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Hougen HY, Iakymenko OA, Punnen S, Ritch CR, Nahar B, Parekh DJ, Kryvenko ON, Gonzalgo ML. Prostate cancer upgrading and adverse pathology in Hispanic men undergoing radical prostatectomy. World J Urol 2022; 40:2017-2023. [PMID: 35689106 DOI: 10.1007/s00345-022-04065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Radical prostatectomy (RP) outcomes in Hispanic men with prostate cancer are not well-described. Prior studies showed varying results regarding the rate of upgrading and upstaging, and these studies included limited pathologic data and lack of central pathology review. We characterized the rate of upgrading, adverse pathology, and oncologic outcomes in Hispanics after prostatectomy using a large institutional database. METHODS We included Hispanic white (HW), non-Hispanic white (NHW), and black men who underwent (RP) between 2010 and 2021 at a single institution. We recorded differences in grade group between biopsy and prostatectomy and performed multivariable analyses for odds of upgrading and adverse pathologic findings. The primary outcome was rate of upgrading in HWs. Using a sub-cohort with follow-up data, we assessed race/ethnicity and upgrading as a predictor of biochemical recurrence (BCR)-free survival. RESULTS Our cohort included 1877 men: 36.7% were NHW, 40.6% were HW, and 22.7% were black. Rates of upgrading were not different between NHW, NHW, and black men at 34.0, 33.8, and 37.3%, respectively (p = 0.4). In the multivariable analysis for upgrading, significant predictors for upgrading were older age (p = 0.002), higher PSA (p < 0.001), and lower prostate weight (p = 0.02), but race/ethnicity did not predict upgrading. In patients with available follow-up (1083, 58%), upgrading predicted worse BCR-free survival (HR 2.17, CI 1.46-3.22, p < 0.0001) but race/ethnicity did not. CONCLUSIONS HW men undergoing RP had similar rates of upgrading and adverse pathologic outcomes as NHW men. Race/ethnicity does not independently predict upgrading or worse oncologic outcomes after RP.
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Affiliation(s)
- Helen Y Hougen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.
| | - Oleksii A Iakymenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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2
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Fan Y, Mulati Y, Zhai L, Chen Y, Wang Y, Feng J, Yu W, Zhang Q. Diagnostic Accuracy of Contemporary Selection Criteria in Prostate Cancer Patients Eligible for Active Surveillance: A Bayesian Network Meta-Analysis. Front Oncol 2022; 11:810736. [PMID: 35083157 PMCID: PMC8785217 DOI: 10.3389/fonc.2021.810736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
Background Several active surveillance (AS) criteria have been established to screen insignificant prostate cancer (insigPCa, defined as organ confined, low grade and small volume tumors confirmed by postoperative pathology). However, their comparative diagnostic performance varies. The aim of this study was to compare the diagnostic accuracy of contemporary AS criteria and validate the absolute diagnostic odds ratio (DOR) of optimal AS criteria. Methods First, we searched Pubmed and performed a Bayesian network meta-analysis (NMA) to compare the diagnostic accuracy of contemporary AS criteria and obtained a relative ranking. Then, we searched Pubmed again to perform another meta-analysis to validate the absolute DOR of the top-ranked AS criteria derived from the NMA with two endpoints: insigPCa and favorable disease (defined as organ confined, low grade tumors). Subgroup and meta-regression analyses were conducted to identify any potential heterogeneity in the results. Publication bias was evaluated. Results Seven eligible retrospective studies with 3,336 participants were identified for the NMA. The diagnostic accuracy of AS criteria ranked from best to worst, was as follows: Epstein Criteria (EC), Yonsei criteria, Prostate Cancer Research International: Active Surveillance (PRIAS), University of Miami (UM), University of California-San Francisco (UCSF), Memorial Sloan-Kettering Cancer Center (MSKCC), and University of Toronto (UT). I2 = 50.5%, and sensitivity analysis with different insigPCa definitions supported the robustness of the results. In the subsequent meta-analysis of DOR of EC, insigPCa and favorable disease were identified as endpoints in ten and twenty-two studies, respectively. The pooled DOR for insigPCa and favorable disease were 0.44 (95%CI, 0.31–0.58) and 0.66 (95%CI, 0.61–0.71), respectively. According to a subgroup analysis, the DOR for favorable disease was significantly higher in US institutions than that in other regions. No significant heterogeneity or evidence of publication bias was identified. Conclusions Among the seven AS criteria evaluated in this study, EC was optimal for positively identifying insigPCa patients. The pooled diagnostic accuracy of EC was 0.44 for insigPCa and 0.66 when a more liberal endpoint, favorable disease, was used. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/], PROSPERO [CRD42020157048].
