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Ozkaya M, Simsekoglu MF, Kalender G, Sahin KC, Gurses I. Clinical and histopathological parameters in transrectal ultrasound-guided biopsies associated with tumor upgrading after radical prostatectomy: A comparative analysis of risk groups. Prostate 2024; 84:1146-1156. [PMID: 38798171 DOI: 10.1002/pros.24751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/15/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Thanks to technological advances, prostate cancer (PCa) can be diagnosed at a younger age. It is known that most of these patients are in the low-intermediate risk group, and the histological grade of the tumor increases in half of those undergoing radical prostatectomy (Rp) compared to their diagnostic biopsies. This is especially important in terms of active surveillance (AS) and/or the timely evaluation of curative treatment options in patients diagnosed at an early age. Our aim was to investigate clinical and histopathological parameters that may be associated with an increase in the histological grade of the tumor in patients with acinar adenocarcinoma who were diagnosed by transrectal ultrasound-guided biopsy (TRUS-Bx) and underwent Rp. METHODS A total of 205 patients with classical acinar adenocarcinoma diagnosed by TRUS-Bx without metastasis and who underwent Rp were grouped according to the D'Amico risk classification. Age at diagnosis, serum prostate-specific antigen (PSA), PSA density, prostate volume, Prostate Imaging Reporting and Data System (PI-RADS) score, clinical stage, Gleason Grade Group (GGG), high-grade intraepithelial neoplasia in tumor-free cores (HGPIN) (single and ≥2 cores), perineural invasion (PNI), and lymphovascular invasion (LVI) was obtained. Additionally, GGG, pathological stage, lymph node metastasis, surgical margin positivity, and tumor volume obtained from Rp were evaluated. Comparisons were made between the case groups in which the tumor grade increased and remained the same, in terms of age, serum PSA, PSA density, HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI in all biopsies (with or without tumors), as well as risk groups. In addition, the relationships of HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI on TRUS-Bx with age, serum PSA and PSA density, tumor volume, surgical margin positivity, pathological stage, lymph node metastasis, and risk groups were examined separately. RESULTS Of the patients, 72 (35.1%) were in the low-risk group, 95 (46.3%) in the intermediate-risk group, and 38 (18.5%) in the high-risk group. Most of the patients with an increased histological grade (n = 38, 48.1%) were in the low-risk group (p < 0.05) and had an advanced median age. HGPIN in single and ≥2 tumor-free cores and PNI were more common in these patients (p < 0.01, p < 0.001, and p < 0.05, respectively). According to the multivariable analysis, advanced age (odds ratio [OR]: 1.087, 95% confidence interval [CI]: 1.029-1.148, p < 0.05), high serum PSA (OR: 1.047, 95% CI: 1.006-1.090, p < 0.05), HGPIN in ≥2 tumor-free cores (OR: 6.346, 95% CI: 3.136-12.912, p < 0.001), and PNI (OR: 3.138, 95% CI: 1.179-8.356, p < 0.05) were independent risk factors for a tumor upgrade. Furthermore, being in the low-risk group was an independent risk factor when compared to the intermediate- and high-risk groups (OR: 0.187, 95% CI: 0.080-0.437, p < 0.001 and OR: 0.054, 95% CI: 0.013-0.230, p < 0.001, respectively). The HGPIN diagnosis was more common in the low- and intermediate-risk groups. Advanced age at diagnosis, high serum PSA and PSA density values were associated with PNI on TRUS-Bx. High serum PSA and PSA density values were associated with LVI on TRUS-Bx. Surgical margin positivity was higher in cases with PNI and LVI detected by TRUS-Bx. HGPIN in ≥2 tumor-free cores, PNI, and LVI on TRUS-Bx were associated with a higher rate of lymph node metastases. CONCLUSIONS In patients diagnosed with acinar adenocarcinoma, the presence of HGPIN even in a single tumor-free core on TRUS-Bx was found to be significant in terms of showing an increase in the histological tumor grade in Rp. The diagnosis of HGPIN in ≥2 tumor-free cores on TRUS-Bx was determined as an independent risk factor for an increased Gleason score after Rp. Furthermore, an advanced age, a high serum PSA value, being in the low-risk group, and the presence of PNI were associated with a tumor upgrade. HGPIN in ≥2 tumor-free cores, PNI, and LVI were also associated with lymph node metastasis. Therefore, the diagnosis of HGPIN should be signed out on pathological reports.
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Affiliation(s)
- Mustafa Ozkaya
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Muhammed Fatih Simsekoglu
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Goktug Kalender
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Kadir Can Sahin
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Iclal Gurses
- Department of Pathology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
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Ferguson J, Carbin DD, Abou Chedid W, Uribe S, Peacock J, Papadopoulos D, Adamou C, Ameen T, Carbanara U, Gabriel J, Kusuma VRM, Hicks J, Moschonas D, Patil K, Perry M. Factors associated with pathological up-staging in MRI cT3a prostate cancer - a retrospective study from a high-volume centre. World J Urol 2024; 42:449. [PMID: 39066799 DOI: 10.1007/s00345-024-05159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/30/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Multiparametric MRI (mpMRI) parameters of pT3a prostate cancer have not been examined in large cohort studies. Therefore, we aimed to identify factors associated with up-staging of mpMRI cT3a in post-operative histopathological confirmation. METHODS Retrospective analysis of a prospectively maintained database of a single UK cancer centre. Only cT3a cases who underwent robotic-assisted radical prostatectomy (RARP) were included (N = 383). MRI and specimen histopathology was reviewed independently by expert uro-radiologists and uro-histopathologists, respectively. Factors included age, BMI, prostate-specific antigen (PSA) level, biopsy international society of urological pathology (ISUP) grade, Prostate Imaging Reporting & Data System (PI-RADS®) score, tumour size, tumour coverage of gland (%), gland weight and surgical margins were analysed as predictors of pT3a prostate cancer. RESULTS N = 383. Mean age 66 years (58-71), mean BMI 27.1 kg/m2 (25.0-30.0). 314 (82.0%) cases down- unchanged or down-staged, and 69 (18.0%) cases upstaged. PSA level (P = 0.002), PI-RADS score (P < 0.001) and ISUP grade (P < 0.001) are positively associated with upstage categories. ISUP grade ≥3 (OR 5.45, CI 1.88, 9.29, P < 0.002), PI-RADS score ≥4 (OR 3.92, CI 1.88-9.29, P < 0.001) and tumour coverage (OR 1.06, CI 1.05-1.08, P < 0.001) significantly positively associated with upstaging disease, with concurrent decreased probability of downstaging (OR 0.55, 0.14, 0.44, respectively, P < 0.05). Tumour coverage was positively correlated with increasing positive surgical margins (P < 0.05). Capsular contact > 15 mm was very unlikely to be upstaged (OR 0.36, CI 0.21-0.62, P < 0.001), aligning with published results past the widely accepted significant level for extracapsular disease on MRI. CONCLUSION The study has identified PSA level, ISUP, PI-RADS score, tumour volume and percentage coverage are key predictive factors in cT3a upstaging. This study uniquely shows tumour coverage percentage as a predictor of cT3a upstaging on mpMRI. ISUP is the strongest predictor, followed by PI-RADS score and tumour coverage of gland. Multi-institutional studies are needed to confirm our findings.
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Affiliation(s)
- Jonathan Ferguson
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | | | - Wissam Abou Chedid
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Santiago Uribe
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Julian Peacock
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | | | - Constantinos Adamou
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Torath Ameen
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Umberto Carbanara
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Joseph Gabriel
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | | | - James Hicks
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Dimitrios Moschonas
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Krishna Patil
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Matthew Perry
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
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Zhou L, Xu LL, Zheng LL, Chen C, Xu L, Zeng JL, Li SY. Predictors of Gleason Grading Group Upgrading in Low-Risk Prostate Cancer Patients From Transperineal Biopsy After Radical Prostatectomy. Acad Radiol 2024; 31:2838-2847. [PMID: 38233258 DOI: 10.1016/j.acra.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate the predictors of Gleason Grading Group (GGG) upgrading in low-risk prostate cancer (Gleason score=3 + 3) from transperineal biopsy after radical prostatectomy (RP). MATERIALS AND METHODS The clinical data of 160 patients who underwent transperineal biopsy and RP from January 2017 to December 2022 were retrospectively analyzed. First, univariate and multivariate logistic regression analysis were used to obtain independent predictors of postoperative GGG upgrading. Then receiver operating characteristic curve was used to evaluate the diagnostic efficacy of predictors. Finally, Linear-by-Linear Association test was used to analyze the risk trends of patients in different predictor groups in the postoperative GGG. RESULTS In this study, there were 81 cases (50.6%) in the GGG concordance group and 79 cases (49.4%) in the GGG upgrading group. Univariate analysis showed age, free/total prostate-specific antigen (f/tPSA), proportion of positive biopsies, positive target of magnetic-resonance imaging (MRI) and positive target of contrast-enhanced ultrasound had significant effects on GGG upgrading (all P < .05). In multivariate logistic regression analysis, age (odds ratio [OR]=1.066, 95%CI=1.007-1.127, P = .027), f/tPSA (OR=0.001, 95%CI=0-0.146, P = .001) and positive target of MRI (OR=3.005, 95%CI=1.353-76.674, P = .007) were independent predictors. The prediction model (area under curve=0.751 P < .001) had higher predictive efficacy than all independent predictors. The proportion of patients in exposed group of different GGG increased with the level of GGG, but decreased in nonexposed group, and the linear trend was significantly different (all P < .001). CONCLUSION Age, f/tPSA, and positive target of MRI were independent predictors of postoperative GGG upgrading. The predictive model constructed had the best diagnostic efficacy.
