3, upgraded GS, index tumor volume ≥ 0.5 mL, and ≥ 1.3 mL were detected in 25 (14.7%), 77 (45.3%), 83 (48.8%), and 53 patients (31.2%), respectively. Less than half of cases had classical (41.2%) and redefined (47.6%) insignificant cancer. The 5-year recurrence-free survival was 86.8%, and the insignificant cancers essentially did not relapse regardless of the surgical margin status. MRI-estimated prostate volume, tumor length on biopsy, prostate-specific antigen density (PSAD), and findings of magnetic resonance imaging were associated with the presence of classical and redefined insignificant cancer. Large prostate volume and short tumor length on biopsy remained as independent predictors in multivariate analysis. Conclusions Favorable features of biopsy often are followed by adverse pathologic findings on prostatectomy specimens despite fulfilling the established criteria. The finding that prostate volume is important does not simply mirror many other studies showing PSAD is important, and the clinical criteria for risk assessment before definitive therapy or active surveillance should incorporate these significant factors other than clinical T-staging or PSAD to minimize under-estimation of cancer in Japanese patients with low-risk PCa.
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Affiliation(s)
- Masahiro Yashi
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan.
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Wang JY, Zhu Y, Wang CF, Zhang SL, Dai B, Ye DW. A nomogram to predict Gleason sum upgrading of clinically diagnosed localized prostate cancer among Chinese patients. CHINESE JOURNAL OF CANCER 2014; 33:241-8. [PMID: 24559852 PMCID: PMC4026544 DOI: 10.5732/cjc.013.10137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens, most of these models are restricted to prostate-specific antigen screening-detected prostate cancer. This study aimed to build a nomogram for the prediction of Gleason sum upgrading in clinically diagnosed prostate cancer. The study cohort comprised 269 Chinese prostate cancer patients who underwent prostate biopsy with a minimum of 10 cores and were subsequently treated with radical prostatectomy. Of all included patients, 220 (81.8%) were referred with clinical symptoms. The prostate-specific antigen level, primary and secondary biopsy Gleason scores, and clinical T category were used in a multivariate logistic regression model to predict the probability of Gleason sum upgrading. The developed nomogram was validated internally. Gleason sum upgrading was observed in 90 (33.5%) patients. Our nomogram showed a bootstrap-corrected concordance index of 0.789 and good calibration using 4 readily available variables. The nomogram also demonstrated satisfactory statistical performance for predicting significant upgrading. External validation of the nomogram published by Chun et al. in our cohort showed a marked discordance between the observed and predicted probabilities of Gleason sum upgrading. In summary, a new nomogram to predict Gleason sum upgrading in clinically diagnosed prostate cancer was developed, and it demonstrated good statistical performance upon internal validation.
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Affiliation(s)
- Jin-You Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P. R. China.
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Differences in Upgrading of Prostate Cancer in Prostatectomies between Community and Academic Practices. Adv Urol 2013; 2013:471234. [PMID: 24260032 PMCID: PMC3821894 DOI: 10.1155/2013/471234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/05/2013] [Indexed: 11/18/2022] Open
Abstract
Objective. To determine whether initial biopsy performed by community or academic urologists affected rates of Gleason upgrading at a tertiary referral center. Gleason upgrading from biopsy to radical prostatectomy (RP) is an important event as treatment decisions are made based on the biopsy score. Materials and Methods. We identified men undergoing RP for Gleason 3 + 3 or 3 + 4 disease at a tertiary care academic center. Biopsy performed in the community was centrally reviewed at the academic center. Multivariate logistic regression was used to determine factors associated with Gleason upgrading. Results. We reviewed 1,348 men. There was no difference in upgrading whether the biopsy was performed at academic or community sites (OR 0.9, 95% CI 0.7-1.2). Increased risk of upgrading was seen in those with >1 positive core, older men, and those with higher PSAs. Secondary pattern 4 and larger prostate size were associated with a reduction in risk of upgrading. Compared to the smallest quartile of prostate size (<35 g), those in the highest quartile (>56 g) had a 49% reduction in risk of upgrading (OR 0.51, 95% CI 0.3-0.7). Conclusion. There was no difference in upgrading between where the biopsy was performed and community and academic urologists.