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Affiliation(s)
- Yu Fan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China.,Department of Urology, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Yelin Mulati
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Lingyun Zhai
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuke Chen
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Yu Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Juefei Feng
- Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Qian Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China.,Peking University Binhai Hospital, Tianjin, China
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3
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Kryvenko ON, Iakymenko OA, De Lima Guido LP, Bhattu AS, Merhe A, Mouzannar A, Briski LM, Oymagil I, Lugo I, Nemov I, Ritch CR, Kava BR, Punnen S, Jorda M, Parekh DJ, Gonzalgo ML. Prostatic Ductal Adenocarcinoma Controlled for Tumor Grade, Stage, and Margin Status Does Not Independently Influence the Likelihood of Biochemical Recurrence in Localized Prostate Cancer After Radical Prostatectomy. Arch Pathol Lab Med 2021; 146:1012-1017. [PMID: 34739539 DOI: 10.5858/arpa.2021-0048-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Prostatic ductal adenocarcinoma (PDA) has historically been considered to be an aggressive subtype of prostate cancer. OBJECTIVE.— To investigate if PDA is independently associated with worse biochemical recurrence (BCR)-free survival after radical prostatectomy. DESIGN.— A review of 1584 radical prostatectomies was performed to grade, stage, and assess margin status in each tumor nodule. Radical prostatectomies with localized PDA (ie, those lacking metastasis) in the tumor nodule with the highest grade and stage and worst margin status were matched with prostatic acinar adenocarcinoma according to grade, stage, and margin status. The effect of PDA on BCR was assessed by multivariable Cox regression and Kaplan-Meier analyses. RESULTS.— Prostatic ductal adenocarcinoma was present in 171 cases. We excluded 24 cases because of lymph node metastasis (n = 13), PDA not in the highest-grade tumor nodule (n = 9), and positive surgical margin in a lower-grade tumor nodule (n = 2). The remaining 147 cases included 26 Grade Group (GG) 2, 44 GG3, 6 GG4, and 71 GG5 cancers. Seventy-six cases had extraprostatic extension, 33 had seminal vesicle invasion, and 65 had positive margins. Follow-up was available for 113 PDA and 109 prostatic acinar adenocarcinoma cases. Prostate-specific antigen density (odds ratio, 3.7; P = .001), cancer grade (odds ratio, 3.3-4.3; P = .02), positive surgical margin (odds ratio, 1.7; P = .02), and tumor volume (odds ratio, 1.3; P = .02) were associated with BCR in multivariable analysis. Prostatic ductal adenocarcinoma, its percentage, intraductal carcinoma, and cribriform Gleason pattern 4 were not significant independent predictors of BCR. CONCLUSIONS.— Advanced locoregional stage, higher tumor grade, and positive surgical margin status rather than the mere presence of PDA are more predictive of worse BCR-free survival outcomes following radical prostatectomy in men with a component of PDA.
