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Karwacki J, Stodolak M, Nowak Ł, Kiełb P, Krajewski W, Lemiński A, Szydełko T, Małkiewicz B. Preoperative Factors for Lymphovascular Invasion in Prostate Cancer: A Systematic Review and Meta-Analysis. Int J Mol Sci 2024; 25:856. [PMID: 38255928 PMCID: PMC10815768 DOI: 10.3390/ijms25020856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Lymphovascular invasion (LVI) is one of the most important prognostic factors in prostate cancer (PCa) and is correlated with worse survival rates, biochemical recurrence (BCR), and lymph node metastasis (LNM). The ability to predict LVI preoperatively in PCa may be useful for proposing variations in the diagnosis and management strategies. We performed a systematic review and meta-analysis to identify preoperative clinicopathological factors that correlate with LVI in final histopathological specimens in PCa patients. Systematic literature searches of PubMed, Embase, and Web of Science were performed up to 31 January 2023. A total of thirty-nine studies including 389,918 patients were included, most of which were retrospective and single-center. PSA level, clinical T stage, and biopsy Gleason score were significantly correlated with LVI in PCa specimens. Meta-analyses revealed that these factors were the strongest predictors of LVI in PCa patients. Prostate volume, BMI, and age were not significant predictors of LVI. A multitude of preoperative factors correlate with LVI in final histopathology. Meta-analyses confirmed correlation of LVI in final histopathology with higher preoperative PSA, clinical T stage, and biopsy Gleason score. This study implies advancements in risk stratification and enhanced clinical decision-making, and it underscores the importance of future research dedicated to validation and exploration of contemporary risk factors in PCa.
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Affiliation(s)
- Jakub Karwacki
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (Ł.N.); (P.K.); (W.K.); (T.S.)
| | - Marcel Stodolak
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (Ł.N.); (P.K.); (W.K.); (T.S.)
| | - Łukasz Nowak
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (Ł.N.); (P.K.); (W.K.); (T.S.)
| | - Paweł Kiełb
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (Ł.N.); (P.K.); (W.K.); (T.S.)
| | - Wojciech Krajewski
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (Ł.N.); (P.K.); (W.K.); (T.S.)
| | - Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (Ł.N.); (P.K.); (W.K.); (T.S.)
| | - Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (Ł.N.); (P.K.); (W.K.); (T.S.)
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Jeon J, Olkhov-Mitsel E, Xie H, Yao CQ, Zhao F, Jahangiri S, Cuizon C, Scarcello S, Jeyapala R, Watson JD, Fraser M, Ray J, Commisso K, Loblaw A, Fleshner NE, Bristow RG, Downes M, Vesprini D, Liu S, Bapat B, Boutros PC. Temporal Stability and Prognostic Biomarker Potential of the Prostate Cancer Urine miRNA Transcriptome. J Natl Cancer Inst 2020; 112:247-255. [PMID: 31161221 DOI: 10.1093/jnci/djz112] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 03/01/2019] [Accepted: 05/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The development of noninvasive tests for the early detection of aggressive prostate tumors is a major unmet clinical need. miRNAs are promising noninvasive biomarkers: they play essential roles in tumorigenesis, are stable under diverse analytical conditions, and can be detected in body fluids. METHODS We measured the longitudinal stability of 673 miRNAs by collecting serial urine samples from 10 patients with localized prostate cancer. We then measured temporally stable miRNAs in an independent training cohort (n = 99) and created a biomarker predictive of Gleason grade using machine-learning techniques. Finally, we validated this biomarker in an independent validation cohort (n = 40). RESULTS We found that each individual has a specific urine miRNA fingerprint. These fingerprints are temporally stable and associated with specific biological functions. We identified seven miRNAs that were stable over time within individual patients and integrated them with machine-learning techniques to create a novel biomarker for prostate cancer that overcomes interindividual variability. Our urine biomarker robustly identified high-risk patients and achieved similar accuracy as tissue-based prognostic markers (area under the receiver operating characteristic = 0.72, 95% confidence interval = 0.69 to 0.76 in the training cohort, and area under the receiver operating characteristic curve = 0.74, 95% confidence interval = 0.55 to 0.92 in the validation cohort). CONCLUSIONS These data highlight the importance of quantifying intra- and intertumoral heterogeneity in biomarker development. This noninvasive biomarker may usefully supplement invasive or expensive radiologic- and tissue-based assays.
