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Celik S, Bozkurt O, Demir O, Gurboga O, Tuna B, Yorukoglu K, Aslan G. Effects of perineural invasion in prostate needle biopsy on tumor grade and biochemical recurrence rates after radical prostatectomy. Kaohsiung J Med Sci 2018; 34:385-390. [PMID: 30063011 DOI: 10.1016/j.kjms.2017.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/14/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022] Open
Abstract
To predict local invasive disease before retropubic radical prostatectomy (RRP), the correlation of perineural invasion (PNI) on prostate needle biopsy (PNB) and RRP pathology data and the effect of PNI on biochemical recurrence (BR) were researched. For patients with RRP performed between 2005 and 2014, predictive and pathologic prognostic factors were assessed. Initially all and D'Amico intermediate-risk group patients were comparatively assessed in terms of being T2 or T3 stage on RRP pathology, positive or negative for PNI presence on PNB and positive or negative BR situation. Additionally the effect of PNI presence on recurrence-free survival (RFS) rate was investigated. When all patients are investigated, multivariate analysis observed that in T3 patients PSA, PNB Gleason score (GS) and tumor percentage were significantly higher; in PNI positive patients PNB GS, core number and tumor percentage were significantly higher and in BR positive patients PNB PNI positivity and core number were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). When D'Amico intermediate-risk patients are evaluated, for T3 patients PSA and PNB tumor percentage; for PNI positive patients PNB core number and tumor percentage; and for BR positive patients PNB PNI positivity were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). Mean RFS in the whole patient group was 56.4 ± 4.2 months for PNI positive and 96.1 ± 5.7 months for negative groups. In the intermediate-risk group, mean RFS was 53.7 ± 5.1 months for PNI positive and 100.3 ± 7.7 months for negative groups (p < 0.001). PNI positivity on PNB was shown to be an important predictive factor for increased T3 disease and BR rates and reduced RFS.
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Affiliation(s)
- Serdar Celik
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Ozan Bozkurt
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Omer Demir
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ozgur Gurboga
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Burcin Tuna
- Department of Pathology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Kutsal Yorukoglu
- Department of Pathology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Guven Aslan
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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Prognostic histopathological and molecular markers on prostate cancer needle-biopsies: a review. BIOMED RESEARCH INTERNATIONAL 2014; 2014:341324. [PMID: 25243131 PMCID: PMC4163394 DOI: 10.1155/2014/341324] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/04/2014] [Indexed: 12/16/2022]
Abstract
Prostate cancer is diverse in clinical presentation, histopathological tumor growth patterns, and survival. Therefore, individual assessment of a tumor's aggressive potential is crucial for clinical decision-making in men with prostate cancer. To date a large number of prognostic markers for prostate cancer have been described, most of them based on radical prostatectomy specimens. However, in order to affect clinical decision-making, validation of respective markers in pretreatment diagnostic needle-biopsies is essential. Here, we discuss established and promising histopathological and molecular parameters in diagnostic needle-biopsies.
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Berney DM, Algaba F, Camparo P, Compérat E, Griffiths D, Kristiansen G, Lopez-Beltran A, Montironi R, Varma M, Egevad L. Variation in reporting of cancer extent and benign histology in prostate biopsies among European pathologists. Virchows Arch 2014; 464:583-7. [PMID: 24590584 DOI: 10.1007/s00428-014-1554-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/27/2014] [Accepted: 02/09/2014] [Indexed: 12/17/2022]
Abstract
It is not known how uropathologists currently report histopathological features of prostate biopsies such as core length, tumor extent, perineural invasion, and non-tumor-associated features such as inflammation and hyperplasia in needle biopsies. A web-based survey was distributed among 661 members of the European Network of Uropathology. Complete replies were received from 266 pathologists in 22 European countries. Total core lengths were reported by 64 %. The numbers of cores positive for cancer was given by 79 %. Linear cancer extent was reported by 81 %, most often given in millimeters for each core (53 %) followed by the estimation of percentage of cancer in each core (40 %). A gap of benign tissue between separate cancer foci in a single core would always be subtracted by 48 % and by 63 % if cancer foci were minute and widely separated. Perineural invasion was reported by 97 %. Fat invasion by tumor was interpreted as extraprostatic extension by 81 %. Chronic and active/acute inflammation was always reported by 32 and 56 % but only if pronounced by 54 and 39 %, respectively. While most (79 %) would never diagnose benign prostatic hyperplasia on needle biopsy, 21 % would attempt to make this diagnosis. Reporting practices for prostate biopsies are variable among European pathologists. The great variation in some methodologies used suggests a need for further international consensus, in order for retrospective data to be comparable between different institutions.
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Affiliation(s)
- D M Berney
- Queen Mary, University of London, London, UK,
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Tumor volume, surgical margin, and the risk of biochemical recurrence in men with organ-confined prostate cancer. Urol Oncol 2011; 31:168-74. [PMID: 21719325 DOI: 10.1016/j.urolonc.2010.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 10/16/2010] [Accepted: 11/16/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We proposed to investigate predictors of biochemical recurrence (BCR) in pT2 prostate cancer by identifying the interrelationship between the tumor volume and surgical margin status, and their impact on recurrence. MATERIALS AND METHODS Clinical, pathologic, and follow-up data of 404 consecutive patients who were treated with radical prostatectomy alone and were diagnosed as pT2 prostate cancer in our institution were reviewed. Percent tumor volume (PTV) was estimated from the cancer distribution map, and the surgical margin status was reviewed by a single pathologist (JYR). Clinicopathologic variables were analyzed with respect to the risk of BCR. RESULTS AND LIMITATIONS Recurrence was observed in 39 (9.7%) patients at a mean of 28.9 (5-47) months. Preoperative PSA, biopsy Gleason score, surgical Gleason score, PTV, and surgical margin status were significantly related to BCR in univariate analysis; in multivariate analysis, PTV (P < 0.001) and surgical Gleason score (P = 0.021) were independent predictors of BCR. PTV was also an independent determinant of positive surgical margin (P = 0.035, HR 1.026, 95% CI 1.002-1.050). By combining the 2 predictors 5-year recurrence-free survivals for PTV ≤ 14.5% and surgical Gleason score ≤ 7, PTV >14.5% or surgical Gleason score > 7, and PTV > 14.5% and surgical Gleason score > 7 were 97.5%, 88.7%, and 44.5%, respectively (log-rank test, P < 0.01). Retrospective study nature, use of PTV instead of actual volume, and intermediate follow-up length are the main limitations of the study. CONCLUSIONS In men with pT2 prostate cancer, percent tumor volume and the surgical Gleason score were independently prognostic of BCR and by combining the 2 factors, risk of BCR could be significantly stratified. Tumor volume further determined surgical margin status undermining its prognostic value as an independent variable.
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Rajab R, Fisher G, Kattan MW, Foster CS, Oliver T, Møller H, Reuter V, Scardino P, Cuzick J, Berney DM. Measurements of cancer extent in a conservatively treated prostate cancer biopsy cohort. Virchows Arch 2010; 457:547-53. [PMID: 20827488 DOI: 10.1007/s00428-010-0971-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 08/23/2010] [Accepted: 08/29/2010] [Indexed: 10/19/2022]
Abstract
The optimal method for measuring cancer extent in prostate biopsy specimens is unknown. Seven hundred forty-four patients diagnosed between 1990 and 1996 with prostate cancer and managed conservatively were identified. The clinical end point was death from prostate cancer. The extent of cancer was measured in terms of number of cancer cores (NCC), percentage of cores with cancer (PCC), total length of cancer (LCC) and percentage length of cancer in the cores (PLC). These were correlated with prostate cancer mortality, in univariate and multivariate analysis including Gleason score and prostate-specific antigen (PSA). All extent of cancer variables were significant predictors of prostate cancer death on univariate analysis: NCC, hazard ration (HR) = 1.15, 95% confidence interval (CI) = 1.04-1.28, P = 0.011; PPC, HR = 1.01, 95% CI = 1.01-1.02, P < 0.0001; LCC, HR = 1.02, 95% CI = 1.01-1.03, P = 0.002; PLC, HR = 1.01, 95% CI = 1.01-1.02, P = 0.0001. In multivariate analysis including Gleason score and baseline PSA, PCC and PLC were both independently significant P = 0.004 and P = 0.012, respectively, and added further information to that provided by PSA and Gleason score, whereas NNC and LCC were no longer significant (P = 0.5 and P = 0.3 respectively). In a final model, including both extent of cancer variables, PCC was the stronger, adding more value than PLC (χ² (1df) = 7.8, P = 0.005, χ² (1df) = 0.5, P = 0.48 respectively). Measurements of disease burden in needle biopsy specimens are significant predictors of prostate-cancer-related death. The percentage of positive cores appeared the strongest predictor and was stronger than percentage length of cancer in the cores.