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Affiliation(s)
- Oleksandr N Kryvenko
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksii A Iakymenko
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Luiz P De Lima Guido
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Amit S Bhattu
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Merhe
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Mouzannar
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Laurence M Briski
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Irfan Oymagil
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Isabella Lugo
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan Nemov
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Chad R Ritch
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Bruce R Kava
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Sanoj Punnen
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Dipen J Parekh
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Mark L Gonzalgo
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
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4
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Hayee A, Lugo I, Iakymenko OA, Kwon D, Briski LM, Zhao W, Nemov I, Punnen S, Ritch CR, Pollack A, Jorda M, Stoyanova R, Parekh DJ, Gonzalgo ML, Kryvenko ON. Anterior or Posterior Prostate Cancer Tumor Nodule Location Predicts Likelihood of Certain Adverse Outcomes at Radical Prostatectomy. Arch Pathol Lab Med 2021; 146:833-839. [PMID: 34669939 DOI: 10.5858/arpa.2021-0104-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Effect of tumor nodule (TN) location in the prostate on adverse radical prostatectomy (RP) outcomes is not well studied in contemporary cohort. OBJECTIVE.— To investigate the significance of TN location with respect to extraprostatic extension (EPE), seminal vesicle invasion (SV+), and positive margin status (SM+) in 1388 RPs. DESIGN.— Each TN at RP was independently graded, staged, and volumetrically assessed. TNs with at least 80% of their volume occupying either the anterior or posterior part of the prostate were categorized accordingly and included in our study, while all other TNs were excluded. RESULTS.— A total of 3570 separate TNs (median = 3 per RP; range = 1-7 per RP) were scored. There were 1320 of 3570 (37%) anterior TNs and 2250 of 3570 (63%) posterior TNs. Posterior TNs were more likely to be higher grade, and exhibit EPE (18% versus 9.4%) and SV+ (4% versus 0.15%), all P < .001. Anterior TNs with EPE were more likely to exhibit SM+ than posterior TNs with EPE (62% versus 30.8%, P < .001). TN location, grade, and volume were significant factors associated with adverse RP outcomes in our univariable analysis. When we controlled for grade and tumor volume in a multivariable analysis using anterior TN location as a reference, posterior TN location was an independent predictor of EPE and SV+ and was less likely to be associated with SM+ (odds ratio = 3.1, 81.5, and 0.7, respectively). CONCLUSIONS.— These associations may be useful in preoperative surgical planning, particularly with respect to improving radiographic analysis of prostate cancer.
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Affiliation(s)
- Amin Hayee
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Isabella Lugo
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksii A Iakymenko
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Deukwoo Kwon
- Department of Public Health Sciences (Kwon), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Laurence M Briski
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan Nemov
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Sanoj Punnen
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Chad R Ritch
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Alan Pollack
- Radiation Oncology (Pollack, Stoyanova), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Radka Stoyanova
- Radiation Oncology (Pollack, Stoyanova), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Dipen J Parekh
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Mark L Gonzalgo
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksandr N Kryvenko
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
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5
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Zavala VA, Bracci PM, Carethers JM, Carvajal-Carmona L, Coggins NB, Cruz-Correa MR, Davis M, de Smith AJ, Dutil J, Figueiredo JC, Fox R, Graves KD, Gomez SL, Llera A, Neuhausen SL, Newman L, Nguyen T, Palmer JR, Palmer NR, Pérez-Stable EJ, Piawah S, Rodriquez EJ, Sanabria-Salas MC, Schmit SL, Serrano-Gomez SJ, Stern MC, Weitzel J, Yang JJ, Zabaleta J, Ziv E, Fejerman L. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 2021; 124:315-332. [PMID: 32901135 PMCID: PMC7852513 DOI: 10.1038/s41416-020-01038-6] [Citation(s) in RCA: 447] [Impact Index Per Article: 149.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA-African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.
