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Ariafar A, Rezaeian A, Zare A, Zeighami S, Hosseini SH, Nikbakht HA, Narouie B. Concordance between Gleason score of prostate biopsies and radical prostatectomy specimens and its predictive factors. Urologia 2022:3915603221118457. [DOI: 10.1177/03915603221118457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The Gleason score is an essential factor for making decisions about prostate cancer management and its prognosis. Thus, we conducted this research to discover the histologic-grading accuracy of needle biopsy specimens, and to identify preoperative clinical and pathological factors that predict upgrading and downgrading from biopsy to radical prostatectomy specimen. Patients and methods: This study was performed on 570 patients who were referred to the medical centers affiliated with Shiraz University of Medical Sciences and underwent radical prostatectomy from 2013 to 2017. Concordance was evaluated between the Gleason score of needle biopsy and radical prostatectomy specimens. Predictors of upgrades and downgrades were assessed in univariate and multivariate logistic regression analyses. Results: Scores were the same in 50% of cases, downgraded in 26%, and upgraded in 24%. The variables predicting a Gleason score upgrade were higher Prostate specific antigen level, larger tumors, and older age. Lower tumor volume, lower Prostate specific antigen, and low maximum percentage of cancer in cores were predictors of downgrading from Gleason score>6 to ⩽6. Also, Body mass index>30, smaller tumor size, and negative lymph nodes were predictors of downgrading from Gleason score>7 to 7. Conclusion: The correlation between biopsy and Radical prostatectomy Gleason scores was only 50%. After dividing them into the new grading groups, this coordination increased by only 5.6%. Physicians need to consider possible limitations of the Gleason score of biopsy and factors that can be predictive of upgrading to high-risk prostate cancer before making treatment decisions.
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Affiliation(s)
- Ali Ariafar
- Urology Oncology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Rezaeian
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Zare
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahryar Zeighami
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hossein Hosseini
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Department of Biostatics and Epidemiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
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Qin XP, Lu QJ, Yang CH, Wang J, Chen JF, Liu K, Chen X, Zhou J, Pan YH, Li YH, Ren SC, Liu JM, Liu WP, Qian HJ, Yi XL, Lai CY, Qu LJ, Gao X, Xu YS, Chen Z, Zhuo YM. CRMP4 CpG Hypermethylation Predicts Upgrading to Gleason Score ≥ 8 in Prostate Cancer. Front Oncol 2022; 12:840950. [PMID: 35359369 PMCID: PMC8960729 DOI: 10.3389/fonc.2022.840950] [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: 12/21/2021] [Accepted: 02/21/2022] [Indexed: 01/07/2023] Open
Abstract
Background This study determined the predictive value of CRMP4 promoter methylation in prostate tissues collected by core needle biopsies for a postoperative upgrade of Gleason Score (GS) to ≥8 in patients with low-risk PCa. Method A retrospective analysis of the clinical data was conducted from 631 patients diagnosed with low-risk PCa by core needle biopsy at multiple centers and then underwent Radical Prostatectomy (RP) from 2014-2019. Specimens were collected by core needle biopsy to detect CRMP4 promoter methylation. The pathologic factors correlated with the postoperative GS upgrade to ≥8 were analyzed by logistic regression. The cut-off value for CRMP4 promoter methylation in the prostate tissues collected by core needle biopsy was estimated from the ROC curve in patients with a postoperative GS upgrade to ≥8. Result Multivariate logistic regression showed that prostate volume, number of positive cores, and CRMP4 promoter methylation were predictive factors for a GS upgrade to ≥8 (OR: 0.94, 95% CI: 0.91-0.98, P=0.003; OR: 3.16, 95% CI: 1.81-5.53, P<0.001; and OR: 1.43, 95% CI: 1.32-1.55, P<0.001, respectively). The positive predictive rate was 85.2%, the negative predictive rate was 99.3%, and the overall predictive rate was 97.9%. When the CRMP4 promoter methylation rate was >18.00%, the low-risk PCa patients were more likely to escalate to high-risk patients. The predictive sensitivity and specificity were 86.9% and 98.8%, respectively. The area under the ROC curve (AUC) was 0.929 (95% CI: 0.883-0.976; P<0.001). The biochemical recurrence (BCR)-free survival, progression-free survival (PFS), and cancer-specific survival (CSS) were worse in patients with CRMP4 methylation >18.0% and postoperative GS upgrade to ≥8 than in patients without an upgrade (P ≤ 0.002). Conclusion A CRMP4 promoter methylation rate >18.00% in prostate cancer tissues indicated that patients were more likely to escalate from low-to-high risk after undergoing an RP. We recommend determining CRMP4 promoter methylation before RP for low-risk PCa patients.