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Affiliation(s)
- Jouhyun Jeon
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | | | - Honglei Xie
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Cindy Q Yao
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Fang Zhao
- Lunenfeld-Tannenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Sahar Jahangiri
- Sunnybrook Research Institute and Department of Radiation Oncology, Sunnybrook-Odette Cancer Centre, Toronto, ON, Canada
| | - Carmelle Cuizon
- Lunenfeld-Tannenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Seville Scarcello
- Sunnybrook Research Institute and Department of Radiation Oncology, Sunnybrook-Odette Cancer Centre, Toronto, ON, Canada
| | - Renu Jeyapala
- Lunenfeld-Tannenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - John D Watson
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Michael Fraser
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Jessica Ray
- Sunnybrook Research Institute and Department of Radiation Oncology, Sunnybrook-Odette Cancer Centre, Toronto, ON, Canada
| | - Kristina Commisso
- Sunnybrook Research Institute and Department of Radiation Oncology, Sunnybrook-Odette Cancer Centre, Toronto, ON, Canada
| | - Andrew Loblaw
- Sunnybrook Research Institute and Department of Radiation Oncology, Sunnybrook-Odette Cancer Centre, Toronto, ON, Canada
| | - Neil E Fleshner
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Robert G Bristow
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Manchester Cancer Research Centre, University of Manchester, Manchester, UK
| | | | - Danny Vesprini
- Sunnybrook Research Institute and Department of Radiation Oncology, Sunnybrook-Odette Cancer Centre, Toronto, ON, Canada
| | - Stanley Liu
- Sunnybrook Research Institute and Department of Radiation Oncology, Sunnybrook-Odette Cancer Centre, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Bharati Bapat
- Lunenfeld-Tannenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Paul C Boutros
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA.,Department of Urology, University of California, Los Angeles, Los Angeles, CA.,Broad Stem Cell Research Centre, University of California, Los Angeles, Los Angeles, CA.,Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA
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3
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Katayama N, Nakamura K, Yorozu A, Kikuchi T, Fukushima M, Saito S, Dokiya T. Biochemical outcomes and predictive factors by risk group after permanent iodine-125 seed implantation: Prospective cohort study in 2,316 patients. Brachytherapy 2019; 18:574-582. [PMID: 31153759 DOI: 10.1016/j.brachy.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/28/2019] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the biochemical freedom from failure (bFFF) by risk group and treatment modality and the predictive factors of bFFF by risk group in patients with prostate cancer undergoing permanent seed implantation (PI) with or without external beam radiation therapy (EBRT) in a nationwide prospective cohort study (Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 [I-125] Seed Implantation) in Japan during the first 2 years. METHODS AND MATERIALS The analyses included 2,316 participants in 42 institutions; bFFF was evaluated using the Phoenix definition and calculated using the Kaplan-Meier method, and the Cox proportional hazards model was used to identify the factors associated with bFFF. RESULTS Median followup period was 60.0 months. The 5-year bFFF rates in all patients, 1,028 low-risk patients, 1,114 intermediate-risk patients, and 133 high-risk patients were 93.6%, 94.9%, 92.7%, and 91.1%, respectively. The 5-year bFFF rates in the PI group and EBRT combination therapy group were 93.7% and 93.3%, respectively. In a multivariate analysis, younger age, higher Gleason score (GS), higher percent positive biopsies (%PB), and lower prostate V100 (p = 0.0012, 0.0030, 0.0026, and 0.0368) in all patients; younger age, higher pretreatment prostate-specific antigen, and lower prostate V100 (p = 0.0002, 0.0048, and 0.0012) in low-risk patients; higher GS, higher %PB, and no hormonal treatment (p = 0.0005, 0.0120, and 0.0022) in intermediate-risk patients; and higher GS and higher %PB (p = 0.0329 and 0.0120) in high-risk patients were significantly associated with bFFF. CONCLUSIONS PI with or without EBRT resulted in excellent short-term biochemical outcomes in all risk groups, especially in high-risk patients. Age, pretreatment prostate-specific antigen, and prostate V100 in low-risk patients; GS, %PB, and hormonal treatment in intermediate-risk patients; and GS and %PB in high-risk patients were independently affected bFFF.
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Affiliation(s)
- Norihisa Katayama
- Department of Radiology, Okayama University Medical School, Okayama, Japan.