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Affiliation(s)
- Valentina A Zavala
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - John M Carethers
- Departments of Internal Medicine and Human Genetics, and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Luis Carvajal-Carmona
- University of California Davis Comprehensive Cancer Center and Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
- Genome Center, University of California Davis, Davis, CA, USA
| | | | - Marcia R Cruz-Correa
- Department of Cancer Biology, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Melissa Davis
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Adam J de Smith
- Center for Genetic Epidemiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Julie Dutil
- Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rena Fox
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Andrea Llera
- Laboratorio de Terapia Molecular y Celular, IIBBA, Fundación Instituto Leloir, CONICET, Buenos Aires, Argentina
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Lisa Newman
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
- Interdisciplinary Breast Program, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Tung Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Nynikka R Palmer
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sorbarikor Piawah
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Stephanie L Schmit
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Silvia J Serrano-Gomez
- Grupo de investigación en biología del cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Mariana C Stern
- Departments of Preventive Medicine and Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey Weitzel
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jun J Yang
- Department of Pharmaceutical Sciences, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jovanny Zabaleta
- Department of Pediatrics and Stanley S. Scott Cancer Center LSUHSC, New Orleans, LA, USA
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Fejerman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Kryvenko ON, Williamson SR, Schwartz LE, Epstein JI. Gleason score 5 + 3 = 8 (grade group 4) prostate cancer-a rare occurrence with contemporary grading. Hum Pathol 2020; 97:40-51. [PMID: 31923450 DOI: 10.1016/j.humpath.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
Grade Group (GG) 4 prostate cancer includes Gleason scores (GS) 3 + 5 = 8, 4 + 4 = 8, and 5 + 3 = 8. Some studies without pathology re-review of historical cohorts proposed that the presence of pattern 5 worsens prognosis compared to GS 4 + 4 = 8 cancer. We assessed how often historically graded GS 5 + 3 = 8 cancers retain this grade with contemporary grading recommendations. Sixteen prostate biopsies and 24 radical prostatectomies (RP) reported from 2005 to 2019 as GS 5 + 3 = 8 were re-reviewed and graded according to contemporary recommendations. In discrepant cases, an attempt was made to explain the different grading. One (6%) biopsy and 3 (12%) RPs remained GS 5 + 3 = 8 (GG4) after re-review. Two (12%) biopsies remained GG4 but were re-graded as GS 3 + 5 = 8 and 1 (4%) RP was reclassified as GS 4 + 4 = 8 (GG4). Eight (50%) biopsies and 15 (64%) RPs were upgraded to Gleason scores 9-10 (GG5). Five (32%) biopsies and 1 (4%) RPs were downgraded to Gleason score 7 (GG2 and 3). One (4%) RP showed GS 3 + 3 = 6 (GG1) cancer. Data from 2013-current from the 3 institutions were available to assess the incidence of GS 5 + 3 = 8 following re-review of the cases. Out of 14 359 biopsies with cancer and 6727 radical prostatectomy specimens, only 1 case (0.007%) and no cases (0%) were graded as GS 5 + 3 = 8, respectively. Reasons for grading discrepancies included: 1) assigning an overall common grade to separate needle cores or tumor nodules; 2) inclusion of <5% lower grade pattern into grading; and 3) misinterpretation of variant histology and patterns. Challenging patterns were poorly-formed glands, signet ring cell-like features, atrophic carcinoma, ductal carcinoma, and mucinous fibroplasia. GS 5 + 3 = 8 (GG4) cancer is very rare with contemporary grading. The reliability of conclusions from retrospective databases regarding the clinical significance of this grade combination without slide re-review is questionable.