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Affiliation(s)
- Ramzi Rajab
- Centre for Molecular Oncology and Imaging, Queen Mary University of London, UK
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Miller JS, Chen Y, Ye H, Robinson BD, Brimo F, Epstein JI. Extraprostatic extension of prostatic adenocarcinoma on needle core biopsy: report of 72 cases with clinical follow-up. BJU Int 2009; 106:330-3. [DOI: 10.1111/j.1464-410x.2009.09110.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adverse prognostic impact of capsular incision at radical prostatectomy for Japanese men with clinically localized prostate cancer. Int Urol Nephrol 2008; 41:581-6. [PMID: 18784981 DOI: 10.1007/s11255-008-9467-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the significance of capsular incision (CI) at radical prostatectomy (RP) for men with prostate cancer. MATERIALS AND METHODS This study included 267 men who underwent RP without neoadjuvant therapy and were pathologically diagnosed as having organ-confined disease. CI was defined as exposing benign or malignant glands at the inked margin without documented extraprostatic extension. RESULTS Pathological examinations identified CI in 53 RP specimens (19.9%), while CI was not detected in the remaining 214 specimens (80.1%). The locations of CIs in RP specimens from these 53 patients were as follows: 39 (73.6%) at the apex, 11 (20.0%) at the anterior site, 4 (7.5%) at the posterior site and 12 (22.6%) at the bladder neck. The incidence of CI was significantly affected by surgical procedure, preoperative serum PSA and microvenous invasion in RP specimen. During the observation period of this study, biochemical recurrence occurred in 10 (18.9%) of the 53 with CI and 20 (9.3%) of the 214 without CI, and the biochemical recurrence-free survival in patients with CI was significantly poorer than those without CI. Furthermore, of several factors examined, biochemical recurrence was significantly associated with preoperative serum PSA, Gleason score, perineural invasion and capsular incision, among which only preoperative serum PSA appeared to be an independent predictor of biochemical recurrence. CONCLUSIONS Despite the lack of independent significance, the presence of CI has an adverse impact on biochemical outcome in patients undergoing RP for clinically localized prostate cancer.
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Yanagisawa N, Li R, Rowley D, Liu H, Kadmon D, Miles BJ, Wheeler TM, Ayala GE. Reprint of: Stromogenic prostatic carcinoma pattern (carcinomas with reactive stromal grade 3) in needle biopsies predicts biochemical recurrence-free survival in patients after radical prostatectomy. Hum Pathol 2008; 39:282-91. [PMID: 18206496 DOI: 10.1016/j.humpath.2007.04.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 04/05/2007] [Accepted: 04/06/2007] [Indexed: 10/22/2022]
Abstract
We previously reported that reactive stromal grading in radical prostatectomies is a predictor of recurrence and that reactive stromal grading 0 and 3 are associated with lower biochemical recurrence-free survival rates than reactive stromal grading 1 and 2. We explored the prognostic significance of reactive stromal grading in preoperative needle biopsies. At Baylor College of Medicine, 224 cases of prostatic carcinoma were diagnosed by needle biopsy. Reactive stromal grading was evaluated on hematoxylin-eosin (H&E)-stained sections on the basis of previously described criteria: grade 0, with 0% to 5% reactive stroma; grade 1, 6% to 15%; grade 2, 16% to 50%; grade 3, 51% to 100%, or at least a 1:1 ratio between glands and stroma. Kaplan-Meier and Cox proportional hazard analyses were used. Reactive stromal grading distribution was as follows: reactive stromal grading 0, 1 case (0.5%); reactive stromal grading 1, 149 cases (66.5%); reactive stromal grading 2, 59 cases (26.3%); reactive stromal grading 3, 15 cases (6.7%). Reactive stromal grading in biopsies was correlated with adverse clinicopathologic parameters in the prostatectomy. Patients with reactive stromal grading 1 and 2 had better survival than those with 0 and 3 (P = .0034). Reactive stromal grading was an independent predictor of recurrence (hazard ratio = 1.953; P = .0174). Reactive stromal grading is independent of Gleason 4 + 3 and 3 + 4 in patients with a Gleason score of 7. Quantitation of reactive stroma and recognition of the stromogenic carcinoma in H&E-stained biopsies is useful to predict biochemical recurrence in prostate carcinoma patients independent of Gleason grade and prostate-specific antigen.
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Yanagisawa N, Li R, Rowley D, Liu H, Kadmon D, Miles BJ, Wheeler TM, Ayala GE. Stromogenic prostatic carcinoma pattern (carcinomas with reactive stromal grade 3) in needle biopsies predicts biochemical recurrence-free survival in patients after radical prostatectomy. Hum Pathol 2007; 38:1611-20. [PMID: 17868773 DOI: 10.1016/j.humpath.2007.04.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 04/05/2007] [Accepted: 04/06/2007] [Indexed: 12/27/2022]
Abstract
We previously reported that reactive stromal grading in radical prostatectomies is a predictor of recurrence and that reactive stromal grading 0 and 3 are associated with lower biochemical recurrence-free survival rates than reactive stromal grading 1 and 2. We explored the prognostic significance of reactive stromal grading in preoperative needle biopsies. At Baylor College of Medicine, 224 cases of prostatic carcinoma were diagnosed by needle biopsy. Reactive stromal grading was evaluated on hematoxylin-eosin (H&E)-stained sections on the basis of previously described criteria: grade 0, with 0% to 5% reactive stroma; grade 1, 6% to 15%; grade 2, 16% to 50%; grade 3, 51% to 100%, or at least a 1:1 ratio between glands and stroma. Kaplan-Meier and Cox proportional hazard analyses were used. Reactive stromal grading distribution was as follows: reactive stromal grading 0, 1 case (0.5%); reactive stromal grading 1, 149 cases (66.5%); reactive stromal grading 2, 59 cases (26.3%); reactive stromal grading 3, 15 cases (6.7%). Reactive stromal grading in biopsies was correlated with adverse clinicopathologic parameters in the prostatectomy. Patients with reactive stromal grading 1 and 2 had better survival than those with 0 and 3 (P = .0034). Reactive stromal grading was an independent predictor of recurrence (hazard ratio = 1.953; P = .0174). Reactive stromal grading is independent of Gleason 4 + 3 and 3 + 4 in patients with a Gleason score of 7. Quantitation of reactive stroma and recognition of the stromogenic carcinoma in H&E-stained biopsies is useful to predict biochemical recurrence in prostate carcinoma patients independent of Gleason grade and prostate-specific antigen.
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Villamón-Fort R, Martínez-Jabaloyas JM, Soriano-Sarriá P, Ramos-Soler D, Pastor-Hernández F, Gil-Salom M. Percentage of Cancer in Prostate Biopsies as Prognostic Factor for Staging and Postoperative Biochemical Failure after Radical Prostatectomy. Urol Int 2007; 78:328-33. [PMID: 17495491 DOI: 10.1159/000100837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2006] [Accepted: 09/26/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess if the percentage of cancer in prostate needle biopsies provides independent prognostic information for predicting pathological stage and/or biochemical relapse after radical prostatectomy. METHODS One hundred and forty prostate cancer patients who underwent radical prostatectomy were evaluated. Preoperative parameters analyzed were patient age, PSA, clinical stage, and the information obtained from sextant biopsies (Gleason score, maximum percentage of cancer in a core, percentage of tissue with cancer in all biopsies and the number of cores positive for cancer). Univariate and multivariate analyses (logistic regression) for the dependent variables (prostate cancer, organ-confined and biochemical relapse) were performed. RESULTS The tumor was organ-confined in 73.6% of patients. In those patients studied for disease progression (n = 126), no biochemical recurrence was observed in 76.2%. In the multivariate analysis for organ-confined disease, the total percentage of biopsy tissue with cancer, the preoperative PSA level, the Gleason score and the clinical stage were the most accurate predictive factors of pathological stage. The multivariate analysis for the study of biochemical failure indicated that only the total percentage of biopsy tissue with cancer, the preoperative PSA level and the Gleason score were independent predictive factors. According to the logistic regression analysis for disease recurrence, 3 risk groups could be identified: low risk (less than 10% probability of disease progression), intermediate risk (30%) and high risk (more than 70%). CONCLUSIONS The percentage of cancer in prostate biopsy provides independent prognostic information for predicting pathological stage and the risk of biochemical failure after radical prostatectomy.