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Affiliation(s)
- Ling Zhou
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Li-Long Xu
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Lin-Lin Zheng
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.)
| | - Chao Chen
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (C.C.)
| | - Li Xu
- Department of Urology Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (L.X.)
| | - Ji-Ling Zeng
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (J.Z.)
| | - Shi-Yan Li
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Rd, Hangzhou 310016, Zhejiang, China (L.Z., L.X., L.Z., S.L.).
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Tosoian JJ, Zhang Y, Xiao L, Xie C, Samora NL, Niknafs YS, Chopra Z, Siddiqui J, Zheng H, Herron G, Vaishampayan N, Robinson HS, Arivoli K, Trock BJ, Ross AE, Morgan TM, Palapattu GS, Salami SS, Kunju LP, Tomlins SA, Sokoll LJ, Chan DW, Srivastava S, Feng Z, Sanda MG, Zheng Y, Wei JT, Chinnaiyan AM. Development and Validation of an 18-Gene Urine Test for High-Grade Prostate Cancer. JAMA Oncol 2024; 10:726-736. [PMID: 38635241 PMCID: PMC11190811 DOI: 10.1001/jamaoncol.2024.0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/06/2023] [Indexed: 04/19/2024]
Abstract
Importance Benefits of prostate cancer (PCa) screening with prostate-specific antigen (PSA) alone are largely offset by excess negative biopsies and overdetection of indolent cancers resulting from the poor specificity of PSA for high-grade PCa (ie, grade group [GG] 2 or greater). Objective To develop a multiplex urinary panel for high-grade PCa and validate its external performance relative to current guideline-endorsed biomarkers. Design, Setting, and Participants RNA sequencing analysis of 58 724 genes identified 54 markers of PCa, including 17 markers uniquely overexpressed by high-grade cancers. Gene expression and clinical factors were modeled in a new urinary test for high-grade PCa (MyProstateScore 2.0 [MPS2]). Optimal models were developed in parallel without prostate volume (MPS2) and with prostate volume (MPS2+). The locked models underwent blinded external validation in a prospective National Cancer Institute trial cohort. Data were collected from January 2008 to December 2020, and data were analyzed from November 2022 to November 2023. Exposure Protocolized blood and urine collection and transrectal ultrasound-guided systematic prostate biopsy. Main Outcomes and Measures Multiple biomarker tests were assessed in the validation cohort, including serum PSA alone, the Prostate Cancer Prevention Trial risk calculator, and the Prostate Health Index (PHI) as well as derived multiplex 2-gene and 3-gene models, the original 2-gene MPS test, and the 18-gene MPS2 models. Under a testing approach with 95% sensitivity for PCa of GG 2 or greater, measures of diagnostic accuracy and clinical consequences of testing were calculated. Cancers of GG 3 or greater were assessed secondarily. Results Of 761 men included in the development cohort, the median (IQR) age was 63 (58-68) years, and the median (IQR) PSA level was 5.6 (4.6-7.2) ng/mL; of 743 men included in the validation cohort, the median (IQR) age was 62 (57-68) years, and the median (IQR) PSA level was 5.6 (4.1-8.0) ng/mL. In the validation cohort, 151 (20.3%) had high-grade PCa on biopsy. Area under the receiver operating characteristic curve values were 0.60 using PSA alone, 0.66 using the risk calculator, 0.77 using PHI, 0.76 using the derived multiplex 2-gene model, 0.72 using the derived multiplex 3-gene model, and 0.74 using the original MPS model compared with 0.81 using the MPS2 model and 0.82 using the MPS2+ model. At 95% sensitivity, the MPS2 model would have reduced unnecessary biopsies performed in the initial biopsy population (range for other tests, 15% to 30%; range for MPS2, 35% to 42%) and repeat biopsy population (range for other tests, 9% to 21%; range for MPS2, 46% to 51%). Across pertinent subgroups, the MPS2 models had negative predictive values of 95% to 99% for cancers of GG 2 or greater and of 99% for cancers of GG 3 or greater. Conclusions and Relevance In this study, a new 18-gene PCa test had higher diagnostic accuracy for high-grade PCa relative to existing biomarker tests. Clinically, use of this test would have meaningfully reduced unnecessary biopsies performed while maintaining highly sensitive detection of high-grade cancers. These data support use of this new PCa biomarker test in patients with elevated PSA levels to reduce the potential harms of PCa screening while preserving its long-term benefits.
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Affiliation(s)
- Jeffrey J. Tosoian
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Yuping Zhang
- Department of Pathology, University of Michigan, Ann Arbor
| | - Lanbo Xiao
- Department of Pathology, University of Michigan, Ann Arbor
| | - Cassie Xie
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nathan L. Samora
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Zoey Chopra
- Department of Pathology, University of Michigan, Ann Arbor
| | - Javed Siddiqui
- Department of Pathology, University of Michigan, Ann Arbor
| | - Heng Zheng
- Department of Pathology, University of Michigan, Ann Arbor
| | - Grace Herron
- Department of Pathology, University of Michigan, Ann Arbor
| | | | - Hunter S. Robinson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Bruce J. Trock
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashley E. Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor
| | | | | | | | - Scott A. Tomlins
- Department of Urology, University of Michigan, Ann Arbor
- Strata Oncology, Ann Arbor, Michigan
| | - Lori J. Sokoll
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel W. Chan
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sudhir Srivastava
- Division of Cancer Prevention, National Institutes of Health, Bethesda, Maryland
| | - Ziding Feng
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Yingye Zheng
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - John T. Wei
- Department of Urology, University of Michigan, Ann Arbor
| | - Arul M. Chinnaiyan
- Department of Pathology, University of Michigan, Ann Arbor
- Department of Urology, University of Michigan, Ann Arbor
- Howard Hughes Medical Institute, Chevy Chase, Maryland
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5
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Hagens MJ, Ribbert LLA, Jager A, Veerman H, Barwari K, Boodt B, de Bruijn RE, Claessen A, Leter MR, van der Noort V, Smeenge M, Roeleveld TA, Rynja SP, Schaaf M, Weltings S, Vis AN, Bekers E, van Leeuwen PJ, van der Poel HG. Histopathological concordance between prostate biopsies and radical prostatectomy specimens-implications of transrectal and transperineal biopsy approaches. Prostate Cancer Prostatic Dis 2024; 27:312-317. [PMID: 37660218 DOI: 10.1038/s41391-023-00714-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the histopathological concordance rates between prostate biopsies and radical prostatectomy specimens according to the applied biopsy approach (transrectal or transperineal). METHODS We studied patients who had been newly diagnosed with clinically significant prostate cancer and who underwent a radical prostatectomy between 2018 and 2022. Patients were included if they underwent a prebiopsy magnetic resonance imaging and if they had not been previously treated for prostate cancer. Histopathological grading on prostate biopsies was compared with that on radical prostatectomy specimens. Univariable and multivariable logistic regression analyses were performed to assess the effect of the applied biopsy approach on histopathological concordance. Additional analyses were performed to assess the effect of the applied biopsy approach on American Urological Association risk group migration, defined as any change in risk group after radical prostatectomy. RESULTS In total, 1058 men were studied, of whom 49.3% (522/1058) and 50.7% (536/1058) underwent transrectal and transperineal prostate biopsies, respectively. Histopathological disconcordance was observed in 37.8% (400/1058) of men while American Urological Association risk group migration was observed in 30.2% (320/1058) of men. A transperineal biopsy approach was found to be independently associated with higher histopathological concordance rates (OR 1.33 [95% CI 1.01-1.75], p = 0.04) and less American Urological Association risk group migration (OR 0.70 [95% CI 0.52-0.93], p = 0.01). CONCLUSIONS The use of a transperineal biopsy approach improved histopathological concordance rates compared to the use of a transrectal biopsy approach. A transperineal biopsy approach may provide more accurate risk stratification for clinical decision-making. Despite recent improvements, histopathologic concordance remains suboptimal and should be considered before initiating management.
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Affiliation(s)
- M J Hagens
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands.
