OLDER AGE AND TIME TO LAST BIOPSY ARE ASSOCIATED WITH RISE IN GLEASON SCORE FOR MEN ON ACTIVE SURVEILLANCE FOR LOW RISK PROSTATE CANCER

2008 ◽  
Vol 179 (4S) ◽  
pp. 154-154 ◽  
Author(s):  
Marc A Dall'Era ◽  
Badrinath R Konety ◽  
Maxwell V Meng ◽  
Katsuto Shinohara ◽  
Nannette Perez ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Older Age ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Multidisciplinary care and pursuit of active surveillance in low-risk prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 131-131
Author(s):  
Ayal Aizer ◽  
Jonathan J. Paly ◽  
Anthony L. Zietman ◽  
Anthony Victor D'Amico ◽  
Paul Linh Nguyen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Social Status ◽  
Active Surveillance ◽  
Older Age ◽  
Low Risk ◽  
Factors Associated ◽  
Multidisciplinary Clinic ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

131 Background: Factors associated with pursuit of active surveillance in men with low-risk prostate cancer are not well-delineated. Methods: 701 patients with low-risk prostate cancer (clinical stage < T2b, Gleason score < 7, and PSA < 10 ng/mL), treated in 2009 at three tertiary care centers affiliated with the same medical school and within the same health care system were identified. All patients were evaluated by one or more urological, radiation, and/or medical oncologists specializing in genitourinary malignancies, either sequentially at independent appointments with differing dates/locations, or concurrently at a multidisciplinary genitourinary oncology clinic in which all three specialists evaluated the patient jointly during a single visit. Pre-treatment and treatment-related variables were recorded. Logistic regression was performed to identify demographic and clinical factors associated with the employment of active surveillance. Results: Forty three percent of patients referred to a multidisciplinary clinic underwent active surveillance, as opposed to 22% of patients seen by individual practitioners (p<.001). On multivariate logistic regression, older age (OR 1.09 (per year), p <.001), increased comorbidities (OR 1.41 (per unit increase in Charlson score), p=.01), unmarried social status (OR 1.76, p=.04), a smaller percentage of positive cores (OR 0.92 (per percent core increase), p<.001), and referral to a multidisciplinary clinic (OR 2.22, p<.01) were all significantly associated with pursuit of active surveillance. The number of physicians or specialities seen in consultation was not significantly associated with pursuit of active surveillance. Conclusions: Older age, increased comorbidities, unmarried social status, and a smaller percentage of positive cores are associated with pursuit of active surveillance. Notably, referral to a multidisciplinary genitourinary oncology clinic significantly increases rates of active surveillance in men with low-risk prostate cancer, implying that the multidisciplinary clinic itself, and not merely the number or type of physicians seen, is important to the shared decision making process for a patient to elect active surveillance.

Multiparametric prostate MRI and MRI/ultrasound fusion biopsy as tools to follow prostate cancer progression for men on active surveillance.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 63-63 ◽  
Author(s):  
Nabeel Shakir ◽  
Annerleim Walton-Diaz ◽  
Soroush Rais-Bahrami ◽  
Baris Turkbey ◽  
Jason Rothwax ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Cancer Progression ◽  
Predictive Value ◽  
Low Risk ◽  
Fusion Biopsy ◽  
Trus Biopsy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

63 Background: Active surveillance (AS) is an option for patients with low risk prostate cancer (PCa); however, determining disease progression is challenging. At the NCI, multiparametric MRI (MP-MRI) with our biopsy protocol (MR-US fusion-guided plus 12 core extended sextant biopsy) has been used to confirm eligibility for AS. We evaluated the utility of these modalities in monitoring patients on AS. Methods: Patients who underwent MP-MRI of the prostate with biopsy per our protocol between 2007-2012 were reviewed. We selected a subset who met Johns Hopkins criteria for AS (Gleason score≤6, PSA density≤0.15, tumor involvement of ≤2 cores, and ≤50% of any single core) by outside 12−core TRUS biopsy. Patients with Gleason score≤6 confirmed at first NCI biopsy session were followed with annual MP-MRI and biopsy. MRI progression was defined as an increase in MP-MRI suspicion level, lesion diameter, or number of lesions. Pathologic progression was defined as an increase to Gleason score≥7 in either 12-core or MR-fusion biopsy. We determined the association between MRI and pathologic progression. Results: 129 patients met JHU criteria for AS by outside biopsy. Mean age was 61.6 years and mean PSA 5.16ng/mL. 28/129 (21.7%) patients had Gleason score ≥7 at first NCI biopsy session.31 patients had at least two biopsy sessions (mean follow up 18 months, range 12-54 months) of which 9/31 (29%) increased in Gleason score, all to 3+4=7. Fusion biopsy detected more pathologic progression than did standard biopsy (Table). The positive predictive value of MP-MRI for pathologic progression was 50%, while the negative predictive value was 84%. The sensitivity and specificity of MP-MRI for increase in Gleason score was 67% and 73%, respectively. Conclusions: Stable findings on MP-MRI are associated with Gleason score stability in patients with low-risk PCa choosing AS. The majority of patients who had pathologic progression were detected on fusion biopsy, which may suggest that random biopsies are unnecessary in this population. Larger studies are needed to validate these findings. [Table: see text]

scholarly journals Role of neutrophil-to-lymphocyte ratio in prediction of Gleason score upgrading and disease upstaging in low-risk prostate cancer patients eligible for active surveillance