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Affiliation(s)
- Rafael Villamón-Fort
- Department of Urology, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Carlsson S, Nilsson A, Wiklund PN. Postoperative urinary continence after robot-assisted laparoscopic radical prostatectomy. ACTA ACUST UNITED AC 2006; 40:103-7. [PMID: 16608806 DOI: 10.1080/00365590500368120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Laparoscopic radical prostatectomy has shown excellent results concerning patient morbidity, with less blood loss compared to conventional surgery. Robot-assisted laparoscopy offers several additional important technical improvements and therefore it might be suggested that robotic radical prostatectomy would also offer surgical advantages. The objective of this study was to evaluate urinary continence for the first 72 cases of robot-assisted radical prostatectomy performed by a single surgical team. MATERIAL AND METHODS We analysed the outcomes of the first 72 consecutive patients to undergo robot-assisted prostatectomy for localized prostate cancer at our hospital between January 2002 and May 2004. A self-administered questionnaire concerning urinary status was mailed to the patients 3 and 6 months after surgery. Pre- and peroperative characteristics were obtained from patient medical records. The mean age was 61.2 years (range 36-71 years) and the mean preoperative prostate-specific antigen level was 6.3 ng/ml (range 2.3-10.7 ng/ml). The preoperative clinical stage was T1c, 67%, T2, 28% and T3, 5% and the mean Gleason sum was 6 (range 5-9). RESULTS Sixty-one of the 68 patients (90%) reported no use of pads and 6 (9%) used a maximum of 1 pad/day 3-6 months after surgery. One patient reported use of >1 pad/day 6 months after surgery. Three significant complications were noted: ureter injury, haemorrhage and femoral nerve injury. CONCLUSIONS In this series, which represents the learning curve for one surgical team, only a tenth of the patients still required pads 3-6 months after surgery. Considering the short follow-up period, the results in this series will probably improve over time.
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Affiliation(s)
- Stefan Carlsson
- Department of Urology, Division of Surgery, Karolinska Hospital, Stockholm, Sweden.
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Sengupta S, Cheville JC, Lohse CM, Zincke H, Myers RP, Riehle DL, Pankratz VS, Blute ML, Sebo TJ. Conventional assessment of needle biopsy specimens is more useful than digital image analysis of proliferation and DNA ploidy in prediction of positive surgical margins at radical prostatectomy. Urology 2006; 68:94-8. [PMID: 16844452 DOI: 10.1016/j.urology.2006.01.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 12/27/2005] [Accepted: 01/27/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The preoperative prediction of the likelihood of positive surgical margins (+SMs) at radical retropubic prostatectomy (RRP) may be useful for counseling and determining the surgical approach. The aim of this study was to assess the additional value of digital image analysis (DIA) of ploidy and proliferation on needle biopsies, in addition to the known preoperative predictors of +SMs at RRP. METHODS We identified 454 patients treated by RRP at our institution from 1995 to 1998 for prostate cancer verified by transrectal ultrasound-guided biopsy, with a specimen adequate for DIA. Patients receiving preoperative hormonal therapy were excluded. The clinical features, transrectal ultrasound-guided biopsy findings, and DIA evaluation of MIB-I immunostaining and DNA ploidy were assessed in a multivariate logistic regression model to predict for +SMs at RRP. RESULTS The mean +/- SD age at treatment was 64.5 +/- 6.5 years, the percentage of positive cores was 40.4% +/- 24.3%, the median prostate-specific antigen level was 6.3 ng/mL (range 0.6 to 112.0), median biopsy Gleason score was 6 (range 4 to 9), and median percentage of diploid nuclei was 67% (range 0% to 100%). Of the 454 patients, 185 (40.7%) had +SMs; this finding was time dependent (1995 to 1996, 45% and 1997 to 1998, 31%; P = 0.004). Univariately, preoperative prostate-specific antigen, biopsy Gleason score, extent of cancer on biopsy, MIB-1 expression, percentage of diploid or nondiploid nuclei, and year of surgery were predictive for +SMs. On multivariate analysis, the preoperative prostate-specific antigen level, biopsy Gleason score, percentage of positive cores, and year of surgery remained significant. CONCLUSIONS The results of our study have shown that the likelihood of +SMs at RRP is best predicted on the basis of conventional prognostic factors. The DIA features of needle biopsies did not provide additional predictive power.
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Affiliation(s)
- Shomik Sengupta
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Naya Y, Ochiai A, Troncoso P, Babaian RJ. A comparison of extended biopsy and sextant biopsy schemes for predicting the pathological stage of prostate cancer. J Urol 2004; 171:2203-8. [PMID: 15126786 DOI: 10.1097/01.ju.0000127729.71350.7f] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE We compared the performance of the extended multisite directed biopsy strategy to the sextant component of this strategy for predicting the pathological stage and Gleason score of the radical prostatectomy specimen. MATERIALS AND METHODS We studied 157 men in whom prostate cancer was diagnosed by extended multisite directed biopsy and who underwent radical retropubic prostatectomy. The pretreatment variables of serum prostate specific antigen, prostate specific antigen density, biopsy specimen Gleason score, the location, number and percent of cancer containing cores, greatest tumor length in a single core and greatest percent of tumor in a single core were determined and compared with the pathological features of prostate cancer in the radical prostatectomy specimens. A comparison of the information obtained from sextant component cores of the extended biopsy strategy with that from all cores of the extended biopsy strategy was performed using chi-square statistics and ROC curve analysis. RESULTS When comparing the areas under the ROC curves, the extended multisite directed biopsy strategy was found to have greater predictive power for extraprostatic extension than the sextant core component of this biopsy scheme, although the difference was not significantly different. The sextant component was equivalent to the extended biopsy strategy for predicting the prostatectomy specimen Gleason score. CONCLUSIONS The extended biopsy strategy has better performance in the upper sensitivity ranges compared to the sextant technique for predicting extraprostatic extension.
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Affiliation(s)
- Yoshio Naya
- Departments of Urology and Pathology, University of Texas M D Anderson Cancer Center, Houston, Texas 77030, USA
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Lotan Y, Shariat SF, Khoddami SM, Saboorian H, Koeneman KS, Cadeddu JA, Sagalowsky AI, McConnell JD, Roehrborn CG. THE PERCENT OF BIOPSY CORES POSITIVE FOR CANCER IS A PREDICTOR OF ADVANCED PATHOLOGICAL STAGE AND POOR CLINICAL OUTCOMES IN PATIENTS TREATED WITH RADICAL PROSTATECTOMY. J Urol 2004; 171:2209-14. [PMID: 15126787 DOI: 10.1097/01.ju.0000127730.78973.fe] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We examined if the percent of positive biopsies is associated with features of biologically aggressive prostate cancer, biochemical progression and development of distant metastases in patients undergoing radical prostatectomy (RP). MATERIALS AND METHODS Multivariate analyses of preoperative features in 605 consecutive patients who underwent RP for clinically localized disease were evaluated to determine the association between the percent positive biopsy cores (PosBx), pathological stage and grade, and biochemical progression following RP. The percent of PosBx cores was defined using the formula, (number of positive biopsy cores/total number of biopsy cores) x 100. RESULTS The mean number of biopsy cores and percent PosBx cores +/- SE was 8.8 +/- 6.0 and 31.4 +/-21.1, respectively. Higher percent PosBx was significantly associated with higher preoperative prostate specific antigen (PSA), extracapsular extension, seminal vesicle invasion, positive surgical margins, higher final Gleason sum, lymphovascular invasion, perineural invasion and metastases to regional lymph nodes. On multivariate analyses adjusted for the effects of standard preoperative features percent PosBx was associated with nonorgan confined disease, seminal vesicle invasion and biochemical progression after surgery (p = 0.049, 0.050 and 0.006, respectively). Percent PosBx retained its independent association with PSA progression after adjustment for the effects of postoperative pathological features (p = 0.015). Higher percent PosBx was associated with shorter PSA doubling time after PSA progression, and an increased risk of distant metastases and overall mortality (p = 0.039, 0.001 and 0.018, respectively). CONCLUSIONS Percent PosBx is associated with established pathological features, biochemical progression, distant metastases and overall death in patients who undergo RP for clinically localized disease. Percent PosBx should be included in preoperative predictive models for prognosticating outcomes after primary treatment and it may assist in selecting patients for inclusion in neoadjuvant and/or adjuvant therapy trials.