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands.
| | - L L A Ribbert
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - A Jager
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - H Veerman
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - K Barwari
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Andros Clinics, Amsterdam, the Netherlands
| | - B Boodt
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Flevoziekenhuis, Almere, the Netherlands
| | - R E de Bruijn
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Ziekenhuis Amstelland, Amstelveen, the Netherlands
| | - A Claessen
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
| | - M R Leter
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Dijklander Ziekenhuis, Hoorn, the Netherlands
| | - V van der Noort
- Department of Statistics, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Smeenge
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, St Jansdal Ziekenhuis, Harderwijk, the Netherlands
| | - T A Roeleveld
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - S P Rynja
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - M Schaaf
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, BovenIJ Ziekenhuis, Amsterdam, the Netherlands
| | - S Weltings
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Zaans Medisch Centrum, Zaandam, the Netherlands
| | - A N Vis
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - E Bekers
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - P J van Leeuwen
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
| | - H G van der Poel
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
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6
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Sorce G, Stabile A, Pellegrino F, Mazzone E, Mattei A, Afferi L, Serni S, Minervini A, Roumiguiè M, Malavaud B, Valerio M, Rakauskas A, Marra G, Gontero P, Porpiglia F, Guo H, Zhuang J, Gandaglia G, Montorsi F, Briganti A. The impact of mpMRI-targeted vs systematic biopsy on the risk of prostate cancer downgrading at final pathology. World J Urol 2024; 42:248. [PMID: 38647689 DOI: 10.1007/s00345-024-04963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Although targeted biopsies (TBx) are associated with improved disease assessment, concerns have been raised regarding the risk of prostate cancer (PCa) overgrading due to more accurate biopsy core deployment in the index lesion. METHODS We identified 1672 patients treated with radical prostatectomy (RP) with a positive mpMRI and ISUP ≥ 2 PCa detected via systematic biopsy (SBx) plus TBx. We compared downgrading rates at RP (ISUP 4-5, 3, and 2 at biopsy, to a lower ISUP) for PCa detected via SBx only (group 1), via TBx only (group 2), and eventually for PCa detected with the same ISUP 2-5 at both SBx and TBx (group 3), using multivariable logistic regression models (MVA). RESULTS Overall, 12 vs 14 vs 6% (n = 176 vs 227 vs 96) downgrading rates were recorded in group 1 vs group 2 vs group 3, respectively (p < 0.001). At MVA, group 2 was more likely to be downgraded (OR 1.26, p = 0.04), as compared to group 1. Conversely, group 3 was less likely to be downgraded at RP (OR 0.42, p < 0.001). CONCLUSIONS Downgrading rates are highest when PCa is present in TBx only and, especially when the highest grade PCa is diagnosed by TBx cores only. Conversely, downgrading rates are lowest when PCa is identified with the same ISUP through both SBx and TBx. The presence of clinically significant disease at SBx + TBx may indicate a more reliable assessment of the disease at the time of biopsy potentially reducing the risk of downgrading at final pathology.
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Affiliation(s)
- G Sorce
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - A Stabile
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - F Pellegrino
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - E Mazzone
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - A Mattei
- Klinik Für Urologie, Luzerner Kantonsspital, Luzerner, Switzerland
| | - L Afferi
- Klinik Für Urologie, Luzerner Kantonsspital, Luzerner, Switzerland
| | - S Serni
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - A Minervini
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - M Roumiguiè
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - B Malavaud
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - M Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Rakauskas
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - G Marra
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - P Gontero
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - F Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - H Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - J Zhuang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - G Gandaglia
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - F Montorsi
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - A Briganti
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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Jawli A, Nabi G, Huang Z. The Performance of Different Parametric Ultrasounds in Prostate Cancer Diagnosis: Correlation with Radical Prostatectomy Specimens. Cancers (Basel) 2024; 16:1502. [PMID: 38672584 PMCID: PMC11047975 DOI: 10.3390/cancers16081502] [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: 02/22/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Prostate cancer is a prevalent cancer among men. Multiparametric ultrasound [mpUS] is a diagnostic instrument that uses various types of ultrasounds to diagnose it. This systematic review aims to evaluate the performance of different parametric ultrasounds in diagnosing prostate cancer by associating with radical prostatectomy specimens. METHODOLOGY A review was performed on various ultrasound parameters using five databases. Systematic review tools were utilized to eliminate duplicates and identify relevant results. Reviewers used the Quality Assessment of Diagnostic Accuracy Results [QUADAS-2] to evaluate the bias and applicability of the study outcomes. RESULT Between 2012 and 2023, eleven studies were conducted to evaluate the performance of the different ultrasound parametric procedures in detecting prostate cancer using grayscale TRUS, SWE, CEUS, and mpUS. The high sensitivity of these procedures was found at 55%, 88.6%, 81%, and 74%, respectively. The specificity of these procedures was found to be 93.4%, 97%, 88%, and 59%, respectively. This high sensitivity and specificity may be associated with the large lesion size. The studies revealed that the sensitivity of these procedures in diagnosing clinically significant prostate cancer was 55%, 73%, 70%, and 74%, respectively, while the specificity was 61%, 78.2%, 62%, and 59%, respectively. CONCLUSIONS The mpUS procedure provides high sensitivity and specificity in PCa detection, especially for clinically significant prostate cancer.
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Affiliation(s)
- Adel Jawli
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
- Department of Clinical Radiology, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Ministry of Health, Kuwait City 13001, Kuwait
| | - Ghulam Nabi
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
| | - Zhihong Huang
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
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8
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Esen B, Seymen H, Gurses B, Armutlu A, Koseoglu E, Tarim K, Ertoy Baydar D, Sarikaya AF, Canda AE, Balbay D, Kordan Y, Tilki D, Esen T, Demirkol MO. The role of PSMA PET/CT to predict upgrading in patients undergoing radical prostatectomy for ISUP grade group 1 prostate cancer. Prostate 2024; 84:32-38. [PMID: 37661579 DOI: 10.1002/pros.24621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES To investigate the additive role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) independent from multiparametric magnetic resonance imaging (mpMRI) and clinical-pathological parameters to predict pathological upgrading in patients with ISUP grade group (GG) 1 prostate cancer (PCa) at prostate biopsy. MATERIALS AND METHODS A total of 41 patients who underwent robotic radical prostatectomy (RP) for GG1 disease at prostate biopsy with preoperative PSMA PET/CT and mpMRI images available for central review were included in the study. Univariate and multivariate logistic regression analyses were performed to determine the independent predictors of pathological upgrading (GG ≥ 2). RESULTS Final RP pathology revealed upgrading in 26 patients (65.9%); to GG 2 disease in 25 cases and GG 4 disease in one case. International Society of Urological Pathology (ISUP) upgrading rates for prostate imaging-reporting and data system (PIRADS)-5, PIRADS-4, and PIRADS ≤ 3 lesions were 78%, 74%, and 38%, respectively. Fourteen out of 15 (93.3%) patients with an SUVmax ≥ 5.6 and all patients with an SUVmax ≥ 6.5 (n = 10) had pathological upgrading. The upgrading rate in patients with SUV < 5.6 was 46.2% (12/26). Intraprostatic SUVmax ≥ 5.6 was found as the only independent predictor of pathological upgrading in multivariate analysis. CONCLUSION High prostatic PSMA uptake was found to be a very reliable predictor of pathological upgrading, but low PSMA uptake cannot exclude pathological upgrading. Intraprostatic PSMA uptake along with previously known mpMRI and biopsy-related parameters should be considered when making a treatment decision in patients with GG1 PCa at prostate biopsy.
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Affiliation(s)
- Baris Esen
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Hulya Seymen
- Department of Nuclear Medicine, School of Medicine, Koç University, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey
| | - Ayse Armutlu
- Department of Pathology, School of Medicine, Koç University, Istanbul, Turkey
| | - Ersin Koseoglu
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Kayhan Tarim
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Dilek Ertoy Baydar
- Department of Pathology, School of Medicine, Koç University, Istanbul, Turkey
| | | | - Abdullah Erdem Canda
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
- RMK AIMES, Rahmi M. Koc Academy of Interventional Medicine, Education, and Simulation, Istanbul, Turkey
| | - Derya Balbay
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Yakup Kordan
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Derya Tilki
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tarik Esen
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Mehmet Onur Demirkol
- Department of Nuclear Medicine, School of Medicine, Koç University, Istanbul, Turkey
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9
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Menne Guricová K, Groen V, Pos F, Monninkhof E, Elias SG, Haustermans K, Smeenk RJ, van der Voort van Zyp J, Draulans C, Isebaert S, van Houdt PJ, Kerkmeijer LGW, van der Heide UA. Risk Modeling for Individualization of the FLAME Focal Boost Approach in External Beam Radiation Therapy for Patients With Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2024; 118:66-73. [PMID: 37725026 DOI: 10.1016/j.ijrobp.2023.07.044] [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: 10/24/2022] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The FLAME trial (NCT01168479) showed that isotoxic focal boosting to the intraprostatic lesion(s) in patients with intermediate- and high-risk prostate cancer improves 5-year disease-free survival (DFS). Although the near-minimum dose to the gross tumor volume (D98%) was associated with improved outcomes, a closer look suggested that this might not be the same for all patients. Therefore, we investigated whether risk factors that are associated with a benefit of focal boosting can be identified. METHODS AND MATERIALS We described the distribution of clinical characteristics and the number of high-risk factors with respect to the D98% in 526 FLAME trial patients. We used penalized Cox regression to develop a prediction model. To investigate a potential benefit in patient subgroups, we compared the model-based predictions of 5-year DFS assuming standard whole-gland radiation therapy of 77 Gy to the predictions assuming an additional focal boost with D98% of 95 Gy. RESULTS Patients with high-risk factors were well represented in the group of 120 patients that received D98% > 85 Gy and showed fewer recurrences compared with the group that received 77 Gy. Applying the model simulating a standard dose of 77 Gy, we predicted a high DFS for grade group (GG) 1 patients, whereas patients with high-risk characteristics appeared to show a low DFS. All risk groups showed a high level of DFS when simulating D98% of 95 Gy. CONCLUSIONS Our results suggest that GG 1 patients already show a low level of failure at a standard dose of 77 Gy, limiting the additional benefit of focal boosting. In contrast, patients with high-risk characteristics, especially GG 4 or 5, show a low 5-year DFS, while focal boosting might improve this substantially. This suggests that reaching a high focal boost dose may be particularly beneficial for these patients.
