Gleason score is superior to pre-treatment PSA in predicting survival from prostate cancer

Introduction: The use of accepted prostate cancer risk stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated risk stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer risk stratification schema to assess the feasibility and need for changes to existing risk stratification systems. Methods: A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and risk stratification in prostate cancer. Search terms included risk stratification, risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing risk stratification schema. Results: The critical review identified three specific clinically relevant potential changes to the most commonly used three-group risk stratification system: (1) the creation of a very-low risk category; (2) the splitting of intermediate-risk into a low- and highintermediate risk groups; and (3) the clarification of the interface between intermediate- and high-risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important risk-stratification factors. Conclusions: Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer risk stratification systems. We propose potential changes to existing systems.

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1958 PRE-TREATMENT PSA LEVEL AND GLEASON SCORE ARE NOT ASSOCIATED WITH CANCER-SPECIFIC ANXIETY PRIOR TO SURGICAL TREATMENT FOR NEWLY DIAGNOSED PROSTATE CANCER

The Journal of Urology ◽

10.1016/j.juro.2010.02.1947 ◽

2010 ◽

Vol 183 (4S) ◽

Author(s):

Alexander Parker ◽

Andrea Tavlarides ◽

Rebecca McNeil ◽

Krisitin Green ◽

Steven Ames ◽

...

Keyword(s):

Prostate Cancer ◽

Surgical Treatment ◽

Gleason Score ◽

Newly Diagnosed ◽

Pre Treatment

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The effects of body mass index on pretreatment characteristics, treatment choice, and response to treatment of intermediate- and high-grade prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.142 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 142-142

Author(s):

Katherine Cox Ansley ◽

Emma Holliday Ramahi ◽

Gregory P. Swanson ◽

Joseph W. Basler ◽

Fei Du

Keyword(s):

Prostate Cancer ◽

Body Mass Index ◽

Body Mass ◽

Gleason Score ◽

Treatment Modality ◽

Primary Treatment ◽

Diabetes Diagnosis ◽

High Grade ◽

Primary Treatment Modality ◽

Pre Treatment

142 Background: The relationship between obesity and prostate cancer outcomes remains unclear. A retrospective cohort study was performed to determine the effect of body mass index (BMI) on patients with intermediate to high-grade prostate cancer. Methods: Our retrospective study cohort included 1077 men from the South Texas Veteran’s Healthcare System Tumor Registry diagnosed with Gleason 7-10 prostate cancer in 1998-2008 and treated with either radical prostatectomy (RP), radiation therapy (RT) or hormone therapy (HT). Mean follow up was 4.6 ± 2.7 years. Patients were stratified into four groups on the basis of their BMI at the time of prostate cancer diagnosis (<25, 25-30, 30-35 or >35). Statistical analysis included Kruskal-wallis test and Pearson’s Chi-square test. Results: There was an inverse relationship between PSA and BMI at diagnosis; however, we found no difference in Gleason score at diagnosis. There was a difference in the primary treatment modality chosen between the BMI groups. Primary treatment modality decision was likely influenced by PSA at diagnosis, among other pre-treatment characteristics. Patients with a BMI >35 were significantly less likely to undergo RP. However, after controlling for age, primary treatment modality, Gleason score, pre-treatment PSA and diabetes diagnosis, there was no difference in overall mortality. Conclusions: Patients with an increasing BMI have a lower PSA at diagnosis, are less likely to receive RP but do not have significantly worse overall survival.

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UP-1.107: A Pre-Treatment Table for the Prediction of Final Histopathology after Radical Prostatectomy in Clinical Unilateral T3a Prostate Cancer Using PSA Density and Biopsy Gleason Score

Urology ◽

10.1016/j.urology.2009.07.554 ◽

2009 ◽

Vol 74 (4) ◽

pp. S203

Author(s):

S. Joniau ◽

C. Hsu ◽

R. Oyen ◽

T. Roskams ◽

H. Van Poppel

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Psa Density ◽

Pre Treatment ◽

Biopsy Gleason Score ◽

Treatment Table

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Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and gleason score in men with clinically localized prostate cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(94)90138-4 ◽