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Affiliation(s)
- Yair Lotan
- Departments of Urology and Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9110, USA.
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Abstract
PURPOSE OF REVIEW Over the past decade, a considerable number of modifications have been made to the techniques for prostate cancer biopsy. In this review, we discuss the developments reported in the literature since January 2003. RECENT FINDINGS The addition of laterally directed biopsies has enhanced the diagnostic performance of the conventional sextant biopsy approach. Several models of the extended biopsy technique have been introduced that increase the number of cores by combining sextant and lateral biopsies to enhance the cancer detection rate. Several reports have shown that the cancer detection rate decreases as prostate volume increases, compared with an increasing cancer detection rate on repeat biopsy in men with large prostate gland volumes. Other studies have shown that the percentage of positive cores and the total percentage of tumor found at biopsy are significant independent predictors of pathological outcome on multivariate analysis. In randomized, double-blind studies, infiltration of the neurovascular bundles with lidocaine significantly reduces pain associated with extended biopsies. SUMMARY Current reports have suggested that: (1) extended biopsy schemes decrease the false-negative rate compared with conventional sextant biopsy; (2) laterally directed biopsies from the anterior horn should be included in extended biopsy protocols; and (3) local anesthesia reduces pain associated with extended biopsy.
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Affiliation(s)
- Atsushi Ochiai
- The University of Texas, MD Anderson Cancer Center, Houston, 77030, USA
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Zhou M, Epstein JI. The reporting of prostate cancer on needle biopsy: prognostic and therapeutic implications and the utility of diagnostic markers. Pathology 2003; 35:472-9. [PMID: 14660096 DOI: 10.1080/00313020310001619163] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Prostate needle biopsy remains the gold standard for diagnosing prostate cancer. Prostate cancer on needle biopsy can be evaluated by numerous techniques of quantifying tumour extent, Gleason score, and the presence of perineural invasion (PNI). These modalities can help clinicians in assessing the risk of extraprostatic disease, progression likelihood, and in helping men with prostate cancer choose among therapeutic options. This review details the information that should be included in the routine pathology report. Recent advances in molecular biology of prostate carcinogenesis have identified many molecular markers for prostate cancer. While several are extremely promising as diagnostic immunohistochemical markers, other prognostic markers are not yet ready to be used in routine practice until they are validated by large prospective studies.
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Affiliation(s)
- Ming Zhou
- Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, OH, USA
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Affiliation(s)
- F H Schröder
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
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Ojea Calvo A, Núñez López A, Domínguez Freire F, Alonso Rodrigo A, Rodríguez Iglesias B, Benavente Delgado J, Barros Rodríguez JM, Gómez-González MC, González Piñeiro A, Otero García M, Nogueira March JL. [Correlation of the anatomo-pathological staging of radical prostatectomy specimens with the amount of cancer in the preoperative sextant biopsy]. Actas Urol Esp 2003; 27:428-37. [PMID: 12918149 DOI: 10.1016/s0210-4806(03)72949-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropublic prostatectomy. MATERIAL AND METHODS We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage. RESULTS Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p = 0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p = 0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p = 0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p = 0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p = 0.972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p = 0.355). Univariate analysis demonstrated that the risk of extraprostatic extension is predicted by the number of cores positive (p = 0.003), the percent of cores positive (p = 0.006), the percent of cancer in all cores (p = 0.001), the Gleason score (p = 0.002), the clinical stage (p = 0.019) and initial PSA (p = 0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p = 0.971), vascular invasion and perineural invasion (p = 0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p = 0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%. CONCLUSIONS The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy.
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Affiliation(s)
- A Ojea Calvo
- Servicio de Urología, Complejo Hospitalario Xeral-Cies, Vigo, Pontevedra
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Bismar TA, Lewis JS, Vollmer RT, Humphrey PA. Multiple measures of carcinoma extent versus perineural invasion in prostate needle biopsy tissue in prediction of pathologic stage in a screening population. Am J Surg Pathol 2003; 27:432-40. [PMID: 12657927 DOI: 10.1097/00000478-200304000-00002] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The capacity of perineural invasion by carcinoma in prostate needle biopsy tissue to independently predict pathologic stage in radical prostatectomy tissues remains uncertain. We sought to determine, in a prostate specific antigen-based screening population, the ability of needle biopsy histologic grade, tumor extent, and perineural invasion to independently predict pathologic stage and margin status in the whole prostate gland. Perineural invasion, Gleason grade, percentage Gleason pattern 4/5 carcinoma, and multiple measures of needle biopsy tumor extent, including number of positive cores, percentage of positive cores, total percentage of carcinoma, greatest percentage of carcinoma in a single core, and total carcinoma length in millimeters, were captured for 215 men from a prostate specific antigen-based screening program diagnosed with prostate cancer in a median of six procured needle biopsy cores. Pathologic stage and surgical margin status were evaluated in corresponding completely embedded radical prostatectomy specimens. A logistic regression model was used to relate the endpoints of extraprostatic extension by carcinoma and/or positive margins to needle biopsy tissue findings. In univariate analyses, total percentage of carcinoma (p = 0.003), greatest percentage of carcinoma in a single core (p = 0.004), total tumor length in millimeters (p = 0.009), and fraction of positive cores (p = 0.02) were all significantly associated with extraprostatic (pT3) carcinoma, whereas all five measures of carcinoma extent in needle biopsy tissue were related to positive margins. Correlation coefficient determinations showed that all five measures of needle biopsy carcinoma extent were highly interrelated. In multivariate analyses, total percentage of carcinoma was significantly related to pathologic T stage (p = 0.003) and positive margins (p = 0.0002). In a multivariate model with the radical prostatectomy whole gland endpoint of either pT3 disease or positive margins, fraction of positive cores (p = 0.00001) was the only variable with significant predictive value. Perineural invasion by carcinoma in needle biopsy tissue was detected in 11% of cases. Neither presence nor absence of perineural carcinoma nor number nor percentage of positive nerves related to pathologic stage in univariate or multivariate analyses. Amount of carcinoma in prostate needle biopsy tissue, using multiple measurements but not perineural invasion, is a significant histologic attribute predictive of pathologic stage and margin status for men with prostate specific antigen screening detected prostatic carcinoma. Reporting of several measures of carcinoma extent in needle biopsy tissue is recommended.
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Affiliation(s)
- Tarek A Bismar
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
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Abstract
This review focuses on new findings and controversial issues in the the pathology and molecular biology of adenocarcinoma of the prostate. Since management of high-grade prostatic intraepithelial neoplasia on needle biopsy--the most common precursor lesion to prostate cancer--is the crucial issue with this lesion, we discuss the risk of cancer subsequent to this histological diagnosis and the issue of whether such neoplasia should be regarded as carcinoma-in-situ. We also look at prostate cancer itself, starting with its diagnosis, reporting on needle biopsy, and reviewing how the most frequently used grading system, the Gleason grading system, affects treatment. The molecular basis of prostate cancer includes inheritable and somatic genetic changes (tumour suppressor genes, loss of heterozygosity, gene targets and regions of chromosomal gain, CpG island promoter methylation, invasion and metastasis suppressor genes, telomere shortening, and genetic instability). Changed gene expression (eg, proliferation-related genes, changes in the androgen receptor, apoptosis and stress-response genes) have potential as biomarkers and therapeutic targets in prostate cancer.
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Affiliation(s)
- Angelo M DeMarzo
- Department of Pathology, Johns Hopkins' University School of Medicine, Johns Hopkins' Hospital, Baltimore, MD 21231, USA
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22
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Abstract
Pathologic evaluation of the prostate biopsy provides the clinician with a wealth of information. Identifying needle biopsy parameters predictive of pathological stage and tumor volume at radical prostatectomy has become a major focus in the field of prostate pathology. From a review of the literature, the following factors are strongly predictive of extraprostatic disease; tumor involvement of greater than 25%, greater than two positive cores, cancer involvement greater than 3 mm, and perineural invasion. Such information could prove useful in patient counseling and identifying high-risk patients who may be good candidates for adjuvant therapy trials.