| | - Katsumasa Nakamura
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | | | | | - Shiro Saito
- Department of Urology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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4
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Abdel Raheem A, Chang KD, Alenzi MJ, Ham WS, Han WK, Choi YD, Rha KH. Predictors of biochemical recurrence after Retzius-sparing robot-assisted radical prostatectomy: Analysis of 359 cases with a median follow-up period of 26 months. Int J Urol 2018; 25:1006-1014. [DOI: 10.1111/iju.13808] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ali Abdel Raheem
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
- Department of Urology; Tanta University Medical School; Tanta Egypt
| | - Ki Don Chang
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Mohammed Jayed Alenzi
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
- Department of Urology; Al Jouf University; Sakakah Saudi Arabia
| | - Won Sik Ham
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
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5
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Abdel-Rahman O. Dissecting the heterogeneity of localized prostate cancer risk groups through integration of percent of positive cores. Future Oncol 2018; 14:1469-1476. [PMID: 29745768 DOI: 10.2217/fon-2017-0596] [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: 11/21/2022] Open
Abstract
AIM To develop a modified risk stratification scheme for localized prostate cancer incorporating percent of positive cores (PPC). METHODS SEER database was accessed for eligible patients. Assessment of the prognostic value of PPC was conducted in a multivariate Cox regression model. A modified risk stratification scheme was proposed. RESULTS In a multivariate model, higher PPC was associated with worse cancer-specific survival (p < 0.0001). A modified risk-stratification scheme was proposed incorporating PPC. Concordance index was evaluated and the results were: D'Amico model: 0.782 (SE: 0.014; 95% CI: 0.755-0.810); modified model: 0.809 (SE: <0.001; 95% CI: 0.781-0.837). CONCLUSION Integration of PPC into the risk stratification model for localized prostate cancer improves its performance.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lotfy El Sayed Street, Cairo, 11566, Egypt.,Department of Oncology, University of Calgary and Tom Baker Cancer Center, Calgary, Alberta T2N4N2, Canada
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6
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Pretreatment Tables Predicting Pathologic Stage of Locally Advanced Prostate Cancer. Eur Urol 2015; 67:319-25. [DOI: 10.1016/j.eururo.2014.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 03/12/2014] [Indexed: 11/21/2022]
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7
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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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8
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Crook J, Ots AF. Prognostic factors for newly diagnosed prostate cancer and their role in treatment selection. Semin Radiat Oncol 2014; 23:165-72. [PMID: 23763882 DOI: 10.1016/j.semradonc.2013.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Adenocarcinoma of the prostate is extremely heterogeneous, ranging from an indolent chronic illness to an aggressive rapidly fatal systemic malignancy. The classic prognostic factors of tumor stage, prostate specific antigen level, and Gleason score have been used for over a decade to categorize patients at the time of diagnosis into broad risk groups that help to determine appropriate management. Although the grouping of patients into favorable, intermediate, and high-risk categories has become standard, and the categories continue to define distinct prognostic subgroups, considerable heterogeneity exists within each risk group. As a range of management options are available, additional prognostic factors can be considered when determining the treatment approach for an individual patient. We review these additional prognostic variables under the headings of patient-related, tumor-related, and treatment-related. The influence of each of these factors may vary depending on treatment factors such as dose, the radiation modality, or the use of concomitant androgen ablation.
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Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, British Columbia Cancer Agency, Center for the Southern Interior, Kelowna, British Columbia, Canada.
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La Radioterapia Nel Trattamento Del Carcinoma Della Prostata: Indicazioni, Evoluzione Tecnologica e Approcci Integrati. Urologia 2013; 80:188-201. [DOI: 10.5301/ru.2013.11499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2013] [Indexed: 11/20/2022]
Abstract
Prostate cancer is a heterogeneous, indolent or sometimes aggressive tumor. Treatment options are various and without proved superiority. Radiotherapy (RT) plays a key role in the disease history. Technological evolution with Intensity Modulate Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) allowed improvement, with significant results on local control and survival. Hypofractionation, Stereotactic Body RT (SBRT) and new brachytherapy approachs are still under investigation, with promising opportunities. Adjuvant vs salvage postoperative RT, hormone association, prophylactic pelvic irradiation are still under debate, but guidelines express overlapping indications. Multidisciplinary managements will be the future for care optimization, providing the best tool for holistic and informed patients' choice.
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Westover K, Chen MH, Moul J, Robertson C, Polascik T, Dosoretz D, Katin M, Salenius S, D'Amico AV. Radical prostatectomy vs radiation therapy and androgen-suppression therapy in high-risk prostate cancer. BJU Int 2012; 110:1116-21. [DOI: 10.1111/j.1464-410x.2012.11012.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Preoperative characteristics of men with unfavorable high-Gleason prostate cancer at radical prostatectomy. Urol Oncol 2011; 31:589-94. [PMID: 21664838 DOI: 10.1016/j.urolonc.2011.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 04/29/2011] [Accepted: 05/01/2011] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Some men with Gleason sum 8-10 prostate cancer (PC) at RP have favorable outcomes: Biochemical recurrence free (BFS) and prostate cancer-specific survival (CSS) are improved for such men with pT2 or pT3a disease compared with pT3b or N1 disease at radical prostatectomy (RP). We examine biopsy characteristics of men with high-grade PC at RP to better select those who may benefit from surgery. MATERIALS AND METHODS A total of 1,174 men from our Institutional Database (1982-2010) had Gleason 8-10 cancer at RP. Their demographic and prostate biopsy characteristics were compared among those with disease defined as favorable (pT2 or pT3a) vs. unfavorable (pT3b or N1). Logistic regression was used to determine predictors of unfavorable disease. Kaplan-Meier analysis was used to determine survival outcomes. RESULTS Biopsy data were available for 1,157 men (median cores 12 [2-20]); 779 (66.4%) favorable, 394 (33.6%) unfavorable; 102 (8.7%), 515 (44.1%), and 552 (47.2%) were low, intermediate, and high-risk. For favorable and unfavorable cases, 10-year BFS was 40.0% and 5.7% (P < 0.001) and CSS was 84.9% and 60.3% (P < 0.001). Multivariate logistic regression revealed that PSA ≥ 20 and perineural invasion (PNI) at biopsy increased the likelihood of unfavorable, high-grade disease. Considering PSA ≥ 20 and PNI as adverse features, 23.7%, 40.1%, and 71.4% of patients with none, 1, or 2 adverse features had unfavorable, high-Gleason PC (P < 0.001). CONCLUSIONS High-Gleason PC was not uniformly associated with poor outcomes after RP, though men with unfavorable (pT3b/N1) disease fared poorly. Preoperative predictors of high-Gleason, unfavorable disease in a cohort of predominantly intermediate and high-risk patients were PSA ≥ 20 and PNI.