1994 ◽

Vol 28 (1) ◽

pp. 33-37 ◽

Cited By ~ 310

Author(s):

Mack Roach ◽

Carol Marquez ◽

Hae-Sook Yuo ◽

Perinchery Narayan ◽

Lorie Coleman ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Prostate Specific Antigen ◽

Gleason Score ◽

Specific Antigen ◽

Lymph Node Involvement ◽

Localized Prostate Cancer ◽

Node Involvement ◽

Pre Treatment

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Pre-treatment Prostate Cancer Volume and Biopsy Gleason Score Predicts Prostate Gland and Transition Zone Shrinkage following Neoadjuvant Cytoreductive Therapy

Brachytherapy ◽

10.1016/j.brachy.2010.02.189 ◽

2010 ◽

Vol 9 ◽

pp. S100

Author(s):

Nathan Bittner ◽

Gregory S. Merrick ◽

Wayne M. Butler ◽

Robert W. Galbreath ◽

Richard Anderson ◽

...

Keyword(s):

Prostate Cancer ◽

Transition Zone ◽

Gleason Score ◽

Prostate Gland ◽

Pre Treatment ◽

Biopsy Gleason Score

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1020 Using pre-treatment PSA and gleason score to predict for extra capsular extension among patients with clinically staged organ confined prostate cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(95)97845-r ◽

1995 ◽

Vol 32 ◽

pp. 232-233 ◽

Cited By ~ 2

Author(s):

Anita Chen ◽

Mack Roach ◽

Aidnag Diaz ◽

Carol Marquez ◽

Dan Chinn ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Pre Treatment

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Computer extracted shape features of prostate capsule from MRI to predict biochemical recurrence of prostate cancer post-treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16579 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16579-e16579

Author(s):

Soumya Ghose ◽

Rakesh Shiradkar ◽

Mirabela Rusu ◽

Jhimli Mitra ◽

Rajat Thawani ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Biochemical Recurrence ◽

Tumor Stage ◽

Post Treatment ◽

Shape Features ◽

Experienced Radiologist ◽

Pre Treatment ◽

Validation Set ◽

Prostate Capsule

e16579 Background: Pre-treatment identification of biochemical recurrence (BCR) from MRI may enable the use of aggressive neo-adjuvant therapies for prostate cancer patients to improve prognosis. BCR is often associated with aggressive cancer growth and/or extra prostatic extension resulting in an irregular bulge and focal capsular retraction. This may induce differences in the shape of the prostate capsule between BCR positive (BCR+) and BCR negative (BCR-) patients as observed on MRI. In this work, we show that computer extracted shape features of the prostate capsule on MRI can identify patients that are at a risk of BCR post-treatment Methods: In a single centre IRB approved study, from a registry of 874 patients, availability of complete image datasets (T1w, T2w and ADC map); no treatment for PCa before MRI; presence of clinically localised PCa; availability of Gleason score; and data available for post-treatment PSA and follow-up for at least 3 years in patients without BCR were used as inclusion criteria to select 80 patients. The prostate capsule was manually segmented on T2w MRI by an experienced radiologist. Two atlases A+ and A- were created for BCR+ and BCR- patients respectively with similar Gleason score (6 to 9), similar numbers in each cohort (25 each) and similar tumor stage (T2 to T3). A t-test based analysis corrected for multiple comparison revealed statistically significant prostate shape differences between A+ and A- in surface of interest (SOI). Curvature features (magnitude and surface normal orientations) were extracted from SOI of the two cohorts. A random forest classifier was trained using the 50 training images (from A+ and A-) and validated using a hold-out validation set of 30 patients. Results: The inter-quartile range, variance, skewness and kurtosis of curvature magnitude and normal orientations were found to be predictive of BCR. The RF classifier trained using these features could predict BCR with an accuracy of 78% and an AUC of 0.71 in the validation set. Conclusions: Curvature magnitude and orientation features of the prostate capsule from the SOI may be predictive of BCR. In future a multi centre independent datasets will be used to validate the findings.

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