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Affiliation(s)
- Javid Javidan
- Department of Urology, University of Michigan Medical Center, 1500 Medical Center Drive, TC2916, Ann Arbor, MI, USA
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23
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Clinical and Pathohistological Prognosticators. Prostate Cancer 2003. [DOI: 10.1007/978-3-642-56321-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bertaccini A, Scattoni V, Comerci F, Martorana G. The Role of TRUS Prostate Biopsy Quantitative Histology in Predicting the Risk of Extraprostatic Disease. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1569-9056(02)00059-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kestin LL, Goldstein NS, Vicini FA, Mitchell C, Gustafson GS, Stromberg JS, Chen PY, Martinez AA. Pathologic evidence of dose-response and dose-volume relationships for prostate cancer treated with combined external beam radiotherapy and high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 2002; 54:107-18. [PMID: 12182980 DOI: 10.1016/s0360-3016(02)02925-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The clinical significance of postradiotherapy (RT) prostate biopsy characteristics is not well understood relative to the known prognostic factors. We performed a detailed pathologic review of posttreatment biopsy specimens in an attempt to clarify their relationship with clinical outcome and radiation dose. METHODS AND MATERIALS Between 1991 and 1998, 78 patients with locally advanced prostate cancer were prospectively treated with external beam RT in combination with high-dose-rate brachytherapy at William Beaumont Hospital and had post-RT biopsy material available for a complete pathologic review. Patients with any of the following characteristics were eligible for study entry: pretreatment prostate-specific antigen level > or =10.0 ng/mL, Gleason score > or =7, or clinical Stage T2b-T3cN0M0. Pelvic external beam RT (46.0 Gy) was supplemented with three (1991-1995) or two (1995-1998) ultrasound-guided transperineal interstitial (192)Ir high-dose-rate implants. The brachytherapy dose was escalated from 5.50 to 10.50 Gy per implant. Post-RT prostate biopsies were performed per protocol at a median interval of 1.5 years after RT. All pre- and post-RT biopsy specimen slides from each case were reviewed by a single pathologist (N.S.G.). The presence and amount of residual cancer, most common RT-effect score, and least amount RT-effect score were analyzed. The median follow-up was 5.7 years. Biochemical failure was defined as three consecutive prostate-specific antigen rises. RESULTS Forty patients (51%) had residual cancer in the post-RT biopsies. The 7-year biochemical control rate was 79% for patients with negative biopsies vs. 62% for those with positive biopsies with marked RT damage vs. 33% for those with positive biopsies with no or minimal RT damage. A greater percentage of positive pre-RT biopsy cores (p = 0.01), lower total RT dose (p = 0.001), lower dose per implant (p = 0.001), and greater percentage of positive post-RT biopsy cores (p = 0.01) were each associated with biochemical failure (Cox regression, univariate analysis). For patients with <25% positive post-RT biopsy cores, the 7-year biochemical control rate was 81% vs. a 62% biochemical control rate for those with 25-49% positive cores and only 32% for those with > or =50% positive cores (p = 0.01). On Cox multiple regression analysis, only the percentage of positive pre-RT biopsy cores and RT dose remained significantly associated with biochemical failure. Of all the factors analyzed, only the pretreatment cancer volume and lower RT dose were significantly associated with residual cancer and/or residual cancer with no or minimal RT damage. A greater percentage of positive pre-RT biopsy cores was associated with both a positive post-RT biopsy (p = 0.08) and a greater percentage of positive post-RT biopsy cores (p = 0.04). A lower total RT dose was associated with both a positive post-RT biopsy (p = 0.08) and a greater percentage of positive post-RT biopsy cores (p = 0.02). For patients who received <80 Gy (equivalent in 2-Gy fractions), 73% had positive post-RT biopsies vs. a 56% biopsy positivity rate for those who received 84-90 Gy and only 39% for those who received > or =92 Gy (p = 0.07). CONCLUSION Patients with positive post-RT biopsies are more likely to experience biochemical failure, especially when the RT damage is minimal. Patients who have a larger pretreatment tumor volume or receive a lower RT dose are more likely to demonstrate post-RT biopsy positivity and biochemical failure.
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Affiliation(s)
- Larry L Kestin
- Department of Radiation Oncology, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA.
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Lewis JS, Vollmer RT, Humphrey PA. Carcinoma extent in prostate needle biopsy tissue in the prediction of whole gland tumor volume in a screening population. Am J Clin Pathol 2002; 118:442-50. [PMID: 12219787 DOI: 10.1309/ywm8-umcn-eyxk-15wv] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Increasing prostate tumor volume has been shown to correlate with numerous adverse prognostic indicators for patients with prostate carcinoma The ability to predict tumor volume from pretreatment parameters is potentially critical in the stratification of patients for different management strategies. We assessed the capacity of preoperative variables to predict tumor volume in 100 men diagnosed with prostate cancer in a prostate-specific antigen (PSA)-based screening program. Preoperative information included total serum PSA concentration and needle biopsy tissue variables, including Gleason score, number of positive cores, linear extent of carcinoma in millimeters, greatest percentage of carcinoma (in a single core), total percentage of carcinoma (all cores), presence of perineural invasion, and percentage of high-grade carcinoma. The postoperative end point was total tumor volume in radical prostatectomy tissue, calculated by image analysis. We determined independently significant factors and generated a predictive modelfor whole gland tumor volume. Total tumor volume was related significantly in multivariate analysis to 3 preoperative variables: linear extent of carcinoma, exponential number of positive cores, and serum PSA. A predictive model generated based on these 3 variables accounted for only 65% of the natural deviance of the data owing to data-point scatter for individual patients, suggesting that additional variables are needed to more accurately predict tumor volume. Findings highlight the importance of reporting quantitative measures of tumor amount in prostate needle biopsy specimens; several measures of tumor extent (vs 1 measure) provide maximal information on prostate cancer size.
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Affiliation(s)
- James S Lewis
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University School of Medicine, St Louis, MO 63110, USA
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27
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Cornud F, Flam T, Chauveinc L, Hamida K, Chrétien Y, Vieillefond A, Hélénon O, Moreau JF. Extraprostatic spread of clinically localized prostate cancer: factors predictive of pT3 tumor and of positive endorectal MR imaging examination results. Radiology 2002; 224:203-10. [PMID: 12091684 DOI: 10.1148/radiol.2241011001] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To identify the factor(s) most predictive of pT3 tumor and those most predictive of a positive endorectal magnetic resonance (MR) imaging result in patients with clinically localized prostate cancer. MATERIALS AND METHODS At multivariate analysis, five preoperative clinical parameters-prostate-specific antigen (PSA) level, digital rectal examination (DRE) result, Gleason score and number of involved sextants at transrectal US-guided biopsy, and endorectal MR imaging result-were used to predict pT3 tumor in 336 patients who underwent radical prostatectomy. On the basis of results of the first four examinations, multivariate analysis was performed also to determine predictors of a positive MR imaging study. RESULTS Significant predictors of pT3 tumor were positive MR imaging result (P < 2 x 10(-8)), more than one sextant involved at biopsy (P < 5 x 10(-5)), and PSA level greater than 10 ng/mL (P < 7 x 10(-3)). Significant predictors of a positive MR imaging result were three or more sextants involved at biopsy (P < 10(-5)), positive DRE result (P < 5 x 10(-3)), and PSA level greater than 10 ng/mL (P < 16 x 10(-3)). In the subgroup of 175 patients who had at least three positive biopsy specimens, the sensitivity of MR imaging was 50% for detection of occult pT3 tumor and 69% for detection of extensive pT3 tumor. The overall specificity of MR imaging was 95%. CONCLUSION Endorectal MR imaging seems to be indicated in carefully selected patients-specifically, those with three or more positive biopsy specimens, a palpable tumor, and/or a PSA level greater than 10 ng/mL.
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Nelson CP, Rubin MA, Strawderman M, Montie JE, Sanda MG. Preoperative parameters for predicting early prostate cancer recurrence after radical prostatectomy. Urology 2002; 59:740-5; discussion 745-6. [PMID: 11992850 DOI: 10.1016/s0090-4295(02)01654-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine whether easily measurable prostate biopsy features could complement Gleason score, prostate-specific antigen (PSA), or clinical stage in predicting recurrence-free survival after prostatectomy. Information relating preoperative parameters to recurrence-free survival is needed to counsel patients with newly diagnosed prostate cancer regarding expectations for postprostatectomy cancer control. METHODS The data of a cohort of 588 consecutive prostatectomy patients (median age 61 years, range 39 to 83) with ascertained preoperative data and up to 4 years of postprostatectomy follow-up were analyzed. Bivariate and multivariate Cox proportional hazards analysis evaluated preoperative factors (clinical stage, PSA, biopsy Gleason score, greatest percentage of a biopsy core involved by cancer [GPC], number of biopsy cores containing cancer, perineural invasion) to identify those relating significantly to recurrence-free survival. Functional forms of these factors were evaluated to optimize accuracy in predicting cancer control. RESULTS The baseline parameters significantly affecting PSA-free survival included PSA level (P <0.01), biopsy Gleason score (P = 0.04), and GPC (P <0.01). Although clinical stage and perineural invasion had a marginal association with PSA-free survival as univariate factors, this association was not independently significant in multivariable analysis. The multivariate Cox model using PSA, Gleason score, and GPC was highly predictive of PSA free-survival (chi-square = 48.2, P = 0.0001). A set of plots representing these data can be used to identify the risk of early postoperative PSA recurrence on the basis of specific preoperative PSA, Gleason score, and GPC values. CONCLUSIONS These findings provide a highly significant model and a simple tool for assisting preoperative patient counseling regarding predicted cancer control after radical prostatectomy.