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Affiliation(s)
- Oleksandr N Kryvenko
- Departments of Pathology and Laboratory Medicine, Urology, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Sean R Williamson
- Department of Pathology and Laboratory Medicine, and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - Lauren E Schwartz
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan I Epstein
- Departments of Pathology, Urology, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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7
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Iakymenko OA, Lugo I, Kwon D, Zhao W, Hayee A, Punnen S, Parekh DJ, Pollack A, Ritch CR, Gonzalgo ML, Stoyanova R, Jorda M, Kryvenko ON. Prostatic Ductal Adenocarcinoma Controlled for Cancer Grade and Tumor Volume Does Not Have an Independent Effect on Adverse Radical Prostatectomy Outcomes Compared to Usual Acinar Prostatic Adenocarcinoma. Urology 2019; 137:108-114. [PMID: 31711982 DOI: 10.1016/j.urology.2019.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/03/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To study if prostatic ductal adenocarcinoma (PDA) controlled by Grade Group (GG), PSA, and tumor volume (TV) is an independent predictor of adverse radical prostatectomy (RP) outcomes. MATERIALS One-hundred and twenty-eight PDA and 1141 acinar continuous RPs were studied. Each tumor nodule (TN) was individually graded, staged, and its TV measured. Univariate analysis (UVA) identified features associated with lymph node metastasis (LN+), extraprostatic extension (EPE), positive surgical margins (SM+), and seminal vesicle invasion (SV+). We then assessed PDA effect on RP outcomes in a multivariate analysis (MVA). RESULTS In 127 cases PDA was present in 1 TN and no TN was pure PDA. One-hundred and twenty-three cases had PDA in TNs with highest grade, stage, and TV. Patients with PDA were older (65 vs 63 years, P < 0.001), had higher GG (P < 0.001), and LN+ (6.3% vs 2.7%, P = 0.049). Controlling these variables by GG eliminated statistical significance. Overall, there were 3249 separate TNs (129 PDA and 3120 acinar). In UVA, PDA predicted EPE (92/124 vs 517/3045), SV+ (28/1129 vs 116/3,120), and SM+ (51/129 vs 296/3120), all P < 0.001. In MVA, PDA lost its effect on EPE (OR = 0.88, P = 0.64), SM+ (OR = 0.86, P = 0.5), and SV+ (OR = 0.99, P = 0.98). CONCLUSION Controlled for grade and TV, PDA was not an independent predictor of adverse RP outcomes, but former 2 were. Hence, higher GG and TV associated with PDA TNs may be predictive of adverse RP outcomes rather than PDA by itself. These conclusions may be used in preoperative risk stratification and definitive therapy planning when PDA is identified on needle biopsy.
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Affiliation(s)
- Oleksii A Iakymenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Isabella Lugo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Deukwoo Kwon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Amin Hayee
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Merce Jorda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL; Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Oleksandr N Kryvenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL; Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
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8
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Chinea FM, Lyapichev K, Epstein JI, Kwon D, Smith PT, Pollack A, Cote RJ, Kryvenko ON. Understanding PSA and its derivatives in prediction of tumor volume: Addressing health disparities in prostate cancer risk stratification. Oncotarget 2017; 8:20802-20812. [PMID: 28160549 PMCID: PMC5400546 DOI: 10.18632/oncotarget.14903] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/10/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives To address health disparities in risk stratification of U.S. Hispanic/Latino men by characterizing influences of prostate weight, body mass index, and race/ethnicity on the correlation of PSA derivatives with Gleason score 6 (Grade Group 1) tumor volume in a diverse cohort. Results Using published PSA density and PSA mass density cutoff values, men with higher body mass indices and prostate weights were less likely to have a tumor volume <0.5 cm3. Variability across race/ethnicity was found in the univariable analysis for all PSA derivatives when predicting for tumor volume. In receiver operator characteristic analysis, area under the curve values for all PSA derivatives varied across race/ethnicity with lower optimal cutoff values for Hispanic/Latino (PSA=2.79, PSA density=0.06, PSA mass=0.37, PSA mass density=0.011) and Non-Hispanic Black (PSA=3.75, PSA density=0.07, PSA mass=0.46, PSA mass density=0.008) compared to Non-Hispanic White men (PSA=4.20, PSA density=0.11 PSA mass=0.53, PSA mass density=0.014). Materials and Methods We retrospectively analyzed 589 patients with low-risk prostate cancer at radical prostatectomy. Pre-operative PSA, patient height, body weight, and prostate weight were used to calculate all PSA derivatives. Receiver operating characteristic curves were constructed for each PSA derivative per racial/ethnic group to establish optimal cutoff values predicting for tumor volume ≥0.5 cm3. Conclusions Increasing prostate weight and body mass index negatively influence PSA derivatives for predicting tumor volume. PSA derivatives’ ability to predict tumor volume varies significantly across race/ethnicity. Hispanic/Latino and Non-Hispanic Black men have lower optimal cutoff values for all PSA derivatives, which may impact risk assessment for prostate cancer.