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Affiliation(s)
- Karolína Menne Guricová
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Veerle Groen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Evelyn Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Robert J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands.
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Keskin ET, Özdemir H, Uğur R, Savun M, Çolakoğlu Y, Şimşek A. Could Prognostic Nutritional Index be a new criteria for active surveillance of prostate cancer? Actas Urol Esp 2023; 47:573-580. [PMID: 37086847 DOI: 10.1016/j.acuroe.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE To evaluate the importance of the Prognotic Nutritional Index(PNI) value for patient selection of active surveillance(AS) in prostate cancer. METHODS Between September 2020 and June 2022, the data of 125-patients who underwent Robot-Assisted-Laparoscopic-Prostatectomy(RALP) were retrospectively analyzed. All patients were suitable for AS preoperatively. Using the pathological results of RALP, patients have been divided two groups. Patients who met the criteria for AS were defined as the first group, others were defined second. Demographic datas, PNI values and hematological parameters of the groups were compared. RESULTS 38% (n:48) patients were found suitable for the group1, and 62%(n:77) were found suitable for the group 2. Upgrading and upstaging were found at 76 patients (61%) and 26(21%), respectively. There is no significant difference between groups on age, BMI, PSA, PSA-density, prostate volume, and PIRADS. PNI value was found higher at first group. The value of 49.45 was calculated by ROC analysis as the ideal PNI cut-off value for predicting upgrading and upstaging of prostate cancer (P < ,001). According to the both univariate and multivariate regression analysis, PNI was found a predictor for exclusion from AS (P < ,001). CONCLUSION Upgrading and upstaging are detected at a higher rate in patients with low PNI values. The use of PNI value in the selection of patients to AS will increase the success rate of ideal patient selection.
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Affiliation(s)
- E T Keskin
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey.
| | - H Özdemir
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey
| | - R Uğur
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey
| | - M Savun
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey
| | - Y Çolakoğlu
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey
| | - A Şimşek
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey
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11
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Zhang J, Kang F, Gao J, Jiao J, Quan Z, Ma S, Li Y, Guo S, Li Z, Jing Y, Zhang K, Yang F, Han D, Wen W, Zhang J, Ren J, Wang J, Guo H, Qin W. A Prostate-Specific Membrane Antigen PET-Based Approach for Improved Diagnosis of Prostate Cancer in Gleason Grade Group 1: A Multicenter Retrospective Study. J Nucl Med 2023; 64:1750-1757. [PMID: 37652543 DOI: 10.2967/jnumed.122.265001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 07/11/2023] [Indexed: 09/02/2023] Open
Abstract
The preoperative Gleason grade group (GG) from transrectal ultrasound-guided prostate biopsy is crucial for treatment decisions but may underestimate the postoperative GG and miss clinically significant prostate cancer (csPCa), particularly in patients with biopsy GG1. In such patients, an SUVmax of at least 12 has 100% specificity for detecting csPCa. In patients with an SUVmax of less than 12, we aimed to develop a model to improve the diagnostic accuracy of csPCa. Methods: The study retrospectively included 56 prostate cancer patients with transrectal ultrasound-guided biopsy GG1 and an SUVmax of less than 12 from 2 tertiary hospitals. All [68Ga]Ga-PSMA-HBED-CC PET scans were centrally reviewed in Xijing Hospital. A deep learning model was used to evaluate the overlap of SUVmax (size scale, 3 cm) and the level of Gleason pattern (size scale, 500 μm). A diagnostic model was developed using the PRIMARY score and SUVmax, and its discriminative performance and clinical utility were compared with other methods. The 5-fold cross-validation (repeated 1,000 times) was used for internal validation. Results: In patients with GG1 and an SUVmax of less than 12, significant prostate-specific membrane antigen (PSMA) histochemical score (H-score) H-score overlap occurred among benign gland, Gleason pattern 3, and Gleason pattern 4 lesions, causing SUVmax overlap between csPCa and non-csPCa. The model of 10 × PRIMARY score + 2 × SUVmax exhibited a higher area under the curve (AUC, 0.8359; 95% CI, 0.7233-0.9484) than that found using only the SUVmax (AUC, 0.7353; P = 0.048) or PRIMARY score (AUC, 0.7257; P = 0.009) for the cohort and a higher AUC (0.8364; 95% CI, 0.7114-0.9614) than that found using only the Prostate Imaging Reporting and Data System (PI-RADS) score of 5-4 versus 3-1 (AUC, 0.7036; P = 0.149) and the PI-RADS score of 5-3 versus 2-1 (AUC, 0.6373; P = 0.014) for a subgroup. The model reduced the misdiagnosis of the PI-RADS score of 5-4 versus 3-1 by 78.57% (11/14) and the PI-RADS score of 5-3 versus 2-1 by 77.78% (14/18). The internal validation showed that the mean 5-fold cross-validated AUC was 0.8357 (95% CI, 0.8357-0.8358). Conclusion: We preliminarily suggest that the model of 10 × PRIMARY score + 2 × SUVmax may enhance the diagnostic accuracy of csPCa in patients with biopsy GG1 and an SUVmax of less than 12 by maximizing PSMA information use, reducing the misdiagnosis of the PI-RADS score, and thereby aiding in making appropriate treatment decisions.
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Affiliation(s)
- Jingliang Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fei Kang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jie Gao
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, China
| | - Jianhua Jiao
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhiyong Quan
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shuaijun Ma
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yu Li
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shikuan Guo
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zeyu Li
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuming Jing
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Keying Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fa Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Donghui Han
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Weihong Wen
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Jing Zhang
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, China; and
| | - Jing Ren
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China;
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12
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Hang J, Hao Y, Zhang S, Xu L, Zhang Q, Guo H. Validation of Epstein criteria and development of a nomogram for active surveillance in a contemporary Chinese population. Urol Oncol 2023; 41:388.e9-388.e16. [PMID: 37481463 DOI: 10.1016/j.urolonc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/27/2023] [Accepted: 05/04/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE To evaluate the Epstein criteria for insignificant prostate cancer (CaP) prediction in a contemporary Chinese population, and to develop a risk model with combined clinical and systematic biopsy and targeted biopsy parameters for active surveillance. METHODS A total of 249 CaP patients with biopsy Gleason score (GS) of 6 were included. One hundred and one patients were eligible for insignificant CaP on final pathology (GS ≤6 and organ-confined). Diagnostic tests were used to validate the ability of the 2 Epstein criteria. Univariate and multivariate regression analyses were performed to identify predictors of insignificant CaP for the development of predictive models. Receiver operating characteristics analysis was used to select the best model, followed by risk nomogram construction and internal validation. RESULTS There were 47 patients met EC1 and 61 met EC2, with pathological upgrading rates of 36% and 41%, respectively, and 70% (71/101) and 64% (65/101) were missed, with areas under the curve of 0.591 and 0.594, respectively. Four prediction models were developed using regression analysis, and model 2 incorporating age, prostate-specific antigen density, maximum percentage of core involvement at systematic biopsy, and percentage of positive cores at targeted biopsy showed the best diagnostic value (area under the curve = 0.731, sensitivity 62.4%, specificity 77.0%) and was used to construct the nomogram. Calibration curves and decision curve analysis demonstrated favorable calibration (mean absolute error 0.048) and clinical benefits of the novel nomogram. CONCLUSION The Epstein criteria need to be revised by incorporating targeted biopsy parameters to improve diagnostic performance, and a novel nomogram was developed with better prediction of insignificant CaP.
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Affiliation(s)
- Junke Hang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ying Hao
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, Jiangsu, China
| | - Shiwei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Institute of Urology, Nanjing University, Nanjing, Jiangsu, China
| | - Linfeng Xu
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Institute of Urology, Nanjing University, Nanjing, Jiangsu, China
| | - Qing Zhang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Institute of Urology, Nanjing University, Nanjing, Jiangsu, China
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Institute of Urology, Nanjing University, Nanjing, Jiangsu, China.