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Affiliation(s)
- Caleb P Nelson
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
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Grossklaus DJ, Coffey CS, Shappell SB, Jack GS, Chang SS, Cookson MS. Percent of cancer in the biopsy set predicts pathological findings after prostatectomy. J Urol 2002; 167:2032-5; discussion 2036. [PMID: 11956432 DOI: 10.1016/s0022-5347(05)65077-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The ability to use pretreatment variables to identify patients with organ confined prostate cancer continues to challenge physicians. We examined information available preoperatively, including prostate needle biopsy, clinical stage and preoperative prostate specific antigen (PSA), and evaluated these data based on pathological variables after radical retropubic prostatectomy. MATERIALS AND METHODS We reviewed results in 135 consecutive patients who underwent radical retropubic prostatectomy at a single institution. Needle biopsy information, such as the number of cores, percent of tumor per biopsy set, laterality of positive cores and Gleason sum, were compared with pathological data on the radical retropubic prostatectomy specimen, including pathological stage, Gleason sum and tumor volume. Clinical data, including biopsy information and pathological findings, were compared using univariate and multivariate models. RESULTS Overall total PSA, percent of tumor in the biopsy and bilateral positive cores directly correlated with tumor volume (p <0.01). Also, increasing PSA, increasing percent of tumor in the biopsy and bilateral positive cores were associated with increased risks of extracapsular extension (p <0.01). CONCLUSIONS From the information readily available from prostate needle biopsy these results suggest that percent of tumor in the biopsy is a useful predictor of pathological stage and tumor volume. Furthermore, including percent of tumor in the biopsy set and bilateral disease with traditional variables such as serum PSA and clinical stage may improve pretreatment tumor staging. This finding adds additional credence to the inclusion of percent of tumor in the biopsy set in models for the preoperative prediction of pathological stage and should be factored into discussions with patients on treatment options.
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Affiliation(s)
- David J Grossklaus
- Department of Urologic Surgery and Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Linson PW, Lee AK, Doytchinova T, Chen MH, Weinstein MH, Richie JP, D'Amico AV. Percentage of core lengths involved with prostate cancer: does it add to the percentage of positive prostate biopsies in predicting postoperative prostate-specific antigen outcome for men with intermediate-risk prostate cancer? Urology 2002; 59:704-8. [PMID: 11992844 DOI: 10.1016/s0090-4295(01)01665-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate whether the percentage of core lengths involved with prostate cancer added clinically significant information concerning the time to postoperative prostate-specific antigen (PSA) failure in the intermediate-risk patient beyond what is provided by the percentage of positive biopsies. METHODS Cox regression multivariable analysis was performed to compare the ability of the two measurements of biopsy cancer volume to predict the time to PSA failure from a series of 184 surgically treated intermediate-risk patients. PSA outcome was estimated using the actuarial method of Kaplan and Meier, and comparisons were made using the log-rank test. RESULTS Both the percentage of core lengths involved with prostate cancer (P = 0.01) and the percentage of positive biopsies (P = 0.002) were significant predictors of the time to PSA failure on univariable analysis. The 4-year PSA outcome was 83% versus 47% (P = 0.0008) and 83% versus 53% (P = 0.007) for the percentage of positive biopsies stratified by 50% or less versus greater than 50% and the percentage of core lengths involved with prostate cancer stratified by 25% or less versus greater than 25%, respectively. However, only the percentage of positive biopsies remained significant (P = 0.03) on multivariable analysis. CONCLUSIONS The percentage of core lengths involved with prostate cancer did not provide additional clinically relevant information to the percentage of positive biopsies for patients with intermediate-risk prostate cancer. Therefore, the routine measurement of core involvement may not be necessary in this patient population.
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Affiliation(s)
- Patrick W Linson
- Joint Center for Radiation Therapy, Harvard Medical School, Boston, Massachusetts 02215, USA
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Hoznek A, Samadi DB, Salomon L, De La Taille A, Olsson LE, Abbou CC. Laparoscopic radical prostatectomy: published series. Curr Urol Rep 2002; 3:152-8. [PMID: 12084208 DOI: 10.1007/s11934-002-0028-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Next to the retropubic and perineal approaches, laparoscopic radical prostatectomy has become the third most common technique in the surgical treatment of localized prostate cancer. Although long-term oncologic data are still lacking, based on several contemporary series, it seems likely that oncologic results will fulfill expectations. Over the past decade, quality-of-life issues have come into the spotlight in oncologic surgery in particular. In this regard, the aim of the laparoscopic technique is to become the best in terms of operative stress, postoperative morbidity, catheterization time, and return to normal activities. The unique intraoperative visibility and magnification of the operative field allow ultraprecise dissection and suturing of vital neural and sphincteric structures. Will the use of this new kind of surgery translate into better functional results? The goal of this review is to analyze the published results of laparoscopic radical prostatectomy in the context of its rapidly evolving open surgical counterpart.
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Affiliation(s)
- András Hoznek
- Service d'Urologie, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
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Grossfeld GD, Latini DM, Lubeck DP, Broering JM, Li YP, Mehta SS, Carroll PR. Predicting disease recurrence in intermediate and high-risk patients undergoing radical prostatectomy using percent positive biopsies: results from CaPSURE. Urology 2002; 59:560-5. [PMID: 11927314 DOI: 10.1016/s0090-4295(01)01658-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine whether percent positive biopsies could be used to predict the probability of disease recurrence in contemporary patients undergoing radical prostatectomy in community-based practice settings. Previous studies have demonstrated the importance of systematic prostate biopsy results in the risk assessment for newly diagnosed patients with prostate cancer. METHODS We studied 1265 patients enrolled in CaPSURE (a longitudinal registry of patients with prostate cancer) who underwent radical prostatectomy as definitive local treatment of their prostate cancer. Preoperative characteristics, including age, race, prostate-specific antigen (PSA) level at diagnosis, clinical T stage, biopsy Gleason score, and percent positive prostate biopsies at the time of diagnosis, were determined for each patient. Disease recurrence was defined as PSA level of 0.2 ng/mL or greater on two consecutive occasions after radical prostatectomy or the occurrence of a second cancer treatment more than 6 months after surgery. Cox proportional regression analysis was performed to determine the significant independent predictors of disease recurrence. Patients were assigned to previously described risk groups on the basis of clinical tumor stage, PSA at diagnosis, and biopsy Gleason score. The likelihood of disease recurrence for each risk group, stratified according to the percentage of positive biopsies (0% to 33%, 34% to 66%, and more than 66%), was determined using the Kaplan-Meier method and compared using the log-rank test. RESULTS The median follow-up was 3.3 years after surgery. The serum PSA level at diagnosis, biopsy Gleason score, percent positive biopsies, and ethnicity were significant independent predictors of disease recurrence. The percentage of positive prostate biopsies was a significant predictor of disease recurrence for low, intermediate, and high-risk patients. For patients with high-risk disease, the likelihood of disease recurrence 5 years after surgery was 24%, 34%, and 59% for patients with 0% to 33%, 34% to 66%, and more than 66% positive biopsies, respectively. CONCLUSIONS Serum PSA, biopsy Gleason score, and percent positive biopsies were significant predictors of disease recurrence in this population. The percent positive biopsies may be useful in identifying high-risk patients suitable for definitive local therapy.