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D'Amico AV. Future of Treatment for Low-Risk Prostate Cancer: For All, for Some, or for None? J Clin Oncol 2011; 29:1940-3. [DOI: 10.1200/jco.2010.34.2006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anthony V. D'Amico
- Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA
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Salonia A, Gallina A, Briganti A, Zanni G, Suardi N, Capitanio U, Colombo R, Bertini R, Freschi M, Guazzoni G, Rigatti P, Montorsi F. Sex hormone-binding globulin is a significant predictor of extracapsular extension in men undergoing radical prostatectomy. BJU Int 2010; 107:1243-9. [DOI: 10.1111/j.1464-410x.2010.09582.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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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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15
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Mitra A, Khoo V. Adjuvant therapy after radical prostatectomy: Clinical considerations. Surg Oncol 2009; 18:247-54. [DOI: 10.1016/j.suronc.2009.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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17
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Kuroda K, Horiguchi A, Asano T, Asano T, Hayakawa M. Prediction of lymphatic invasion by peritumoral lymphatic vessel density in prostate biopsy cores. Prostate 2008; 68:1057-63. [PMID: 18386298 DOI: 10.1002/pros.20768] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Lymphatic invasion in radical prostatectomy specimens has been suggested to be an unfavorable prognostic factor in clinically localized prostate cancer. Lymphangiogenesis detected by antibodies specific for lymphatic endothelial cells has been associated with lymphatic invasion and lymph node metastasis in prostate cancer. This study was designed to examine whether lymphangiogenesis in prostate biopsy could predict lymphatic spread in radical prostatectomy specimens. METHODS Paraffin-embedded positive biopsy cores obtained from 99 patients who underwent radical prostatectomy at our institution were immunostained with D2-40 monoclonal antibody, which specifically recognizes lymphatic endothelium. The association between lymphatic parameters in prostate biopsy and pathological parameters in radical prostatectomy specimens was analyzed. RESULTS Peritumoral and intratumoral lymphatic (ITL) vessels were observed in 90 (90.9%) and 23 cases (23.2%). Average and maximal peritumoral lymphatic vessel density (PTLD) and the presence of ITL in positive biopsy cores were significantly associated with positive biopsy core rates (P = 0.0015 for average PTLD, P < 0.0001 for maximal PTLD, and P = 0.0038 for ITL) and lymphatic vessel invasion (P < 0.0001 for average PTLD, P < 0.0001 for maximal PTLD, and P = 0.0322 for ITL). Among preoperative parameters, the biopsy Gleason score (P = 0.0092, HR = 6.108) and average PTLD (P = 0.0034, HR = 1.860) were significant predictors of lymphatic invasion in radical prostatectomy specimens in multivariate analysis. CONCLUSIONS PTLD in prostate biopsy specimens assessed by immunohistochemistry using D2-40 antibody could be a useful parameter for predicting lymphatic spread of clinically localized prostate cancer.
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Affiliation(s)
- Kenji Kuroda
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan.