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13
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Weinstein IC, Wu X, Hill A, Brennan D, Omil-Lima D, Basourakos S, Brant A, Lewicki P, Al Hussein Al Awamlh B, Spratt D, Bittencourt LK, Scherr D, Zaorsky NG, Nagar H, Hu J, Barbieri C, Ponsky L, Vickers AJ, Shoag JE. Impact of Magnetic Resonance Imaging Targeting on Pathologic Upgrading and Downgrading at Prostatectomy: A Systematic Review and Meta-analysis. Eur Urol Oncol 2023:S2588-9311(23)00080-9. [PMID: 37236832 DOI: 10.1016/j.euo.2023.04.004] [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: 11/19/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/28/2023]
Abstract
CONTEXT The evidence supporting multiparametric magnetic resonance imaging (MRI) targeting for biopsy is nearly exclusively based on biopsy pathologic outcomes. This is problematic, as targeting likely allows preferential identification of small high-grade areas of questionable oncologic significance, raising the likelihood of overdiagnosis and overtreatment. OBJECTIVE To estimate the impact of MRI-targeted, systematic, and combined biopsies on radical prostatectomy (RP) grade group concordance. EVIDENCE ACQUISITION PubMed MEDLINE and Cochrane Library were searched from July 2018 to January 2022. Studies that conducted systematic and MRI-targeted prostate biopsies and compared biopsy results with pathology after RP were included. We performed a meta-analysis to assess whether pathologic upgrading and downgrading were influenced by biopsy type and a net-benefit analysis using pooled risk difference estimates. EVIDENCE SYNTHESIS Both targeted only and combined biopsies were less likely to result in upgrading (odds ratio [OR] vs systematic of 0.70, 95% confidence interval [CI] 0.63-0.77, p < 0.001, and 0.50, 95% CI 0.45-0.55, p < 0.001), respectively). Targeted only and combined biopsies increased the odds of downgrading (1.24 (95% CI 1.05-1.46), p = 0.012, and 1.96 (95% CI 1.68-2.27, p < 0.001) compared with systematic biopsies, respectively. The net benefit of targeted and combined biopsies is 8 and 7 per 100 if harms of up- and downgrading are considered equal, but 7 and -1 per 100 if the harm of downgrading is considered twice that of upgrading. CONCLUSIONS The addition of MRI-targeting results in lower rates of upgrading as compared to systematic biopsy at RP (27% vs 42%). However, combined MRI-targeted and systematic biopsies are associated with more downgrading at RP (19% v 11% for combined vs systematic). Strong heterogeneity suggests further research into factors that influence the rates of up- and downgrading and that distinguishes clinically relevant from irrelevant grade changes is needed. Until then, the benefits and harms of combined MRI-targeted and systematic biopsies cannot be fully assessed. PATIENT SUMMARY We reviewed the ability of magnetic resonance imaging (MRI)-targeted biopsies to predict cancer grade at prostatectomy. We found that combined MRI-targeted and systematic biopsies result in more cancers being downgraded than systematic biopsies.
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Affiliation(s)
- Ilon C Weinstein
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Xian Wu
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Alexander Hill
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Donald Brennan
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Danly Omil-Lima
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Spyridon Basourakos
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Aaron Brant
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Patrick Lewicki
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | | | - Daniel Spratt
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Leonardo Kayat Bittencourt
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Doug Scherr
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Himanshu Nagar
- Department of Radiation Oncology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Jim Hu
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Christopher Barbieri
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Lee Ponsky
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
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Thompson A, Eguru V, Moosa S, Ng Y. Do Concomitant Systematic Biopsies Add to Fusion Targeted Biopsies in the Diagnosis and Management of Clinically Significant Prostate Cancer? UROLOGY RESEARCH & PRACTICE 2023; 49:169-177. [PMID: 37877866 PMCID: PMC10346108 DOI: 10.5152/tud.2023.22221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/15/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Magnetic resonance imaging targeted biopsy clearly detects more clinically significant prostate cancer than systematic biopsy. Whether concomitant systematic biopsy adds to targeted biopsy in the detection of clinically significant prostate cancer remains uncertain. The primary outcome measure of this study was to ascertain the percentage of clinically significant prostate cancer on systematic biopsy missed by targeted biopsy. Furthermore, we sought to determine whether systematic biopsy results influenced the clinical management of patients. MATERIALS AND METHODS This prospective observational study included all men undergoing Fusion targeted biopsy in our Health Board. All men had PI-RADS scores of 3-5 on magnetic resonance imaging. Histology from targeted biopsy and systematic biopsy was reviewed to determine any additional benefit of performing systematic biopsy. Clinical outcomes were also reviewed. Clinically significant prostate cancer was defined by (i) International Society of Urological Pathology ≥ 2 and (ii) UCL criteria of any primary Gleason 4 or core length ≥ 6 mm. RESULTS A total of 104 men were included in the study of whom 18 patients were biopsy naïve, 65 had at least 1 previous negative biopsy, and 20 had previous biopsies that showed clinically insignificant cancer. The percentage of clinically significant prostate cancer missed on targeted biopsy was between 9.1% and 11.1%. Moreover, 17.1% of patients with clinically significant prostate cancer would not have proceeded to radical treatment if the systematic biopsy had not been performed. CONCLUSION Our data support a growing field of evidence that although magnetic resonance imaging targeted biopsy is more sensitive than systematic biopsy at detecting clinically significant prostate cancer, systematic biopsy adds to the number of patients diagnosed with clinically significant prostate cancer in those already undergoing prostate biopsy.
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Affiliation(s)
- Alice Thompson
- University Hospital of Wales Healthcare NHS Trust, Northern Ireland, UK
| | - Venkat Eguru
- Hywel Dda University Health Board, Northern Ireland, UK
| | - Sohail Moosa
- Hywel Dda University Health Board, Northern Ireland, UK
| | - Yeung Ng
- Hywel Dda University Health Board, Northern Ireland, UK
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Adverse Pathology after Radical Prostatectomy of Patients Eligible for Active Surveillance-A Summary 7 Years after Introducing mpMRI-Guided Biopsy in a Real-World Setting. Bioengineering (Basel) 2023; 10:bioengineering10020247. [PMID: 36829741 PMCID: PMC9952076 DOI: 10.3390/bioengineering10020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Over the last decade, active surveillance (AS) of low-risk prostate cancer has been increasing. The mpMRI fusion-guided biopsy of the prostate (FBx) is considered to be the gold standard in preoperative risk stratification. However, the role of FBx remains unclear in terms of risk stratification of low-risk prostate cancer outside high-volume centers. The aim of this study was to evaluate adverse pathology after radical prostatectomy (RP) in a real-world setting, focusing on patients diagnosed with Gleason score (GS) 6 prostate cancer (PCa) and eligible for AS by FBx. SUBJECTS AND METHODS Between March 2015 and March 2022, 1297 patients underwent FBx at the Department of Urology, Ludwig-Maximilians-University of Munich, Germany. MpMRI for FBx was performed by 111 different radiology centers. FBx was performed by 14 urologists from our department with different levels of experience. In total, 997/1297 (77%) patients were diagnosed with prostate cancer; 492/997 (49%) of these patients decided to undergo RP in our clinic and were retrospectively included. Univariate and multivariable logistic regression analyses were performed to evaluate clinical and histopathological parameters associated with adverse pathology comparing FBx and RP specimens. To compare FBx and systematic randomized biopsies performed in our clinic before introducing FBx (SBx, n = 2309), we performed a propensity score matching on a 1:1 ratio, adjusting for age, number of positive biopsy cores, and initial PSA (iPSA). RESULTS A total of 492 patients undergoing FBx or SBx was matched. In total, 55% of patients diagnosed with GS 6 by FBx were upgraded to clinically significant PCa (defined as GS ≥ 7a) after RP, compared to 52% of patients diagnosed by SBx (p = 0.76). A time delay between FBx and RP was identified as the only correlate associated with upgrading. A total of 5.9% of all FBx patients and 6.1% of all SBx patients would have been eligible for AS (p > 0.99) but decided to undergo RP. The positive predictive value of AS eligibility (diagnosis of low-risk PCa after biopsy and after RP) was 17% for FBx and 6.7% for SBx (p = 0.39). CONCLUSIONS In this study, we show, in a real-world setting, that introducing FBx did not lead to significant change in ratio of adverse pathology for low-risk PCa patients after RP compared to SBx.