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Affiliation(s)
- Gary D Grossfeld
- Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California 94143-1711, USA
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Huland H, Graefen M, Haese A, Hammerer PG, Palisaar J, Pichlmeier U, Henke RP, Erbersdobler A, Huland E, Lilja H. Prediction of tumor heterogeneity in localized prostate cancer. Urol Clin North Am 2002; 29:213-22. [PMID: 12109347 DOI: 10.1016/s0094-0143(02)00006-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Clinical T1 and T2 prostatic carcinoma is a heterogeneous tumor with respect to pathologic stage and outcome. In the authors' experience, 60% of patients have a pT2 prostatic carcinoma, and 2% to 4% have tumors less than 0.5 cm3 in volume. The latter group cannot be predicted by the use of preoperative parameters with a sufficient sensitivity and specificity. Quantitative analysis of six systematic biopsies, that is, reporting the number of biopsies with any Gleason grade 4 or 5 cancer or the number of biopsies with more than 50% Gleason grade 4 and 5 cancer, together with preoperative PSA levels can be used to predict the different pathologic stages and risk groups of patients with T1 or T2 prostatic carcinoma. CART analysis that using these preoperative parameters can predict the lymph node stage and the capsular penetration on each side of the prostate with a sufficient positive and negative predictive value and a sufficient specificity to avoid routine lymphadenectomy in approximately 80% of the patients classified as a low-risk group for having lymph nodes positive for disease. CART analysis also allows a solid identification of patients in whom the unilateral or bilateral nerve may be spared during surgery. These algorithms may be improved further by determining the HK-2 level in the blood or by including other molecular biologic markers in the analysis of the biopsies. Clinical T1 or T2 prostatic carcinoma is a heterogeneous but fairly predictable tumor.
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Affiliation(s)
- Hartwig Huland
- Department of Urology, University Clinics Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany.
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Barocas DA, Han M, Epstein JI, Chan DY, Trock BJ, Walsh PC, Partin AW. Does capsular incision at radical retropubic prostatectomy affect disease-free survival in otherwise organ-confined prostate cancer? Urology 2001; 58:746-51. [PMID: 11711353 DOI: 10.1016/s0090-4295(01)01336-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the influence of isolated, histologically identified capsular incision (CI) (exposure of benign or malignant glands to the inked surgical margin in the setting of organ-confined disease) on disease progression after anatomic radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. METHODS Between March 1993 and September 1999, 4747 men underwent RRP at the Johns Hopkins Hospital; 107 men (2.3%) were diagnosed with CI in otherwise organ-confined disease; 92 (86%) had at least 6 months (mean 30) of follow-up. We matched these CI cases (based on surgeon, age, clinical stage, final pathologic Gleason grade, and preoperative serum prostate-specific antigen level) one-for-one with controls in three additional pathologically defined groups and compared the freedom from disease progression (prostate-specific antigen level greater than 0.2 ng/mL and/or local palpable recurrence) after RRP. RESULTS The actuarial 3-year likelihood of freedom from disease progression was 87.8% for the CI group, 96.4% for men with organ-confined disease (P = 0.10), 91.3% for men with extraprostatic extension and negative surgical margins (P = 0.99), and 73.9% for men with positive surgical margins resulting from extraprostatic extension (P <0.01). No statistically significant difference was found in the actuarial likelihood of freedom from disease progression between men with CI into benign glands (n = 22) and men with CI into tumor (n = 70) (P = 0.93). CONCLUSIONS No statistically significant difference was found in the likelihood of early recurrence between patients with isolated CI and other specimen-confined disease. Patients with isolated CI have a significantly lower likelihood of early recurrence than patients with positive surgical margins due to extraprostatic extension, regardless of whether the CI is into benign glands or tumor. Long-term follow-up is necessary to confirm these findings.
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Affiliation(s)
- D A Barocas
- James Buchanan Brady Urological Institute, Departments of Department ofUrology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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36
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Abstract
Transrectal ultrasound guided systemic sextant needle biopsy of the prostate has been the procedure of choice for the diagnosis of prostate cancer. Several shortcomings of this procedure have been recognized and there is concern that it may represent an inadequate sampling of the prostate. Refinements include modifications of biopsy location and an increase in the number of cores obtained. Enhanced ultrasound techniques may improve the accuracy of prostate biopsy. In addition, research continues to develop prognostic factors derived from the core biopsy that may enhance the prediction of tumor biology. This paper provides a basic review of transrectal ultrasound diagnosis of prostate cancer with emphasis on advances in this area.
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Affiliation(s)
- M Ismail
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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37
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Van Der Cruijsen-Koeter IW, Wildhagen MF, De Koning HJ, Schröder FH. The value of current diagnostic tests in prostate cancer screening. BJU Int 2001; 88:458-66. [PMID: 11589658 DOI: 10.1046/j.1464-4096.2001.02381.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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EPSTEIN JONATHANI, POTTER STEVENR. THE PATHOLOGICAL INTERPRETATION AND SIGNIFICANCE OF PROSTATE NEEDLE BIOPSY FINDINGS: IMPLICATIONS AND CURRENT CONTROVERSIES. J Urol 2001. [DOI: 10.1016/s0022-5347(05)65953-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- JONATHAN I. EPSTEIN
- From the Brady Urological Institute and Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - STEVEN R. POTTER
- From the Brady Urological Institute and Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
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39
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Feneley MR, Partin AW. Indicators of pathologic stage of prostate cancer and their use in clinical practice. Urol Clin North Am 2001; 28:443-58. [PMID: 11590805 DOI: 10.1016/s0094-0143(05)70154-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pathologic stage is the most reliable means of predicting the likelihood of curable prostate cancer at the time of definitive treatment. Its prediction is of the greatest importance to individuals with clinically localized disease, principally because of the therapeutic and prognostic implications. Multivariate models integrating variables that can be derived from clinical and pathologic assessment have been shown to be reliable and useful in urologic practice. Among these variables, the combination of clinical stage, serum PSA, and biopsy Gleason score provides reliable assessment of the risk for extraprostatic disease that can be used readily for counseling individual patients. Other biopsy-derived parameters may contribute additional information, but their value in multivariate analysis has not been validated in a multi-institutional setting. The development of new prognostic markers is a priority objective in current research to distinguish patients in whom cancer cannot be controlled by surgical treatment. For patients undergoing radical prostatectomy, definitive pathologic stage certainly will remain an important prognostic factor; therefore, clinical practice will continue to be determined by its accurate prediction.
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Affiliation(s)
- M R Feneley
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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40
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Villamón Fort R, Martínez Jabaloyas JM, Gil Salom M, Soriano Sarriá MP, Pastor Hernández F, Günther S, García Sisamón F. [Percentage of tumor in prostatic biopsy cylinders as prognosis factor of organ-limited disease in candidates for radical prostatectomy]. Actas Urol Esp 2001; 25:493-8. [PMID: 11534402 DOI: 10.1016/s0210-4806(01)72658-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED The present study analyzes the prognostic influence of tumor percentage in cylinders of prostatic biopsy in this patient group. MATERIAL AND METHODS Retrospective study of 68 patients with a diagnosis of adenocarcinoma, clinical stage T1-T2 who had undergone a radical prostatectomy from May 1997 to october 2000. Following preoperative parameters were analyzed: age, PSA, clinical staging, Gleason and six cylinders of ultrasonography-leaded transrectal prostatic biopsy, studying the amount of positive biopsies, the tumor percentage of the total amount of biopsies and the maximum percentage of tumor in one cylinder. Univariate (square-Chi, Student t) and multivariate (multiple logistic regression) analysis are performed in order to study the relationship of these parameters with the presence or not of an organ-located disease. RESULTS An organ-located disease was shown at 44 patients through the piece of radical prostatectomy. The univariate analysis gave all studied parameters, except age, a prognostic value of the existence or not of an organ-located disease. In the multivariate analysis only the total percentage of biopsy tumors (p = 0.0002) and PSA (p = 0.005) behaved as independent prognostic factors. CONCLUSION Tumor percentage in prostatic biopsy seems to be a factor with a high predictive value of an organ-located disease, possibly because it is an index of tumoral volume.