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Relationship of Biochemical Outcome to Percentage of Positive Biopsies in Men with Clinically Localized Prostate Cancer Treated with Permanent Interstitial Brachytherapy. Urology 2008; 71:723-7. [DOI: 10.1016/j.urology.2007.09.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 08/15/2007] [Accepted: 09/16/2007] [Indexed: 11/18/2022]
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Briganti A, Chun FKH, Hutterer GC, Gallina A, Shariat SF, Salonia A, Scattoni V, Valiquette L, Montorsi F, Rigatti P, Graefen M, Huland H, Karakiewicz PI. Systematic Assessment of the Ability of the Number and Percentage of Positive Biopsy Cores to Predict Pathologic Stage and Biochemical Recurrence after Radical Prostatectomy. Eur Urol 2007; 52:733-43. [PMID: 17350750 DOI: 10.1016/j.eururo.2007.02.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 02/23/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We hypothesized that the number and/or percentage of positive cores, proxies of tumor volume, could improve the ability to predict pathologic stages and/or biochemical recurrence (BCR). To test this hypothesis, we examined radical retropubic prostatectomy (RRP) data from three centers on two continents. MATERIAL AND METHODS Clinical data from men undergoing RRP at three different institutions were used to predict pathologic stages and BCR. Univariable and multivariable logistic analyses and Cox regression analyses were used. Predictive accuracy (PA) was assessed with the area under the receiver operating characteristics curve estimates, which were subjected to 200 bootstraps to reduce overfit bias. The statistical significance of PA gains was assessed with the Mantel-Haenszel test. RESULTS The number and the percentage of positive cores were independent predictors of virtually all pathologic stage outcomes and of BCR. In PA analyses, the percentage of positive cores improved the PA of pathologic stage predictions and of BCR predictions between 0.06% and 1.49%. Conversely, the number of positive cores improved the PA of pathologic stage predictions and of BCR predictions between 0.36% and 1.14%. CONCLUSIONS The information derived from biopsy cores is important and can improve the ability to predict pathologic stage and BCR. It appears that the percentage of cores is most helpful in stage predictions. Conversely, the number of cores appears to improve mostly BCR predictions. Consideration of both variables might not be helpful because of the similarity of information they encode.
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Affiliation(s)
- Alberto Briganti
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
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Malaeb BS, Rashid HH, Lotan Y, Khoddami SM, Shariat SF, Sagalowsky AI, McConnell JD, Roehrborn CG, Koeneman KS. Prostate cancer disease-free survival after radical retropubic prostatectomy in patients older than 70 years compared to younger cohorts. Urol Oncol 2007; 25:291-7. [PMID: 17628294 DOI: 10.1016/j.urolonc.2006.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 08/01/2006] [Accepted: 08/02/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the feasibility of radical retropubic prostatectomy (RRP) as an option for treating men older than 70 years with organ confined prostate cancer and to compare biochemical progression-free survival with younger cohorts. MATERIALS AND METHODS A total of 689 consecutive patients who were treated with RRP from 1994 to 2002 for clinically localized prostate cancer were categorized into 3 different age groups: younger than 50 years (n = 49), 50-70 years (n = 601), and older than 70 years (n = 39). Patients older than 70 years were healthy individuals for their age. Preoperative and postoperative cancer-specific characteristics were compared among these 3 groups. RESULTS There was no statistical significant difference among the 3 age strata in terms of clinical parameters (prostate-specific antigen, Gleason score, clinical stage, percent and number of positive biopsy cores) and pathologic findings (surgical margin, lymph node status, extracapsular extension, lymphovascular invasion, and pathologic Gleason score). The rate of seminal vesicle invasion and prostate volume increased with advancing age (P = 0.034 and P < 0.001). In multivariate logistic regression analysis, age was not associated with seminal vesicle invasion. The 5-year prostate-specific antigen progression-free estimates for patients younger than 50, 50-70, and older than 70 years were 82% (95% confidence interval [CI] 69% to 96%), 82% (95% CI 78% to 86%), and 65% (95% CI 43% to 86%), respectively (P = 0.349). The overall and cause-specific mortalities were not different. CONCLUSIONS RRP could be considered a standard treatment option in men older than 70 years with localized prostate cancer. Further studies are necessary to assess the survival benefit and health-related quality of life after radical prostatectomy versus watchful waiting in patients older than 70 years.
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Affiliation(s)
- Bahaa S Malaeb
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
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Dotan ZA, Ramon J. Staging of prostate cancer. RECENT RESULTS IN CANCER RESEARCH. FORTSCHRITTE DER KREBSFORSCHUNG. PROGRES DANS LES RECHERCHES SUR LE CANCER 2007; 175:109-30. [PMID: 17432557 DOI: 10.1007/978-3-540-40901-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Zohar A Dotan
- The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Cooperberg MR, Freedland SJ, Pasta DJ, Elkin EP, Presti JC, Amling CL, Terris MK, Aronson WJ, Kane CJ, Carroll PR. Multiinstitutional validation of the UCSF cancer of the prostate risk assessment for prediction of recurrence after radical prostatectomy. Cancer 2007; 107:2384-91. [PMID: 17039503 DOI: 10.1002/cncr.22262] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The University of California, San Francisco (UCSF) Cancer of the Prostate Risk Assessment (CAPRA) is a novel preoperative index which predicts the risk of biochemical recurrence after radical prostatectomy. The performance of the index is at least as good as the best available instruments based on clinical variables, and the 0 to 10 score is simple to calculate for both clinical and research purposes. This study used a large external dataset to validate CAPRA. METHODS Data were abstracted from the Shared Equal Access Regional Cancer Hospital (SEARCH) database, a registry of men who underwent radical prostatectomy at 4 Veterans Affairs and 1 active military medical center. Of 2096 men in the database, 1346 (64%) had full data available to calculate the CAPRA score. Performance of the CAPRA score was assessed with proportional hazards regression, survival analysis, and the concordance (c) index. RESULTS Of the studied patients, 41% were non-Caucasian, and their mean age was 62 years. Twenty-six percent suffered recurrence; median follow-up among patients who did not recur was 34 months. The hazard ratio (HR) for each 1-point increase in CAPRA was 1.39 (95% CI [confidence interval], 1.31-1.46). The 5-year recurrence-free survival rate ranged from 86% for CAPRA 0-1 patients to 21% for CAPRA 7-10 patients. Increasing CAPRA scores were significantly associated with increasing risk of adverse pathologic outcomes. The c-index for CAPRA for the validation set was 0.68, compared with 0.66 for the original development set. CONCLUSIONS The UCSF-CAPRA accurately predicted both biochemical and pathologic outcomes after radical prostatectomy among a large, diverse, cohort of men. These results validated the effectiveness of this powerful and straightforward instrument.