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Sugino Y, Sasaki T, Ebara S, Tatenuma T, Ikehata Y, Nakayama A, Kawase M, Toide M, Yoneda T, Sakaguchi K, Teishima J, Makiyama K, Kitamura H, Saito K, Koie T, Koga F, Urakami S, Inoue T. Clinical Factors Associated With Pathological Grade Group 1 Patients in D'Amico Intermediate-Risk Group Following Robot-Assisted Radical Prostatectomy: A Retrospective Multicenter Cohort Study in Japan (The MSUG94 Group). Clin Genitourin Cancer 2022; 20:593-600. [PMID: 35773146 DOI: 10.1016/j.clgc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION We aimed to examine the relationship between D'Amico intermediate-risk and pathological grade group 1 (pGG1) after robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS In this retrospective multicenter cohort study, D'Amico intermediate-risk prostate cancer patients who did not receive neoadjuvant therapy, and underwent RARP at 10 institutions in Japan were examined for preoperative factors associated with pGG1. RESULTS In total, we enrolled 1161 D'Amico intermediate-risk prostate cancer patients. The pGG1 and pGG ≥2 groups comprised 73 (6.3%), and 1088 (93.7%) cases, respectively. Biochemical recurrence-free survival (BCRFS) of the pGG1 group was equivalent to that of the D'Amico low-risk patients. Among the 3 D'Amico intermediate-risk factors (IRF), the pGG1-rate was 24% with prostate-specific antigen (PSA) of 10 to 20 ng/mL alone, and 30% with cT2b alone. Both groups had significantly higher pGG1-rates than other groups. Down-grading from biopsy GG ≥2 to pGG1 was relatively rare (3.9%). Patients with pGG1 were further stratified by prostate volume (PV) (cutoff, 40 cc) among patients with one IRF and PSA of 10 to 20 ng/mL. Patients with one IRF, PSA of 10 to 20 ng/mL, and PV >40 cc had a relatively good BCRFS similar to that of the D'Amico low-risk group. CONCLUSION Among intermediate-risk prostate cancer patients, those with pGG1 have a good prognosis. Downgrading from biopsy GG ≥2 is rare, and definitive treatment may be recommended for patients with biopsy GG ≥2. Patients with one IRF, PSA of 10 to 20 ng/mL, and PV >40 cc who are eligible for RARP may be candidates for active surveillance.
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Affiliation(s)
- Yusuke Sugino
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Takeshi Sasaki
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Shin Ebara
- Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | | | - Akinori Nakayama
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahiro Toide
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tatsuaki Yoneda
- Department of Urology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | - Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | | | | | - Kazutaka Saito
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan.
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Terracciano D, La Civita E, Athanasiou A, Liotti A, Fiorenza M, Cennamo M, Crocetto F, Tennstedt P, Schiess R, Haese A, Ferro M, Steuber T. New strategy for the identification of prostate cancer: The combination of Proclarix and the prostate health index. Prostate 2022; 82:1469-1476. [PMID: 35971798 DOI: 10.1002/pros.24422] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/10/2022] [Accepted: 07/11/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Prostate health index (PHI) and, more recently, Proclarix have been proposed as serum biomarkers for prostate cancer (PCa). In this study, we aimed to evaluate Proclarix and PHI for predicting clinically significant prostate cancer (csPCa). PATIENTS AND METHODS Proclarix and PHI were measured using samples of 344 men from two different centers. All patients underwent prostate biopsy, and among those, 188 men with PCa on biopsy had an additional radical prostatectomy (RP). All men had a prostate-specific antigen (PSA) between 2 and 10 ng/ml. Evaluation of area under the curve (AUC) and performance at predefined cut-offs of Proclarix and PHI risk scores as well as the linear combination thereof was performed to predict csPCa. PSA density was used as an independent comparator. RESULTS The cohort median age and PSA were 65 (interquartile range [IQR]: 60-71) and 5.6 (IQR: 4.3-7.2) ng/ml, respectively. CsPCa was diagnosed in 161 (47%) men based on the RP specimen. ROC analysis showed that Proclarix and PHI accurately predicted csPCa with no significant difference (AUC of 0.79 and 0.76, p = 0.378) but significantly better when compared to PSA density (AUC of 0.66, p < 0.001). When using specific cut-offs, Proclarix (cut-off 10) revealed higher specificity and positive predictive value than PHI (cut-off 27) at similar sensitivities. The combination of Proclarix and PHI provided a significant increase in the AUC (p ≤ 0.007) compared to the individual tests alone and the highest clinical benefit was achieved. CONCLUSION Results of this study show that both Proclarix and PHI accurately detect the presence of csPCa. The model combining Proclarix and PHI revealed the synergistic effect and improved the diagnostic performance of the individual tests.
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Affiliation(s)
- Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Antonietta Liotti
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mariano Fiorenza
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Michele Cennamo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Pierre Tennstedt
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Schiess
- Proteomedix AG, Research & Development, Zurich-Schlieren, Switzerland
| | - Alexander Haese
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Thomas Steuber
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Guimarães T, Gil M, Medeiros M, Andrade V, Guerra J, Pinheiro H, Fernandes F, Pina J, Lopes Dias J, Campos Pinheiro L. Magnetic resonance imaging target fusion biopsy vs. transrectal ultrasound-guided biopsy - A comparative study of ISUP score upgrading risk in the final radical prostatectomy specimen. Arch Ital Urol Androl 2022; 94:278-284. [DOI: 10.4081/aiua.2022.3.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The aim of this study was to com-pare the risk of International Society of Urological Pathology (ISUP) score upgrading between magnetic resonance imaging targeted fusion biopsy (MRI-TB) and tran-srectal ultrasound-guided biopsy (TRUS-B) in the final radical prostatectomy (RP) specimen pathological report.Materials and methods: This retrospective single center study included 51 patients with prostate cancer (PCa) diagnosed with MRI-TB and 83 patients diagnosed with TRUS-B between October/2019 and July/2021. We compared the rates of ISUP score upgrading between both groups after robotic-assisted radi-cal prostatectomy (RARP) and the specific transition of each ISUP score based on biopsy modality. The rate of ISUP score concordance and downgrading were also assessed. To define the intra and interobserver concordance for each ISUP score in biopsy and RP specimen for each biopsy modality, the Cohen’s Kappa coefficient was calculated. ISUP scores and biopsy modal-ity were selected for multivariate analysis and a logistic regres-sion model was built to provide independent risk factors of ISUP score upgrading.Results: The difference of the rate of upgrading between MRI-TB group and TRUS-B group was statistically significant (p = 0.007) with 42.2% of patients of TRUS-B group experiencing an upgrade in their ISUP score while only 19.6% in MRI-TB group. Concordance and downgrading rates did not statistically differ between the two groups. Strength of concordance using Cohen’s Kappa coefficient was fair in both groups but higher in MRI-TB group (TRUS-B group k = 0.230; p < 0.001; concordance: 47%vs. MRI/TB group k = 0.438; p < 0.001; concordance: 62.7%). Biopsy modality and ISUP 1 on biopsy were independent predic-tors of ISUP upgrading after RP.Conclusions: MRI-TB is highly accurate with lower risk of PCa upgrading after RP than TRUS-B. Patients with ISUP 1 on biopsy have greater susceptibility to upgrading their ISUP score.
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19
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Hiwase MD, Jay A, Bulamu N, Teh J, Paterson F, Kichenadasse G, Vincent AD, O'Callaghan M. Evaluation of selective bone scan staging in prostate cancer - external validation of current strategies and decision-curve analysis. Prostate Cancer Prostatic Dis 2022; 25:336-343. [PMID: 35288662 PMCID: PMC9184265 DOI: 10.1038/s41391-022-00515-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
Background Recommendations for staging newly diagnosed prostate cancer patients vary between guidelines and literature. Methods Our objective was to validate and compare prediction models selecting newly diagnosed prostate cancer patients for bone scan staging. To achieve this, we validated eleven models in a population-based cohort of 10,721 patients diagnosed with prostate cancer between 2005 and 2019. The primary outcome was net-benefit. This was assessed at different balances of conservatism and tolerance, represented by preference ratio and number-willing-to-test (NWT). Secondary outcomes included calibration slope, calibration-in-the-large (intercept), and discrimination measured by Area-under-the-receiver-operator-characteristics curve (AUC). Results For preference ratios less than 1:39 (NWT greater than 40), scanning everyone provided greater net-benefit than selective staging. For preference ratios 1:39 to 3:97 (NWT 33–40), the European Association of Urology (EAU) 2020 guideline recommendation was the best approach. For preference ratios 3:97–7:93 (NWT 14–33), scanning EAU high-risk patients only was preferable. For preference ratios 7:93–1:9 (NWT 10–13), scanning only Gnanapragasam Group 5 patients was best. All models had similar fair discrimination (AUCs 0.68–0.80), but most had poor calibration. Conclusions We identified three selective staging strategies that outperformed all other approaches but did so over different ranges of conservatism and tolerance. Scanning only EAU high-risk patients provided the greatest net-benefit over the greatest range of preference ratios and scenarios, but other options may be preferable depending upon the local healthcare system’s degree of conservatism and tolerance.