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Affiliation(s)
- Xiao-Ping Qin
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qi-Ji Lu
- Department of Urology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China
| | - Cheng-Huizi Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jue Wang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian-Fan Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Kan Liu
- Department of Urology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xin Chen
- Department of Pathology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jing Zhou
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Hang Pan
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong-Hong Li
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Shan-Cheng Ren
- Department of Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jiu-Min Liu
- Department of Urology, Guangdong General Hospital, Guangzhou, China
| | - Wei-Peng Liu
- Department of Urology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Hui-Jun Qian
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xian-Lin Yi
- Department of Urology, Cancer Hospital, Guangxi Medical University, Nanning, China
| | - Cai-Yong Lai
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Li-Jun Qu
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xin Gao
- Department of Urology, The Third Affiliated Hospital of Sun Yet-Sen University, Guangzhou, China
| | - Yu-Sheng Xu
- Department of Emergency, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zheng Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yu-Min Zhuo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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The impact of time from biopsy to radical prostatectomy on Gleason score undergrading and other related factors. Actas Urol Esp 2020; 44:187-195. [PMID: 31843220 DOI: 10.1016/j.acuro.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/15/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥50% of cylinders and a DPSA ≥0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU.
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Zhang GMY, Han YQ, Wei JW, Qi YF, Gu DS, Lei J, Yan WG, Xiao Y, Xue HD, Feng F, Sun H, Jin ZY, Tian J. Radiomics Based on MRI as a Biomarker to Guide Therapy by Predicting Upgrading of Prostate Cancer From Biopsy to Radical Prostatectomy. J Magn Reson Imaging 2020; 52:1239-1248. [PMID: 32181985 DOI: 10.1002/jmri.27138] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Biopsy Gleason score (GS) is crucial for prostate cancer (PCa) treatment decision-making. Upgrading in GS from biopsy to radical prostatectomy (RP) puts a proportion of patients at risk of undertreatment. PURPOSE To develop and validate a radiomics model based on multiparametric magnetic resonance imaging (mp-MRI) to predict PCa upgrading. STUDY TYPE Retrospective, radiomics. POPULATION A total of 166 RP-confirmed PCa patients (training cohort, n = 116; validation cohort, n = 50) were included. FIELD STRENGTH/SEQUENCE 3.0T/T2 -weighted (T2 W), apparent diffusion coefficient (ADC), and dynamic contrast enhancement (DCE) sequences. ASSESSMENT PI-RADSv2 score for each tumor was recorded. Radiomic features were extracted from T2 W, ADC, and DCE sequences and Mutual Information Maximization criterion was used to identify the optimal features on each sequence. Multivariate logistic regression analysis was used to develop predictive models and a radiomics nomogram and their performance was evaluated. STATISTICAL TESTS Student's t or chi-square were used to assess the differences in clinicopathologic data between the training and validation cohorts. Receiver operating characteristic (ROC) curve analysis was performed and the area under the curve (AUC) was calculated. RESULTS In PI-RADSv2 assessment, 67 lesions scored 5, 70 lesions scored 4, and 29 lesions scored 3. For each sequence, 4404 features were extracted and the top 20 best features were selected. The radiomics model incorporating signatures from the three sequences achieved better performance than any single sequence (AUC: radiomics model 0.868, T2 W 0.700, ADC 0.759, DCE 0.726). The combined mode incorporating radiomics signature, clinical stage, and time from biopsy to RP outperformed the clinical model and radiomics model (AUC: combined model 0.910, clinical model 0.646, radiomics model 0.868). The nomogram showed good performance (AUC 0.910) and calibration (P-values: training cohort 0.624, validation cohort 0.294). DATA CONCLUSION Radiomics based on mp-MRI has potential to predict upgrading of PCa from biopsy to RP. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 5 J. Magn. Reson. Imaging 2020;52:1239-1248.