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Affiliation(s)
- Felix M Chinea
- Departments of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kirill Lyapichev
- Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan I Epstein
- Departments of Pathology, Urology, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Deukwoo Kwon
- Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paul Taylor Smith
- Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan Pollack
- Departments of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Richard J Cote
- Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Biochemistry, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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9
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Improving the evaluation and diagnosis of clinically significant prostate cancer. Curr Opin Urol 2017; 27:191-197. [DOI: 10.1097/mou.0000000000000388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Kryvenko ON. Editorial Comment. J Urol 2017; 197:1235-1236. [PMID: 28189556 DOI: 10.1016/j.juro.2016.12.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Oleksandr N Kryvenko
- Departments of Pathology and Laboratory Medicine, and Urology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
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11
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Kryvenko ON, Epstein JI. Definition of Insignificant Tumor Volume of Gleason Score 3 + 3 = 6 (Grade Group 1) Prostate Cancer at Radical Prostatectomy—Is it Time to Increase the Threshold? J Urol 2016; 196:1664-1669. [DOI: 10.1016/j.juro.2016.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Oleksandr N. Kryvenko
- Department of Pathology and Laboratory Medicine, Department of Urology and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
- Departments of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions (JIE), Baltimore, Maryland
| | - Jonathan I. Epstein
- Department of Pathology and Laboratory Medicine, Department of Urology and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
- Departments of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions (JIE), Baltimore, Maryland
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12
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Do Black NonHispanic Men Produce Less Prostate Specific Antigen in Benign Prostate Tissue or Cancer Compared to White NonHispanic Men with Gleason Score 6 (Grade Group 1) Prostate Cancer? J Urol 2016; 196:1659-1663. [PMID: 27343801 DOI: 10.1016/j.juro.2016.06.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE We evaluated prostate specific antigen production by benign prostate tissue and Gleason score 3+3=6 (Grade Group 1) prostate cancer in black and white nonHispanic men. MATERIALS AND METHODS We used Gleason score 3+3=6 (Grade Group 1) cases to assess prostate specific antigen production by benign prostate tissue in cases with low volume cancer that did not influence prostate specific antigen and in those with high volume cancer in which gland weight did not influence prostate specific antigen. We then created age, prostate specific antigen and prostate weight adjusted cohorts to demonstrate tumor volume per 1 ng/ml prostate specific antigen and 1 μg prostate specific antigen mass. Prostate specific antigen density and prostate specific antigen mass density were used to adjust for prostate weight. RESULTS Comparison of 58 black and 301 white men with low volume cancer demonstrated equal prostate specific antigen production by benign prostate tissue. Comparison of 30 black and 75 white men with high volume cancer indicated that prostate specific antigen was being driven by cancer volume, with lower prostate specific antigen production in black men. In the cohort of 54 black and 134 white men matched by age, prostate specific antigen and prostate weight, tumor volume per 1 ng/ml prostate specific antigen or 1 μg prostate specific antigen mass adjusted for prostate weight was 25% and 26% higher in black men, respectively. CONCLUSIONS Benign prostate tissue produces equal amounts of prostate specific antigen in black and white men. Gleason score 3+3=6 (Grade Group 1) prostate cancer produces less prostate specific antigen in black men. These data should be considered for lowering prostate specific antigen and its derivatives in determining biopsy thresholds and for adjusting values for active surveillance criteria in black men.
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