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Affiliation(s)
- Mrunal D Hiwase
- University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia. .,Department of Surgery, Central Adelaide Health Network, Adelaide, SA, Australia.
| | - Alex Jay
- Flinders Medical Centre, Urology Unit, Adelaide, SA, Australia
| | - Norma Bulamu
- Health Economist, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Johnathan Teh
- University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia.,Northern Adelaide Health Network, Adelaide, SA, Australia
| | - Felix Paterson
- Nuclear Medicine Physician and Radiologist, Dr Jones and Partners Radiology and Flinders Medical Centre, Adelaide, SA, Australia
| | - Ganessan Kichenadasse
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Bedford Park, SA, 5042, Australia
| | - Andrew D Vincent
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, Australia
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20
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The impact of surgical downgrading on prostate cancer recurrence: systematic review and analysis of a multiethnic population. World J Urol 2021; 40:709-718. [PMID: 34850269 DOI: 10.1007/s00345-021-03892-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To perform a systematic review and a retrospective cohort analysis evaluating the rates of surgical downgrading of prostate cancer (PCa) from biopsy (PBx) to radical prostatectomy (RP), and their association with biochemical recurrence (BCR) in a multiethnic population. METHODS A systematic review of PubMed and other databases was performed. We included retrospective studies evaluating the relationship between surgical downgrading and BCR-free survival. Data regarding Gleason score (GL) downgrading were abstracted from the articles and categorized as follows: GL8-10 to GL7, GL7 to GL6, and GL 7(4 + 3) to GL7(3 + 4). We also performed a retrospective cohort review of patients who underwent RP at our institution from 2005 through 2020. Kaplan-Meier survival analysis and Cox proportional hazards models were used to compare BCR among downgraded versus non-downgraded men. RESULTS Systematic review yielded 137 abstracts; of these, 36 full-texts were reviewed, 8 of which were included in our systematic review. Despite substantial variability, all showed that GL at RP is one of the most important factors of BCR-free survival. A total of 1,484 men with PCa were analyzed from our institution. On multivariate analysis, GL7 to GL6 downgrading (HR = 0.50, p = 0.022) and GL8-10 to GL7 downgrading (HR = 0.42, p = 0.011) were associated with reduced risk of BCR when compared to men with GL7 and GL8-10 concordance, respectively. However, GL7(4 + 3) to GL7(3 + 4) downgrading was not significantly associated with reduced BCR (HR = 0.56, p = 0.12), when compared to GL7(4 + 3) concordance, although HR was similar. CONCLUSION Surgical downgrading at RP was associated with a reduced risk of BCR compared to GL concordant disease, and these findings have been validated within our multiethnic population. Pathologic downgrading at the time of RP may be a more useful predictor of subsequent BCR in comparison to that associated with GL concordant pathology.
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21
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Porcaro AB, Gallina S, Bianchi A, Cerrato C, Tafuri A, Rizzetto R, Amigoni N, Orlando R, Serafin E, Gozzo A, Migliorini F, Antoniolli SZ, Lacola V, De Marco V, Brunelli M, Cerruto MA, Siracusano S, Antonelli A. Endogenous testosterone density as ratio of endogenous testosterone levels on prostate volume predicts tumor upgrading in low-risk prostate cancer. Int Urol Nephrol 2021; 53:2505-2515. [PMID: 34677784 PMCID: PMC8599336 DOI: 10.1007/s11255-021-03008-0] [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: 05/25/2021] [Accepted: 09/28/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To evaluate preoperative endogenous testosterone (ET) density (ETD), defined as the ratio of ET on prostate volume, and tumor upgrading risk in low-risk prostate cancer (PCa). MATERIALS AND METHODS From November 2014 to December 2019, 172 low-risk patients had ET (nmol/L) measured. ETD, prostate-specific antigen density (PSAD) and the ratio of percentage of biopsy positive cores (BPC) to prostate volume (PV), defined as BPC density (BPCD), were evaluated. Associations with tumor upgrading in the surgical specimen were assessed by statistical methods. RESULTS Overall, 121 patients (70.3%) had tumor upgrading, which was predicted by BPCD (odds ratio, OR = 4.640; 95% CI 1.903-11.316; p = 0.001; overall accuracy: 70.3%). On multivariate analysis, tumor upgrading and clinical density factors related to each other for BPCD being predicted by ETD (regression coefficient, b = 0.032; 95% CI 0.021-0.043; p < 0.0001), PSAD (b = 1.962; 95% CI 1.067-2.586; p < 0.0001) and tumor upgrading (b = 0.259; 95% CI 0.112-0.406; p = 0.001). According to the model, as BPCD increased, ETD and PSAD increased, but the increase was higher for upgraded cases who showed either higher tumor load but significantly lower mean levels of either ET or PSA. CONCLUSIONS As ETD increased, higher tumor loads were assessed; however, in upgraded patients, lower ET was also detected. ETD might stratify low-risk disease for tumor upgrading features.
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Affiliation(s)
- Antonio Benito Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy.
| | - Sebastian Gallina
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Alberto Bianchi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy.
| | - Riccardo Rizzetto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Nelia Amigoni
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Rossella Orlando
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Emanuele Serafin
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Alessandra Gozzo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Stefano Zecchini Antoniolli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Vincenzo Lacola
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Salvatore Siracusano
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy
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22
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Combined Systematic and MRI-US Fusion Prostate Biopsy Has the Highest Grading Accuracy When Compared to Final Pathology. ACTA ACUST UNITED AC 2021; 57:medicina57060519. [PMID: 34067302 PMCID: PMC8224801 DOI: 10.3390/medicina57060519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 02/05/2023]
Abstract
Background and objectives: Systematic prostate biopsy (SB) has a low Gleason group (GG) accuracy when compared to final pathology. This may negatively impact the inclusion of patients into specific risk groups and treatment choice. The aim of our study was to assess the GG accuracy of magnetic resonance imaging-ultrasound (MRI-US) fusion prostate biopsy. Materials and Methods: Of a cohort of minimally invasive radical prostatectomy (RP), we selected all patients who were diagnosed with prostate cancer (PCa) via MRI-US fusion biopsy (n = 115). Results: Combined biopsy had the highest rate for GG concordance (61.7% vs. 60.4% for SB vs. 45.3% for MRI-US fusion biopsy) and the lowest for upgrading (20.9% vs. 24.5% for SB vs. 34.9% for MRI-US fusion biopsy), p < 0.0001. No clinical data were predictive for upgrading or downgrading at final pathology. Locally advanced PCa was associated with a high Prostate Imaging-Reporting and Data System (PIRADS) score (p = 0.0014) and higher percentages of positive biopsy cores (PBC)/targeted (p = 0.0002) and PBC/total (p = 0.01). Positive surgical margins were correlated with higher percentages of PBC/systematic (p = 0.003) and PBC/total (p = 0.009). Conclusions: Pre-biopsy prostate MRI improves GG concordance between biopsy and RP. Combined biopsy provides the highest grading accuracy when compared to final pathology. Targeted and systematic biopsy data are predictive for adverse pathologic outcomes.
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Takeshima Y, Yamada Y, Teshima T, Fujimura T, Kakutani S, Hakozaki Y, Kimura N, Akiyama Y, Sato Y, Kawai T, Yamada D, Kume H. Clinical significance and risk factors of International Society of Urological Pathology (ISUP) grade upgrading in prostate cancer patients undergoing robot-assisted radical prostatectomy. BMC Cancer 2021; 21:501. [PMID: 33947348 PMCID: PMC8097801 DOI: 10.1186/s12885-021-08248-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate the clinical significance and risk factors of upgrading in the International Society of Urological Pathology (ISUP) Grade Group System in men undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer. METHODS A total of 583 patients diagnosed with prostate cancer by systematic biopsy were treated with RARP without neoadjuvant therapy from November 2011 to December 2018. Clinicopathological data were obtained from our clinical records. ISUP grade upgrading (IGU) was defined as 'ISUP grade in prostatectomy specimen determined to be higher than that in the biopsy specimen'. Clinicopathological factors, including age, PSA, prostate volume at biopsy (PV), PSA density, clinical stage, body mass index (BMI), interval from biopsy to prostatectomy, maximum percentage of cancer involvement per core (%CI), total number of biopsy cores, percentage of cancer positive biopsy cores (%PC), and sampling density were analyzed to detect potential risk factors of IGU. Biochemical recurrence (BCR) rates were calculated to analyze the effect of IGU on cancer prognosis. RESULTS In univariate analysis, BMI was a positive predictor of IGU, while %CI, %PC, and sampling density were negative predictors of IGU. BMI and %PC were statistically significant predictors of IGU in multivariate analysis. For cases diagnosed as ISUP grade group 2 or higher at biopsy, there was a significant difference in BCR rates between cases with and without IGU. CONCLUSIONS The results from our cohort showed that elements of both high-grade cancer risk (such as BMI) and sampling efficiency (such as %PC) contribute to IGU. Excluding cases diagnosed as ISUP grade group 1 at biopsy, BCR-free rates were significantly worse in cases with IGU, highlighting the need for more accurate pathological diagnosis at biopsy.