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Truong M, Slezak JA, Lin CP, Iremashvili V, Sado M, Razmaria AA, Leverson G, Soloway MS, Eggener SE, Abel EJ, Downs TM, Jarrard DF. Development and multi-institutional validation of an upgrading risk tool for Gleason 6 prostate cancer. Cancer 2013; 119:3992-4002. [PMID: 24006289 DOI: 10.1002/cncr.28303] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/13/2013] [Accepted: 05/21/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many patients with low-risk prostate cancer (PC) who are diagnosed with Gleason score 6 at biopsy are ultimately found to harbor higher grade PC (Gleason ≥ 7) at radical prostatectomy. This finding increases risk of recurrence and cancer-specific mortality. Validated clinical tools that are available preoperatively are needed to improve the ability to recognize likelihood of upgrading in patients with low-risk PC. METHODS More than 30 clinicopathologic parameters were assessed in consecutive patients with Gleason 6 PC upon biopsy who underwent radical prostatectomy. A nomogram for predicting upgrading (Gleason ≥ 7) on final pathology was generated using multivariable logistic regression in a development cohort of 431 patients. External validation was performed in 2 separate cohorts consisting of 1151 patients and 392 patients. Nomogram performance was assessed using receiver operating characteristic curves, calibration, and decision analysis. RESULTS On multivariable analysis, variables predicting upgrading were prostate-specific antigen density using ultrasound (odds ratio [OR] = 229, P = .003), obesity (OR = 1.90, P = .05), number of positive cores (OR = 1.23, P = .01), and maximum core involvement (OR = 0.02, P = .01). On internal validation, the bootstrap-corrected predictive accuracy was 0.753. External validation revealed a predictive accuracy of 0.677 and 0.672. The nomogram demonstrated excellent calibration in all 3 cohorts and decision curves demonstrated high net benefit across a wide range of threshold probabilities. The nomogram demonstrated areas under the curve of 0.597 to 0.672 for predicting upgrading in subsets of men with very low-risk PC who meet active surveillance criteria (all P < .001), allowing further risk stratification of these individuals. CONCLUSIONS A nomogram was developed and externally validated that uses preoperative clinical parameters and biopsy findings to predict the risk of pathological upgrading in Gleason 6 patients. This can be used to further inform patients with lower risk PC who are considering treatment or active surveillance.
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Affiliation(s)
- Matthew Truong
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Suer E, Gokce MI, Gulpinar O, Gucal Guclu A, Haciyev P, Gogus C, Turkolmez K, Baltaci S. How significant is upgrade in Gleason score between prostate biopsy and radical prostatectomy pathology while discussing less invasive treatment options? Scand J Urol 2013; 48:177-82. [DOI: 10.3109/21681805.2013.829519] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vora A, Large T, Aronica J, Haynes S, Harbin A, Marchalik D, Nissim H, Lynch J, Bandi G, McGeagh K, Kowalczyk K, Ghasemian R, Venkatesan K, Verghese M, Hwang J. Predictors of Gleason score upgrading in a large African-American population. Int Urol Nephrol 2013; 45:1257-62. [PMID: 23864415 DOI: 10.1007/s11255-013-0495-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/10/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Gleason score from biopsy specimens is important for prostate cancer (PCa) risk stratification and influences treatment decisions. Gleason score upgrading (GSU) between biopsy and surgical pathology specimens has been reported as high as 50 % and presents a challenge in counseling low-risk patients. While recent studies have investigated predictors of GSU, populations in these studies have been largely Caucasian. We report our analysis of predictors of GSU in a large urban African-American population. METHODS A total of 959 patients with D'Amico low-risk prostate cancer underwent radical prostatectomy at Georgetown University or Washington Hospital Center between January 2005 and July 2012. Race, age, PSA, body mass index (BMI), cancer of the prostate risk assessment (CAPRA) score, and transrectal ultrasound (TRUS) biopsy characteristics (percent of biopsy cores showing adenocarcinoma, highest percent of biopsy core involved with cancer, and measured TRUS prostate volume) were analyzed with both univariate and multivariate analyses to identify significant predictors of GSU while controlling for clinical parameters. RESULTS Of the 959 cases, 288 (30.0 %) were upgraded on final pathologic specimen with approximately 38 % (133/355) of African-American patients experiencing GSU. BMI (P = 0.02), percent positive biopsy cores (P < 0.01) and percent of core involved with cancer (P < 0.01), increasing CAPRA score, and serum PSA were independent predictors of GSU on both uni- and multivariate regression analyses. African Americans had a 73 % increase in the incidence of GSU over other races. CONCLUSION More than a quarter of low-risk prostate cancer patients were upgraded on final pathology in our series. Higher BMI, serum PSA, CAPRA score, percent of cores positive, and percent of cores involved were independent predictors of GSU. Individuals with those clinical parameters may harbor occult high-grade disease and should be carefully counseled on treatment decisions.