2016 ◽  
Vol 10 (11-12) ◽  
pp. 383 ◽  
Author(s):  
Mehmet Ilker Gokce ◽  
Semih Tangal ◽  
Nurullah Hamidi ◽  
Evren Suer ◽  
Muhammed Arif Ibis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Cost Effective ◽  
Low Risk ◽  
Neutrophil To Lymphocyte Ratio ◽  
Recurrence Rates ◽  
Lymphocyte Ratio ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Introduction: Active surveillance (AS) is an option for management of low-risk prostate cancer (PCa). However, grade and stage progression is an important consideration. Neutrophil-to-lymphocyte ratio (NLR) is a useful marker of cancer-related inflammation. In this study, we aimed to identify the roles of neutrophil count (NC), lymphocyte count (LC), and NLR to predict Gleason score (GS) upgrading, disease upstaging, and biochemical recurrence rates (BCR) in low-risk PCa patients.Methods: We retrospectively evaluated data of 210 low-risk PCa patients eligible for AS, but who underwent radical prostatectomy. The roles of NC, LC, and NLR on the GS upgrading, disease upstaging, and BCR rates were investigated. Univariate and multivariate models were used to determine the effect of these parameters. Results: There were 104 and 106 patients in the NLR <2.5 and NLR ≥2.5 groups, respectively. GS upgrading in the NLR ≥2.5 group was more common than in the NLR<2.5 group (p=0.04). The NLR ≥2.5 group had significantly higher GS (8‒10; p=0.03). With regard to NLR, the groups were found to have similar rates of disease upstaging (9/104 in NLR <2.5 vs. 16/106 in NLR ≥2.5; p=0.200). BCR rates were also significantly different between groups (p=0.033). NC an LC were not found to be associated with GS upgrading, disease upstaging, or BCR.Conclusions: NLR is a predictor of GS upgrading and BCR, but not disease upstaging in patients with low-risk PCa. Furthermore, higher NLR was found to be associated with higher GS PCa. NLR is a cost-effective and easily accessible tool that can be used in the decision-making process for treatment of low-risk PCa cases.

scholarly journals Assessment of PSIM (Prostatic Systemic Inflammatory Markers) Score in Predicting Pathologic Features at Robotic Radical Prostatectomy in Patients with Low-Risk Prostate Cancer Who Met the Inclusion Criteria for Active Surveillance

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 355
Author(s):  
Matteo Ferro ◽  
Gennaro Musi ◽  
Deliu Victor Matei ◽  
Alessandro Francesco Mistretta ◽  
Stefano Luzzago ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Active Surveillance ◽  
Inflammatory Markers ◽  
Low Risk ◽  
Inclusion Criteria ◽  
Robotic Radical Prostatectomy ◽  
Lymphocyte Ratio ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Background: circulating levels of lymphocytes, platelets and neutrophils have been identified as factors related to unfavorable clinical outcome for many solid tumors. The aim of this cohort study is to evaluate and validate the use of the Prostatic Systemic Inflammatory Markers (PSIM) score in predicting and improving the detection of clinically significant prostate cancer (csPCa) in men undergoing robotic radical prostatectomy for low-risk prostate cancer who met the inclusion criteria for active surveillance. Methods: we reviewed the medical records of 260 patients who fulfilled the inclusion criteria for active surveillance. We performed a head-to-head comparison between the histological findings of specimens after radical prostatectomy (RP) and prostate biopsies. The PSIM score was calculated on the basis of positivity according to cutoffs (neutrophil-to-lymphocyte ratio (NLR) 2.0, platelets-to-lymphocyte ratio (PLR) 118 and monocyte-to-lymphocyte-ratio (MLR) 5.0), with 1 point assigned for each value exceeding the specified threshold and then summed, yielding a final score ranging from 0 to 3. Results: median NLR was 2.07, median PLR was 114.83, median MLR was 3.69. Conclusion: we found a significantly increase in the rate of pathological International Society of Urological Pathology (ISUP) ≥ 2 with the increase of PSIM. At the multivariate logistic regression analysis adjusted for age, prostate specific antigen (PSA), PSA density, prostate volume and PSIM, the latter was found the sole independent prognostic variable influencing probability of adverse pathology.

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