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Affiliation(s)
- Matthew R Cooperberg
- Department of Urology, Program in Urologic Oncology, Urologic Outcomes Research Group, UCSF Comprehensive Cancer Center, University of California, San Francisco, California 94143, USA.
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De Torres Ramírez I. Factores pronósticos y predictivos del carcinoma de próstata en la biopsia prostática. Actas Urol Esp 2007; 31:1025-44. [DOI: 10.1016/s0210-4806(07)73765-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Descazeaud A, Rubin M, Chemama S, Larré S, Salomon L, Allory Y, Vordos D, Hoznek A, Yiou R, Chopin D, Abbou C, de la Taille A. Saturation biopsy protocol enhances prediction of pT3 and surgical margin status on prostatectomy specimen. World J Urol 2006; 24:676-80. [PMID: 17089179 DOI: 10.1007/s00345-006-0134-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 10/13/2006] [Indexed: 11/30/2022] Open
Abstract
A 21-samples saturation biopsy procedure (SBP) was developed in order to improve prostate cancer detection rate. Out of 650 patients who underwent this protocol, 150 had a clinically localized prostate cancer and underwent a radical prostatectomy. The number of cores positive for tumor was assessed in the SBP, and also in the sextant component of the SBP (SC) and in the non-sextant component of the SBP (NSC). Numbers of cores positive for tumor on SBP, SC, and NSC were significantly higher in pT3 group versus pT2 (P < 0.001 each) and in positive surgical margins (PSM) group versus no PSM (P < 0.001 each). When comparing area under the curve obtained from SBP with those obtained from NSC and SC, the SBP showed higher accuracy than the NSC and the SC for the prediction of pT3 and PSM. On multivariate analyses, SC and NSC were independent predictors of pT3 and PSM on radical prostatectomy.
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Affiliation(s)
- Aurélien Descazeaud
- Department of Urology, Henri-Mondor Hospital, Assistance Publique-Hopitaux de Paris, Creteil, France.
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Abstract
PURPOSE OF REVIEW Issues relating to the disease are critical in the diagnosis, management, and prognostication of prostate cancer. RECENT FINDINGS New data have emerged regarding the disease of prostate cancer and its precursors. The diagnosis of prostate cancer on needle biopsy has been refined because of the recent discovery of alpha-methylacyl-CoA racemase, which preferentially labels adenocarcinoma of the prostate. Modifications and additions to the Gleason grading system were published based on a consensus conference of urological pathologists. Various models have been proposed using Gleason score, clinical findings, as well as measurements of tumor volume on needle biopsy to enhance the prediction in men undergoing radical prostatectomy and to predict "insignificance". Several studies have confirmed that certain findings in radical prostatectomy are adverse, yet conflicting studies were published as to the independent prognosis of tumor volume. The risk of cancer following a diagnosis of high-grade prostatic intraepithelial neoplasia on needle biopsy has decreased to the point at which this author does not recommend a routine repeat needle biopsy within the first year following the diagnosis of high-grade prostatic intraepithelial neoplasia. SUMMARY This review summarizes developments over the last year in the disease of prostate cancer and its precursors.
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Affiliation(s)
- Jonathan I Epstein
- Departments of Disease, Urology, and Oncology, The Johns Hopkins Hospital, 401 N. Broadway, Baltimore, MD 21231, USA.