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Affiliation(s)
- Gu-Mu-Yang Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yu-Qi Han
- School of Life Science and Technology, Xidian University, Xi'an, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jing-Wei Wei
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Ya-Fei Qi
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dong-Sheng Gu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jing Lei
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei-Gang Yan
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China
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Turan T, Güçlüer B, Efiloğlu Ö, Şendoğan F, Atış RG, Çaşkurlu T, Yıldırım A. The factors predicting upgrading of prostate cancer by using International Society for Urological Pathology (ISUP) 2014 Gleason grading system. Turk J Urol 2019; 45:S36-S41. [PMID: 30485787 PMCID: PMC7595028 DOI: 10.5152/tud.2018.57946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/07/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the factors to predict Gleason score upgrading (GSU) of patients with prostate cancer who were evaluated by using the International Society for Urological Pathology (ISUP) 2014 Gleason grading system. MATERIAL AND METHODS Between January 2008 and December 2015, we retrospectively investigated patients who had undergone radical prostatectomy and followed up in the uro-oncology outpatient clinic. The pathologic specimens of the patients were evaluated based on the ISUP 2014 classification system. The patients were divided into two groups with or without upgraded Gleason scores. Factors that could be effective in predicting upgrading such as age, prostate-specific antigen (PSA), prostate volume, D'Amico risk classification, PSA density, cancer of the prostate risk assessment (CAPRA) scores, biopsy tumor percentage, body mass index, and clinical stage parameters were compared between both groups. RESULTS Of the 265 patients who could be evaluated and followed up regularly, Gleason score upgrades were observed in 110 (41.5%) patients. Advanced age (p=0.009), PSA >20 ng/mL (p=0.036), PSA density >0.35 (p=0.005), high CAPRA score (p=0.031), and high biopsy tumor percentage (p=0.009) were discovered to be correlated with Gleason score upgrade in univariate logistic regression analysis. Advanced age alone was a predictor for GSU in multivariate logistic regression analysis (p=0.002). Five-year biochemical recurrence-free survival rate was 86% in the non-GSU group and 55% in the GSU group (p<0.001). CONCLUSION GSU risk should be taken into consideration in making therapeutic decisions for older patients with prostate cancer, and precautions should be taken against development of aggressive disease.
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Affiliation(s)
- Turgay Turan
- Department of Urology, İstanbul Medeniyet University, İstanbul, Turkey
| | - Berrin Güçlüer
- Department of Pathology, İstanbul Medeniyet University, İstanbul, Turkey
| | - Özgür Efiloğlu
- Department of Urology, İstanbul Medeniyet University, İstanbul, Turkey
| | - Furkan Şendoğan
- Department of Urology, İstanbul Medeniyet University, İstanbul, Turkey
| | | | - Turhan Çaşkurlu
- Department of Urology, İstanbul Medeniyet University, İstanbul, Turkey
| | - Asıf Yıldırım
- Department of Urology, İstanbul Medeniyet University, İstanbul, Turkey
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Kim SJ, Ryu JH, Yang SO, Lee JK, Jung TY, Kim YB. Does the Time Interval from Biopsy to Radical Prostatectomy Affect the Postoperative Oncologic Outcomes in Korean Men? J Korean Med Sci 2019; 34:e234. [PMID: 31559708 PMCID: PMC6763398 DOI: 10.3346/jkms.2019.34.e234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prostate cancer (PC) is the second most common type of cancer in men worldwide and the fifth most common cancer among Korean men. Although most PCs grow slowly, it is unclear whether a longer time interval from diagnosis to treatment causes worse outcomes. This study aimed to investigate whether the time interval from diagnosis to radical prostatectomy (RP) in men with clinically localized PC affects postoperative oncologic outcomes. METHODS We retrospectively analyzed data of 427 men who underwent RP for localized PC between January 2005 and June 2016. The patients were divided into two groups based on the cutoff median time interval (100 days) from biopsy to surgery. The associations between time interval from biopsy to surgery (< 100 vs. ≥ 100 days) and adverse pathologic outcomes such as positive surgical margin, pathologic upgrading, and upstaging were evaluated. Biochemical recurrence (BCR)-free survival rates were analyzed and compared based on the time interval from biopsy to surgery. RESULTS Pathologic upgrading of Gleason score in surgical specimens was more frequent in the longer time interval group and showed marginal significance (38.8% vs. 30.0%; P = 0.057). Based on multivariable analysis, an association was observed between time interval from biopsy to surgery and pathologic upgrading (odds ratio, 2.211; 95% confidence interval [CI], 1.342-3.645; P = 0.002). BCR-free survival did not differ based on time interval from biopsy to surgery, and significant association was not observed between time interval from biopsy to surgery and BCR on multivariable analysis (hazard ratio, 1.285; 95% CI, 0.795-2.077; P = 0.305). CONCLUSION Time interval ≥ 100 days from biopsy to RP in clinically localized PC increased the risk of pathologic upgrading but did not affect long-term BCR-free survival rates in Korean men.