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Affiliation(s)
- R Villamón Fort
- Servicio de Urología, Hospital Clínico Universitario, Valencia
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41
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Campbell T, Blasko J, Crawford ED, Forman J, Hanks G, Kuban D, Montie J, Moul J, Pollack A, Raghavan D, Ray P, Roach M, Steinberg G, Stone N, Thompson I, Vogelzang N, Vijayakumar S. Clinical staging of prostate cancer: reproducibility and clarification of issues. Int J Cancer 2001; 96:198-209. [PMID: 11410889 DOI: 10.1002/ijc.1017] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The American Joint Committee on Cancer (AJCC) staging system for prostate cancer adopted in 1992 is based on tumor-node-metastasis (TNM) designations. It has been widely accepted for use in local and advanced disease. The purpose of this study was to assess reproducibility of staging among observers and to help clarify staging issues. Twelve prostate cancer cases were sent to 20 physicians with special expertise in prostate cancer including eight urologists, eight radiation oncologists, and four medical oncologists. Physicians were asked to assign a stage based on the 1992 AJCC clinical staging. The most frequently reported stage assigned to each case was taken to be the consensus. Agreement was the percentage of physicians who reported that particular stage. Seventy-five percent of the physicians responded. The overall agreement for assignment of T stage was 63.9%. Differences were found by specialty for inclusion of available information in designating a T stage. The overall agreement for N stage was 73.8%. The most common designation was Nx regardless of availability of a computed tomography scan. The overall agreement for M stage was 76.6%. Without a bone scan the most common designation was Mx regardless of Gleason grade or prostate-specific antigen (PSA). A frequent comment was that PSA was more indicative of disease extent than current clinical staging. The reproducibility of the 1992 clinical AJCC staging is poor even among experts in the field. This problem arises primarily from disagreement regarding which studies are included in assigning a stage. Some of these difficulties are addressed in the 1997 revision. However, the clinical staging does not address the true biological significance of disease in many instances.
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Affiliation(s)
- T Campbell
- University of Chicago, Chicago, Illinois, USA
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42
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UNDER STAGING AND UNDER GRADING IN A CONTEMPORARY SERIES OF PATIENTS UNDERGOING RADICAL PROSTATECTOMY: RESULTS FROM THE CANCER OF THE PROSTATE STRATEGIC UROLOGIC RESEARCH ENDEAVOR DATABASE. J Urol 2001. [DOI: 10.1097/00005392-200103000-00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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UNDER STAGING AND UNDER GRADING IN A CONTEMPORARY SERIES OF PATIENTS UNDERGOING RADICAL PROSTATECTOMY: RESULTS FROM THE CANCER OF THE PROSTATE STRATEGIC UROLOGIC RESEARCH ENDEAVOR DATABASE. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66543-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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44
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THE EXTENT OF BIOPSY INVOLVEMENT AS AN INDEPENDENT PREDICTOR OF EXTRAPROSTATIC EXTENSION AND SURGICAL MARGIN STATUS IN LOW RISK PROSTATE CANCER:. J Urol 2000. [DOI: 10.1097/00005392-200012000-00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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THE EXTENT OF BIOPSY INVOLVEMENT AS AN INDEPENDENT PREDICTOR OF EXTRAPROSTATIC EXTENSION AND SURGICAL MARGIN STATUS IN LOW RISK PROSTATE CANCER: : IMPLICATIONS FOR TREATMENT SELECTION. J Urol 2000. [DOI: 10.1016/s0022-5347(05)66933-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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46
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Vaishampayan U, Hussain M. Adjuvant chemo-/hormonal therapy trials for locally advanced prostate cancer. Curr Oncol Rep 2000; 2:402-8. [PMID: 11122871 DOI: 10.1007/s11912-000-0059-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients with clinical or pathologic locally advanced prostate cancer (LAPC) are at risk for systemic and local disease progression or relapse. Pre- and post-therapy predictors of risk include prostate-specific antigen (PSA) levels, clinical and pathologic stage, Gleason's score (GS) of the biopsy and prostatectomy specimens, positive margins, and post-therapy PSA kinetics. Combined modality trials have been done predominantly in LAPC patients treated with radiation. The data indicate a local control and disease-free survival advantage to the use of androgen deprivation. Neoadjuvant hormonal therapy with radical prostatectomy (RP) has no proven role thus far; however, recent data on adjuvant hormonal therapy in patients with pathologic D1 disease treated with radical prostatectomy suggest a potential benefit. Chemotherapy trials are still in their infancy but present exciting opportunities for future research. The heterogeneity in the hormone responsiveness of prostate cancer, the availability of several active chemotherapy combinations, and the refinement in risk prediction have stimulated a series of adjuvant therapy trials which constitute the subject of this discussion. Emphasis on enrollment in clinical trials is thus imperative in LAPC.
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Affiliation(s)
- U Vaishampayan
- Division of Hematology/Oncology, Department of Internal Medicine, Wayne State University and Barbara Ann Karmanos Cancer Institute, 5 Hudson, Harper Hospital, 3990 John R Road, Detroit, MI 48201, USA
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47
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Carroll PR. Prostate biopsy: a wealth of information when done and interpreted correctly. J Clin Oncol 2000; 18:1161-3. [PMID: 10715283 DOI: 10.1200/jco.2000.18.6.1161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Presti JC. Prostate cancer: assessment of risk using digital rectal examination, tumor grade, prostate-specific antigen, and systematic biopsy. Radiol Clin North Am 2000; 38:49-58. [PMID: 10664666 DOI: 10.1016/s0033-8389(05)70149-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Refinement in the local staging and risk assessment for prostate cancer patients utilizing clinical parameters is ongoing. DRE, tumor grade, and PSA provide some useful information for risk assessment in individual patients. More recent studies using percent free PSA levels and systematic biopsy results have added additional staging information and may play a more significant role in the future in risk assessment. This information should supplement additional imaging tests in the management of these patients.
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Affiliation(s)
- J C Presti
- Department of Urology, University of California San Francisco, USA
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49
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Tigrani VS, Bhargava V, Shinohara K, Presti JC. Number of positive systematic sextant biopsies predicts surgical margin status at radical prostatectomy. Urology 1999; 54:689-93. [PMID: 10510929 DOI: 10.1016/s0090-4295(99)00211-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine whether the number of positive sextant biopsies contributes to the prediction of positive surgical margins, as the value of systematic prostate biopsies in predicting margin status at radical prostatectomy is unclear. METHODS Consecutive patients (n = 108) who underwent radical retropubic prostatectomy and systematic sextant biopsies were retrospectively evaluated. Serum prostate-specific antigen, digital rectal examination, primary Gleason grade, Gleason score, and the number and location of positive sextant biopsies were recorded for each patient. Radical prostatectomy specimens were evaluated by step-section techniques at 3 to 5-mm intervals. Univariate comparisons for each of these variables was performed between the positive and negative margin groups using the Mann-Whitney U test or chi-square analysis. Logistic regression analysis was performed for these variables. RESULTS Twenty-two (20.4%) of 108 patients had a positive surgical margin because of extension of the tumor through the capsule. Patients with three or more positive biopsies were at higher risk of having a positive surgical margin (P = 0.009). Patients with bilaterally positive biopsies at either the base or midprostate were more likely to have a positive surgical margin. The risk of a positive surgical margin was not significantly determined by the primary Gleason grade, Gleason score, or prostate-specific antigen. Multivariate logistic regression models were created that consistently demonstrate that the number of positive biopsies was the best predictor of margin status. CONCLUSIONS This study demonstrated that the number of positive sextant biopsies contributes to the prediction of margin status at radical prostatectomy.
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Affiliation(s)
- V S Tigrani
- Department of Urology, University of California, San Francisco, School of Medicine, and San Francisco Veterans Affairs Medical Center, USA
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50
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Epstein JI, Lecksell K, Carter HB. Prostate cancer sampled on sextant needle biopsy: significance of cancer on multiple cores from different areas of the prostate. Urology 1999; 54:291-4. [PMID: 10443727 DOI: 10.1016/s0090-4295(99)00105-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the relationship between the location of positive sites, when more than one sextant site shows prostate cancer in a given patient, and pathologic stage, tumor volume, and margin status if radical prostatectomy is performed. METHODS We performed biopsies using a spring-loaded biopsy gun on 343 Stage T1c (nonpalpable) radical prostatectomy specimens from each sextant site. RESULTS In 56 cases, carcinoma was identified in two separate sextant sites. In 38 cases, the sites were vertical to each other (ie, left apex, left mid); in 8 cases, the sites were diagonal (ie, left apex, right mid); in 5 cases, the sites were horizontal (ie, left apex, right apex); and in 5 cases, they were not contiguous but were separated by an uninvolved sextant site (ie, left apex, left base). Tumors were more likely to be multifocal in cases with diagonally positive biopsies (P <0.0001) and horizontally positive biopsies (P <0.0001) than in those with vertically positive biopsies. No significant differences were found in organ-confined status and margin positivity among cases with different positive biopsy locations. The dominant tumor nodule was larger (mean 2.76 cc) in cases with noncontiguously positive biopsies than in all other groups combined (mean 1.44 cc) (P = 0.017). CONCLUSIONS When more than one sextant site shows cancer, there are differences in terms of whether the tumors sampled are multifocal versus solitary depending on which sites are positive. However, no significant differences were found in predicting pathologic stage and margin positivity.
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Affiliation(s)
- J I Epstein
- Department of Pathology and James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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