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Antunes AA, Srougi M, Dall'Oglio MF, Crippa A, Campagnari JC, Leite KRM. The percentage of positive biopsy cores as a predictor of disease recurrence in patients with prostate cancer treated with radical prostatectomy. BJU Int 2005; 96:1258-63. [PMID: 16287441 DOI: 10.1111/j.1464-410x.2005.05823.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyse the prognostic value of the percentage of positive biopsy cores (PPBC) in determining the pathological features and biochemical outcome of patients with prostate cancer treated by radical prostatectomy, as published data evaluating the prognostic value of PPBC in such patients have limitations. PATIENTS AND METHODS A group of 534 patients with clinically localized prostate cancer was selected. The PPBC was defined as the number of positive biopsy cores/total number of biopsy cores x 100, and grouped into categories of <25%, 25.1-50%, 50.1-75% and 75.1-100%. Patients were divided in low-, intermediate- and high-risk groups according to the usual variables. RESULTS The mean follow-up was 60.5 months. PPBC was associated with the preoperative serum prostate-specific antigen (PSA) level, biopsy Gleason score and clinical stage. On multivariate analysis, PPBC was a significant predictor of extraprostatic disease and seminal vesicle involvement. Of patients in the four PPBC categories, 16%, 27%, 33% and 60%, respectively, had biochemical recurrence (P < 0.001), and on Cox regression analysis, PPBC was an independent predictor of disease recurrence. After segregating patients into risk groups the PPBC further stratified patients using thresholds of 75% (P = 0.006), 25% (P = 0.026) and 50% (P = 0.011) for low-, intermediate- and high-risk groups, respectively. CONCLUSIONS We confirmed, with a longer follow-up, the clinical utility of the PPBC in determining the pathological features and biochemical outcome of patients with prostate cancer treated with radical prostatectomy, and established thresholds for use in patients in the three risk groups.
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Affiliation(s)
- Alberto A Antunes
- Division of Urology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
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Algaba F, Arce Y, Oliver A, Barandica C, Santaularia JMA, Montañés R. Prognostic Parameters Other Than Gleason Score for the Daily Evaluation of Prostate Cancer in Needle Biopsy. Eur Urol 2005; 48:566-71. [PMID: 16084008 DOI: 10.1016/j.eururo.2005.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Accepted: 06/28/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate in prostate needle biopsies the usefulness and the efficacy of not time-consuming morphologic parameters in order to predict whether prostate cancer is organ-confined or it is not, that could contribute additional information to pre-surgical serum PSA and Gleason score, both of them parameters already accepted as clinically significant. METHODS Three hundred and two consecutive patients were evaluated, of whom a diagnostic needle biopsy and the radical prostatectomy specimen with no pre-surgical hormone therapy were available. Bilateral or unilateral extension, number of positive cores, percentage of positive cores, intraprostatic perineural invasion (IPNI) and the presence of high-grade prostatic intraepithelial neoplasia (HGPIN) in any of the biopsy cores were evaluated in the needle biopsy. RESULTS The median of cores is 6. The IPNI, the presence of bilateral tumour, and the percentage of positive cores, higher than 37.5% (ROC curve), show significant crude OR (4.0, 2.8, 6.9 respectively). The regression model discloses that only the percentage of positive cores shows a significant OR (5.8) adjusting for bilaterality, IPNI, HGPIN and age. CONCLUSIONS The percentage of cores with cancer and the bilateral involvement are another two parameters predictive of cancer with extraprostatic extension. (p<0.0005 in both). IPNI has statistical significance too (p<0.002), but it is related to the tumour volume expressed through the two mentioned parameters.
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Affiliation(s)
- F Algaba
- Pathology Section, Fundació Puigvert, Calle Cartagena 340-350-08025, Barcelona, Spain.
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Guzzo TJ, Vira M, Hwang WT, D'amico A, Tomaszewski J, Whittington R, Wein AJ, Vanarsdalen K, Malkowicz SB. Impact of multiple biopsy cores on predicting final tumor volume in prostate cancer detected by a single microscopic focus of cancer on biopsy. Urology 2005; 66:361-5. [PMID: 16098364 DOI: 10.1016/j.urology.2005.02.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2004] [Revised: 01/30/2005] [Accepted: 02/24/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To compare the impact that the number of biopsy cores have on final pathologic findings when minimal disease is detected at biopsy. Discordance has been noted between transrectal ultrasound-guided biopsy results and tumor volume even when minimal amounts of tumor are found on biopsy. METHODS We identified patients who had undergone radical retropubic prostatectomy for a single microscopic focus of adenocarcinoma from a prospectively maintained surgical database. Patients were stratified into two groups: those with six biopsies or less and those with seven or more. The Gleason score, margin status, presence of extracapsular extension, and percentage of tumor volume were compared. RESULTS A total of 102 patients in our database had a single microscopic focus of adenocarcinoma detected by needle biopsy. Of these patients, 65 underwent six or fewer biopsies and 37 underwent seven or more at transrectal ultrasonography. Of the 37 patients in group 2, 27 (73%) had a final tumor volume of less than 5% compared with 24 (37%) of 65 patients in group 1 (P = 0.002). Of the group 2 patients, 15 (75%) with Stage T1c had an estimated tumor volume of less than 5% compared with only 11 (34%) in group 1 (P = 0.01). No statistically significant difference was noted between the two groups for margin status, presence of extracapsular extension, or Gleason score. CONCLUSIONS A single microscopic focus of cancer obtained after multiple cores predicts for a significantly lower tumor volume on final pathologic examination across clinical stages. In the context of greater tissue sampling, the minimal disease designation may carry more predictive value and be a useful parameter in stratifying patients with Stage T1c and other good-risk factors with regard to surgical outcome.