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Affiliation(s)
- Sang Jin Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Jae Hyun Ryu
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung Ok Yang
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Jeong Kee Lee
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Yun Beom Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea.
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Zhao Y, Deng FM, Huang H, Lee P, Lepor H, Rosenkrantz AB, Taneja S, Melamed J, Zhou M. Prostate Cancers Detected by Magnetic Resonance Imaging–Targeted Biopsies Have a Higher Percentage of Gleason Pattern 4 Component and Are Less Likely to Be Upgraded in Radical Prostatectomies. Arch Pathol Lab Med 2018; 143:86-91. [DOI: 10.5858/arpa.2017-0410-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
In Gleason score (GS) 7 prostate cancers, the quantity of Gleason pattern 4 (GP 4) is an important prognostic factor and influences treatment decisions. Magnetic resonance imaging (MRI)–targeted biopsy has been increasingly used in clinical practice.
Objective.—
To investigate whether MRI-targeted biopsy may detect GS 7 prostate cancer with greater GP 4 quantity, and whether it improves biopsy/radical prostatectomy GS concordance.
Design.—
A total of 243 patients with paired standard and MRI-targeted biopsies with cancer in either standard or targeted or both were studied, 65 of whom had subsequent radical prostatectomy. The biopsy findings, including GS and tumor volume, were correlated with the radical prostatectomy findings.
Results.—
More prostate cancers detected by MRI-targeted biopsy were GS 7 or higher. Mean GP 4 percentage in GS 7 cancers was 31.0% ± 29.3% by MRI-targeted biopsy versus 25.1% ± 29.5% by standard biopsy. A total of 122 of 218 (56.0%) and 96 of 217 (44.2%) prostate cancers diagnosed on targeted biopsy and standard biopsy, respectively, had a GP 4 of 10% or greater (P = .01). Gleason upgrading was seen in 12 of 59 cases (20.3%) from MRI-targeted biopsy and in 24 of 57 cases (42.1%) from standard biopsy (P = .01). Gleason upgrading correlated with the biopsy cancer volume inversely and GP 4 of 30% or less in standard biopsy. Such correlation was not found in MRI-targeted biopsy.
Conclusions.—
Magnetic resonance imaging–targeted biopsy may detect more aggressive prostate cancers and reduce the risk of Gleason upgrading in radical prostatectomy. This study supports a potential role for MRI-targeted biopsy in the workup of prostate cancer and inclusion of percentage of GP 4 in prostate biopsy reports.
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Affiliation(s)
- Yani Zhao
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Fang-Ming Deng
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Hongying Huang
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Peng Lee
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Hebert Lepor
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Andrew B. Rosenkrantz
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Samir Taneja
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Jonathan Melamed
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
| | - Ming Zhou
- From the Departments of Pathology (Drs Zhao, Deng, Huang, Lee, Melamed, and Zhou), Urology (Drs Lepor and Taneja), and Radiology (Dr Rosenkrantz), New York University Langone Medical Center, New York, New York; and the Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Zhou)
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8
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Meunier ME, Neuzillet Y, Radulescu C, Cherbonnier C, Hervé JM, Rouanne M, Molinié V, Lebret T. [Does the delay from prostate biopsy to radical prostatectomy influence the risk of biochemical recurrence?]. Prog Urol 2018; 28:475-481. [PMID: 29907495 DOI: 10.1016/j.purol.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 03/19/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The influence of the delay between prostate biopsy and radical prostatectomy for patients with localized prostate cancer is controversial. The objective of this study was to establish a time limit between prostate biopsy and radical prostatectomy beyond which the risks of upgradging and biochemical recurrence (BCR) are increased. MATERIAL AND METHODS Between January 2013 and January 2017, a retrospective analysis of the clinical, biological and histological data of 513 patients treated with radical prostatectomy for localized prostate cancer was performed in a single center. The primary endpoint was the assessment of the risk of BCR by the difference between post-biopsy USCF-CAPRA and post-surgical CAPRA-S scores. The secondary endpoint was the evaluation of the upgrading by the difference between