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Affiliation(s)
- Yuta Takeshima
- Division of Innovative Cancer Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Minato-Ku, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan.
| | - Taro Teshima
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
| | - Shigenori Kakutani
- Department of Urology, Chiba Tokushukai Hospital, Funabashi-shi, Chiba, Japan
| | - Yuji Hakozaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Naoki Kimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
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Costa DN, Cai Q, Xi Y, Recchimuzzi DZ, Subramanian N, Bagrodia A, Rofsky NM, Roehrborn CG, Hornberger B, Shah RB, Goldberg K, Diaz de Leon A, Pedrosa I. Gleason Grade Group Concordance between Preoperative Targeted Biopsy and Radical Prostatectomy Histopathologic Analysis: A Comparison Between In-Bore MRI-guided and MRI-Transrectal US Fusion Prostate Biopsies. Radiol Imaging Cancer 2021; 3:e200123. [PMID: 33817652 PMCID: PMC8011452 DOI: 10.1148/rycan.2021200123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
Purpose To determine and compare rates of grade group (GG) discrepancies between different targeted biopsy techniques (in-bore vs fusion) after propensity score weighting using whole-mount radical prostatectomy (RP) histopathologic analysis as the reference standard. Materials and Methods This retrospective study evaluated men who underwent targeted (fusion or in-bore) biopsy between April 2017 and January 2019 followed by prostatectomy. The primary endpoint of the study was a change in GG from biopsy to RP at a patient level. For downgrade and upgrade analysis, men with biopsy GG1 (downgrade not possible) and GG5 (upgrade not possible) were excluded, respectively. GG upgrade, downgrade, and concordance rates of each targeting approach were compared using propensity score weighting and logistic regression with inverse probability of treatment weighting. Significance level was set at .05. Index lesion GG on RP specimen served as the reference standard. Results A total of 191 men (90 in the in-bore [mean age, 63 years ± 7 (standard deviation)] and 101 in the fusion biopsy group [mean age, 65 years ± 7]) were eligible and included. Fewer GG upgrades were noted in the in-bore biopsy group (14%; 12 of 85) compared with the fusion plus systematic biopsy group (30%; 28 of 93) (P = .012). The incidence of GG downgrade in the in-bore group (25%; 21 of 84) was higher than in the fusion group (17%; 16 of 93); however, the difference was not statistically significant (P = .2). Of the 77 men misclassified by both biopsy techniques, the majority (56%, n = 43) had a change in GG of 2 to 3 or 3 to 2. Conclusion Superior sampling accuracy with MRI-guided in-bore biopsies offers a lower incidence of GG upgrades compared with MRI-transrectal US fusion biopsies upon RP.Keywords: Biopsy/Needle Aspiration, MR-Imaging, Oncology, Pathology, Prostate Supplemental material is available for this article.© RSNA, 2021.
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Affiliation(s)
- Daniel N. Costa
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Qi Cai
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Yin Xi
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Debora Z. Recchimuzzi
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Naveen Subramanian
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Aditya Bagrodia
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Neil M. Rofsky
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Claus G. Roehrborn
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Brad Hornberger
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Rajal B. Shah
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Kenneth Goldberg
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Alberto Diaz de Leon
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Ivan Pedrosa
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
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Wang X, Zhang Y, Ji Z, Yang P, Tian Y. Old men with prostate cancer have higher risk of Gleason score upgrading and pathological upstaging after initial diagnosis: a systematic review and meta-analysis. World J Surg Oncol 2021; 19:18. [PMID: 33472645 PMCID: PMC7818761 DOI: 10.1186/s12957-021-02127-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the predictive performance of age for the risk of Gleason score change and pathologic upstaging. EVIDENCE ACQUISITION Ovid MEDLINE, Ovid Embase, and the Cochrane Library were searched from inception until May 2020. Quality of included studies was appraised utilizing the Newcastle-Ottawa Quality Assessment Scale for case-control studies. The publication bias was evaluated by funnel plots and Egger's tests. EVIDENCE SYNTHESIS Our search yielded 27 studies with moderate-to-high quality including 84296 patients with mean age of 62.1 years. From biopsy to prostatectomy, upgrading and upstaging occurred in 32.3% and 9.8% of patients, respectively. Upgrading from diagnostic biopsy to confirmatory biopsy was found in 16.8%. Older age was associated with a significant increased risk of upgrading (OR 1.04, 95% CI 1.03-1.05), and similar direction of effect was found in studies focused on upgrading from diagnostic biopsy to confirmatory biopsy (OR 1.06, 95% CI 1.04-1.08). For pathologic upstaging within older men compared with younger, the pooled odds was 1.03 (95% CI 1.01-1.04). CONCLUSION Thorough consideration of age in the context of effect sizes for other factors not only prompts more accurate risk stratification but also helps providers to select optimal therapies for patients with prostate cancer.
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Affiliation(s)
- Xiaochuan Wang
- Department of Urology, Capital Medical University affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, 100050, Beijing, People's Republic of China
| | - Yu Zhang
- Department of Urology, Capital Medical University affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, 100050, Beijing, People's Republic of China
| | - Zhengguo Ji
- Department of Urology, Capital Medical University affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, 100050, Beijing, People's Republic of China
| | - Peiqian Yang
- Department of Urology, Capital Medical University affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, 100050, Beijing, People's Republic of China
| | - Ye Tian
- Department of Urology, Capital Medical University affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, 100050, Beijing, People's Republic of China.
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26
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Wang X, Zhang Y, Zhang F, Ji Z, Yang P, Tian Y. Predicting Gleason sum upgrading from biopsy to radical prostatectomy pathology: a new nomogram and its internal validation. BMC Urol 2021; 21:3. [PMID: 33407381 PMCID: PMC7789761 DOI: 10.1186/s12894-020-00773-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/15/2020] [Indexed: 12/01/2022] Open
Abstract
Background To explore the rate of Gleason sum upgrading (GSU) from biopsy to radical prostatectomy pathology and to develop a nomogram for predicting the probability of GSU in a Chinese cohort. Methods We retrospectively reviewed our prospectively maintained prostate cancer (PCa) database from October 2012 to April 2020. 198 patients who met the criteria were enrolled. Multivariable logistic regression analysis was performed to determine the predictors. Nomogram was constructed based on independent predictors. The receiver operating curve was undertaken to estimate the discrimination. Calibration curve was used to assess the concordance between predictive probabilities and true risks. Results The rate of GSU was 41.4%, whilst GS concordance rate was 44.4%. The independent predictors are prostate specific antigen (PSA), greatest percentage of cancer (GPC), clinical T-stage and Prostate Imaging Reporting and Data System (PI-RADS) score. Our model showed good discrimination (AUC of 0.735). Our model was validated internally with good calibration with bias-corrected C-index of 0.726. Conclusions Utilization of basic clinical variables (PSA and T-stage) combined with imaging variable (PI-RADS) and pathological variable (GPC) could improve performance in predicting actual probabilities of GSU in the 24-core biopsy scheme. Our nomogram could help to assess the true risk and make optimal treatment decisions for PCa patients.
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Affiliation(s)
- Xiaochuan Wang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China
| | - Yu Zhang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China
| | - Fengbo Zhang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China
| | - Zhengguo Ji
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China
| | - Peiqian Yang
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China
| | - Ye Tian
- Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China.
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Gosein MA, Narinesingh D, Motilal S, Ramkissoon AP, Goetz CM, Sadho K, Mosodeen MD, Banfield R. Biparametric MRI prior to Radical Radiation Therapy for Prostate Cancer in a Caribbean Population: Implications for Risk Group Stratification and Treatment. Radiol Imaging Cancer 2020; 2:e200007. [PMID: 33778724 PMCID: PMC7983799 DOI: 10.1148/rycan.2020200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/20/2020] [Accepted: 04/07/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess risk-group migration and subsequent management change following biparametric MRI using a risk-stratified approach in a group of Caribbean men with prostate adenocarcinoma being offered external beam radiation therapy (EBRT). MATERIALS AND METHODS This retrospective study assessed the biparametric MRI findings in men who opted for EBRT from January 2018 to June 2019 (n = 79; mean age, 67.9 years ± 6.2 [standard deviation]). Serum prostate-specific antigen level, digital rectal examination findings, histologic grade group (GG) from transrectal US-guided biopsy, prior androgen deprivation therapy (ADT), and any prior CT results were used to stratify patients into low-, intermediate-, and high-risk groups, according to the National Comprehensive Cancer Network risk categories. Risk-group stratification prior to MRI separated patients into low- (seven of 79 [8.9%]), intermediate- (36 of 79 [45.6%]) and high-risk (36 of 79 [45.6%]) groups. Following MRI, any risk group (low, intermediate, high, nodal involvement, and metastatic disease) or oncologic management changes were recorded. Multivariable binary logistic regression analyses were used to assess predictor of upgrade status, with adjustment for demographic covariates jointly. RESULTS Following MRI, 30 of 79 (38.0%) patients had risk-group upshifts compared with their original assessment. Patients were recategorized into low risk (one of 79, 1.3%), intermediate risk (19 of 79, 24.1%), high risk (51 of 79, 64.6%), nodal involvement (one of 79, 1.3%), and metastatic disease (seven of 79, 8.9%). From the original groupings, there were six of seven (85.7%) from the low group, 18 of 36 (50.0%) from the intermediate group, and six of 36 (16.7%) from the high group that had risk group upward shifts. There was no association with GG: GG2 versus GG1, P = .53; GG3 versus GG1, P = .98; or prior ADT (P = .37) and the adjusted odds of risk-group upshifts. MRI findings resulted in treatment plan modification for 39 of 79 (49.4%) men overall. CONCLUSION Prostate MRI should be considered for patients in high-risk populations prior to EBRT because upstaging from MR image assessment may have implications for modification of treatment.Keywords: MR-Imaging, Prostate, Radiation Therapy© RSNA, 2020See the commentary by Davenport and Shankar in this issue.
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