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Affiliation(s)
- Thomas J Guzzo
- Department of Urology, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania 19104 , USA.
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Maroni PD, Crawford ED. Surgical Management of Prostate Cancer: Optimizing Patient Selections and Clinical Outcome. Surg Oncol Clin N Am 2005; 14:301-19. [PMID: 15817241 DOI: 10.1016/j.soc.2004.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Paul D Maroni
- Division of Urology, Department of Surgery, University of Colorado Health Sciences Center, Denver, 80252, USA
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Antunes AA, Dall'Oglio MF, Sant'Anna AC, Paranhos M, Leite KRM, Srougi M. Prognostic value of the percentage of positive fragments in biopsies from patients with localized prostate cancer. Int Braz J Urol 2005; 31:34-41. [PMID: 15763006 DOI: 10.1590/s1677-55382005000100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 01/20/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the prognostic value of the percentage of positive fragments (PPF) in biopsies from patients with localized prostate cancer (PCa) undergoing radical prostatectomy. MATERIALS AND METHODS During the period from March 1991 to November 2000, 440 patients were selected. Cases receiving neoadjuvant or adjuvant hormone therapy, or adjuvant radiotherapy, were excluded, as were cases presenting Gleason scores higher than 6 at biopsy. PPF was defined as the total number of fragments divided by the total number of biopsy fragments times 100. This variable was initially divided into categories from 0 to 25%, 25.1% to 50%, 50.1 to 75% and 75% to 100%. During the postoperative period, patients were assessed every 2 months for 1 year, then every 6 months for 5 years, and then yearly. Biochemical recurrence was defined as serum PSA higher than or equal to 0.4 ng/mL. Median follow-up was 60 months. RESULTS One hundred and nine (24.8%) of the 440 patients under study had biochemical recurrence. In the univariate analysis, PPF significantly influenced disease-free survival (log-rank, p < 0.001), and patients with PPF between 75 and 100% presented a risk of a biochemical recurrence of the disease 3 times higher than patients with PPF between 0 and 25% (p < 0.001). After the Cox regression analysis, both serum PSA (p = 0.001) and PPF (p < 0.001) showed to be independent predictive factors for disease-free survival following surgery. CONCLUSION PPF measurement in biopsy is a simple and practical method, which should be routinely used as a predictive factor for biochemical recurrence in patients with PCa presenting Gleason scores between 2 and 6.
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Affiliation(s)
- Alberto A Antunes
- Division of Urology, Paulista School of Medicine, Federal University of Sao Paulo, UNIFESP, Sao Paulo, SP, Brazil
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Dall'Oglio MF, Sant'Anna AC, Antunes AA, Nesrallah LJ, Leite KR, Srougi M. Analysis of risk factors of involvement of seminal vesicles in patients with prostate cancer undergoing radical prostatectomy. Int Braz J Urol 2004; 30:472-8. [PMID: 15663804 DOI: 10.1590/s1677-55382004000600004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 10/27/2004] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine through preoperative serum PSA level, Gleason score on biopsy and percentage of fragments affected by tumor on biopsy, the probability of involvement of the seminal vesicles. MATERIALS AND METHODS During the period between March 1991 to December 2002, we selected 899 patients undergoing radical prostatectomy for treatment of localized prostate adenocarcinoma. The analyzed preoperative variables were PSA, percentage of positive fragments and Gleason score on the biopsy. Pre-operative PSA was divided in scales from 0 to 4.0 ng/mL, 4.1 to 10 ng/mL, 10.1 to 20 ng/mL and > 20 ng/mL, Gleason score was categorized in scales from 2 to 6. 7 and 8 to 10, and the percentage of affected fragments was divided in 0 to 25%, 25.1% to 50%, 50.1% to 75%, and 75.1% to 100%. All these variables were correlated with the involvement of seminal vesicles in the surgical specimen. RESULTS Of the 899 patients under study, approximately 11% (95% CI, [9% - 13%]) had involvement of seminal vesicles. On the multivariate analysis, when PSA was < or = 4, the Gleason score was 2 to 6, and less than 25% of fragments were involved on the biopsy, only 3.6%, 7.6% and 6.2% of patients respectively, had involvement of seminal vesicles. On the multivariate analysis, we observed that PSA, Gleason score and the percentage of involved fragments were independent prognostic factors for invasion of seminal vesicles. CONCLUSION The preoperative variables used in the present study allow the identification of men with minimal risk (lower than 5%) if involvement of seminal vesicles.
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Affiliation(s)
- Marcos F Dall'Oglio
- Division of Urology, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Syrian Lebanese Hospital, São Paulo, SP, Brazil.
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