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Affiliation(s)
- Anup Vora
- Departments of Urology, Washington Hospital Center and Georgetown University Hospital, 3401 38th ST NW, Suite 915, Washington, DC, 20016, USA,
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Park HJ, Ha YS, Park SY, Kim YT, Lee TY, Kim JH, Lee DH, Kim WJ, Kim IY. Incidence of upgrading and upstaging in patients with low-volume Gleason score 3+4 prostate cancers at biopsy: finding a new group eligible for active surveillance. Urol Int 2013; 90:301-5. [PMID: 23391718 DOI: 10.1159/000345292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/15/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to identify patients with low-volume Gleason score 3+4 (GS3+4) prostate cancer (PCa) who may be candidates for active surveillance (AS) by analyzing the incidence of upgrading and upstaging following radical prostatectomy (RP). PATIENTS AND METHODS Of 907 patients who underwent RP at our institute over the last 5 years, 66 men diagnosed with low-volume GS3+4 PCa at needle biopsy were identified. The incidence of upstaging and upgrading was assessed. RESULTS The overall rate of upgrading and upstaging was 31.8 and 25.6%, respectively. Preoperative PSA levels were significantly higher in patients who were upgraded (p = 0.015). The optimal preoperative PSA cutoff level for the prediction of upgrading was 4.73 ng/ml (sensitivity 85.7%, specificity 57.8%). Patients with <15% of maximum cores positive had significantly lower upstaging rate than those with >15% of maximum cores positive (p = 0.035). Clinical stage and number of positive cores had marginal association with upgrading and upstaging statistically (p = 0.061 and 0.081, respectively). CONCLUSIONS In patients with low-volume GS3+4 PCa at biopsy, underestimation may be effectively avoided when we select patients with PSA <4.73 and % maximum cancer involvement on positive cores <15%.
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Affiliation(s)
- Hee Jung Park
- Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
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Capitanio U, Suardi N. Prostate cancer in 2010: GSU: misclassification or biological progression? Nat Rev Urol 2011; 8:65-6. [PMID: 21304540 DOI: 10.1038/nrurol.2010.247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Umberto Capitanio
- Department of Urology and Urological Research Institute, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
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Moon SJ, Park SY, Lee TY. Predictive factors of Gleason score upgrading in localized and locally advanced prostate cancer diagnosed by prostate biopsy. Korean J Urol 2010; 51:677-82. [PMID: 21031086 PMCID: PMC2963779 DOI: 10.4111/kju.2010.51.10.677] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/16/2010] [Indexed: 11/30/2022] Open
Abstract
Purpose The Gleason score (GS) is an important factor that is considered when making decisions about prostate cancer and its prognosis. However, upgrading of the GS can occur between transrectal ultrasonography (TRUS) biopsy and radical prostatectomy. This study analyzed the clinical factors predictive of upgrading of the GS after radical prostatectomy compared with that at the time of TRUS biopsy. Materials and Methods We analyzed the medical records of 107 patients who had undergone radical prostatectomy. Patients were divided into two groups. Group 1 consisted of patients in whom the GS was not upgraded, and group 2 consisted of patients in whom the GS was upgraded. Associations between preoperative clinical factors and upgrading of the GS were analyzed. Preoperative clinical factors included age, prostate-specific antigen (PSA), prostate volume, PSA density, GS of TRUS biopsy, maximum core percentage of cancer, percentage of positive cores, number of biopsies, location of positive core with maximum GS, high-grade prostatic intraepithelial neplasia (HGPIN), inflammation on biopsy, and clinical stage. Results Among 85 patients, 42 (49%) patients had an upgraded GS after operation. TRUS biopsy core number of 12 or fewer (p=0.029) and prostate volume of 36.5 ml or less (p<0.001) were associated with upgrading of the GS. Preoperative clinical factors associated with nonupgrading of the GS were the detection of positive cores with a maximum GS at the apex (p=0.002) or in a hypoechoic lesion (p=0.002) in TRUS. Conclusions If the positive cores with maximum GS are located at the apex or in a hypoechoic lesion in TRUS, we can expect that the GS will not be upgraded. In patients with the clinical predictive factors of a prostate volume of 36.5 ml or less and TRUS biopsy core number of less than 12, we can expect upgrading of the GS after radical prostatectomy, and more aggressive treatment may be needed.
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Affiliation(s)
- Seung Jin Moon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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