the Gleason score on biopsy and on surgical specimen. The risks of BCR and upgrading were compared by Student test according to different delays between prostate biopsy and radical prostatectomy. The shortest delays for which a significant difference was found were reported. RESULTS In this study, 513 patients were included. The median age at the time of the biopsy was 65 years (IQR: 60-69). The median preoperative PSA was 7.30ng/mL (IQR: 5.60-9.94). The median time between biopsy and surgery was 108 days (IQR: 86-141). For the entire cohort, the risk of BCR was significantly higher above a threshold of 90 days (P=0.039). No threshold was found for Gleason 6(3+3) patients. A 90-day threshold was found for Gleason 7(3+4) patients (P=0.038). Gleason patients≥8 had more upgrading beyond a 60-day threshold (P=0.040). CONCLUSION Our study showed that after a 3 months delay, the risk of BCR was significantly higher for localized prostate cancer. It seemed possible to extend this period for low-risk patients, whereas it seemed necessary to keep it for intermediate-risks and to reduce it to 2 months for high-risks. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M E Meunier
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France
| | - Y Neuzillet
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
| | - C Radulescu
- Service d'anatomopathologie, hôpital Foch, 92151 Suresnes, France
| | - C Cherbonnier
- Service d'anatomopathologie, hôpital Foch, 92151 Suresnes, France
| | - J-M Hervé
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France
| | - M Rouanne
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
| | - V Molinié
- Service d'anatomopathologie, centre hospitalier de Martinique, 93232 Le Lamentin, France
| | - T Lebret
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
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Evans SM, Patabendi Bandarage V, Kronborg C, Earnest A, Millar J, Clouston D. Gleason group concordance between biopsy and radical prostatectomy specimens: A cohort study from Prostate Cancer Outcome Registry - Victoria. Prostate Int 2016; 4:145-151. [PMID: 27995114 PMCID: PMC5153432 DOI: 10.1016/j.prnil.2016.07.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 07/27/2016] [Indexed: 11/26/2022] Open
Abstract
Background A new prostate cancer (PCa) prognostic grading system [Gleason groups (GGs)] has been proposed based on the contemporary Gleason scores (GSs), which has five simplified prognostic categories. The objective of this study was to evaluate the agreement between the GGs of prostate biopsy and radical prostatectomy specimens and to identify predictive factors for upgrading GGs. Methods A total of 5339 cases of RP notified to the Prostate Cancer Outcomes Registry, Victoria, Australia over 6 years (2009–2014) from 46 hospitals, were included. The upgrading was evaluated using the new PCa prognostic grading system, the International Society of Urologic Pathology grade groups, which has five prognostic categories. GG 1 is GS ≤ 6, GG 2 is GS 3 + 4 = 7, GG 3 is GS 4 + 3 = 7, GG 4 is GS 8, and GG 5 is GS 9 and 10. Predictors of upgrading were assessed using univariate and multivariate models. Results The GG of prostate biopsies and RP specimens were concordant in 54.5% of cases, while 31.1% were upgraded and 14.3% were downgraded. Longer time interval between biopsy and RP [44–99 days: odds ratio (OR) = 1.3, 95% confidence interval (CI) = 1.1–1.6; > 99 days: OR = 3.0, 95% CI = 2.4–3.8), and RP performed in a metropolitan hospital (biopsy in a regional hospital: OR = 2.2, 95% CI = 1.6–3.2, biopsy in a metropolitan hospital: OR = 1.7, 95% CI = 1.2–2.2) were significant predictors of GG upgrading. Patients who were diagnosed by transperineal biopsy compared to transrectal ultrasound (OR = 0.6, 95% CI = 0.5–0.8) and higher percentage of positive biopsy cassettes (25–62.5%: OR = 0.7, 95% CI = 0.6–0.8, > 62.5: OR = 0.6, 95% CI = 0.5–0.8) were significantly associated with less likelihood of upgrade. Conclusion The lack of concordance among hospitals may be attributable to the specialist expertise of the pathologist. Expert review of specimens may help to overcome this discordance. Clinicians should consider clinical parameters and potential limitations of the GG at biopsy when making treatment decisions with regard to PCa.
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Affiliation(s)
- Sue M Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Caroline Kronborg
- Department of Medicine, The Alfred Hospital, Alfred Health, Melbourne, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeremy Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Clouston
- Tissupath Pathology Services, Mount Waverley, Melbourne, Australia
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