Prostate cancer

2017 ◽  
Author(s):  
Matthew Cooperberg ◽  
Peter Carroll
Keyword(s):  
Prostate Cancer ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Mortality Rates ◽  
Low Risk ◽  
Gleason Grade ◽  
Aggressive Treatment ◽  
Careful Monitoring ◽  
Biopsy Tissue

Management of prostate cancer remains controversial, in large part because of its wide heterogeneity in terms of aggressiveness and prognosis. Early detection efforts based on prostate specific antigen (PSA) and aggressive treatment of high-risk cancers have yielded major improvements in mortality rates, but overtreatment of low-risk cancers—those unlikely to cause symptoms or threaten life if they were never detected—is associated with high rates of avoidable toxicity and cost. Prostate cancer can be effectively risk-stratified based on tools (e.g. nomograms, CAPRA score) integrating the PSA level, Gleason grade, clinical stage, and extent of biopsy tissue involvement. Most men with low-risk tumours are eligible for active surveillance, a programme of careful monitoring based on PSA and follow-up biopsies. Men with higher-risk cancers are best served with radical prostatectomy or radiation therapy.

Prostate brachytherapy implant quality on biochemical control.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 128-128
Author(s):  
Don Muller ◽  
Paul Monsour
Keyword(s):  
Prostate Cancer ◽  
Clinical Stage ◽  
Biochemical Failure ◽  
Low Risk ◽  
Prostate Brachytherapy ◽  
Gleason Grade ◽  
Intermediate Risk ◽  
Biochemical Control ◽  
Dosimetric Analysis

128 Background: prostate brachytherapy at our institution was analyzed for implant quality on biochemical control. Methods: We treated 368 patients with clinically localized prostate cancer. All patients underwent 1 month CT based dosimetric analysis. Follow up data was available on 289 patients with a minimum follow up of 5 years. Gleason score was 6 in 80% (n=233), and 7 in 20% (n=56). Clinical stage was T1c in 90% of cases (n=260), T2a was 8% (n=23), T2b was <1% (n=3), T2c was < 1% (n=2). The initial prostate-specific antigen was < 10 ng/ml in 95% (n=274), 10.1-20 ng/ml in 5% (15).Patients with low risk disease ( clinical stage T1c, Gleason score 6 with a PSA < 10 ng/ml) n=228. Patients with intermediate risk disease Gleason 7 adenocarcinoma or with a PSA> 10 ng/ml < 20 ng/ml )n= 61. All patients were treated with I (125). All patients underwent a 1-month CT-based dosimetric analysis. The implant dose was defined as the dose delivered to 90% of the prostate volume on post implant dosimetry (D(90)). Results: At minimum follow up of 5 years overall freedom from biochemical failure was 91.4%. For Gleason grade 6 freedom from biochemical failure was 95%. For Gleason grade 7 freedom from biochemical failure was 77%. Based on PSA freedom from biochemical failure for PSA <10 ng/ml at diagnosis was 92 % and for PSA >10 ng/ml and <20 ng/ml was 80%. In patients with low risk disease ( clinical stage T1c, Gleason 6 adenocarcinoma with a PSA < 10ng/ml) the freedom from biochemical failure was 94%. In patients with intermediate risk disease (Gleason 7 adenocarcinoma or with a PSA >10 ng/ml <20 ng/ml ) freedom from biochemical failure was 84%. Patients with optimal dose implants n=264 freedom from biochemical failure was 95%. Patients with suboptimal dose implants n=25 freedom from biochemical failure was 52% Conclusions: With a minimum follow up of 5 years our data support the use of implant alone in low risk prostate cancer patients with a freedom from biochemical failure of 94%. Our data also shows the importance of implant quality in achieving optimal out comes.

scholarly journals Changes in Prostate Cancer Grade on Serial Biopsy in Men Undergoing Active Surveillance

2011 ◽  
Vol 29 (20) ◽  
pp. 2795-2800 ◽  
Author(s):  
Sima P. Porten ◽  
Jared M. Whitson ◽  
Janet E. Cowan ◽  
Matthew R. Cooperberg ◽  
Katsuto Shinohara ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Sampling Error ◽  
Survival Rates ◽  
Specific Antigen ◽  
Extended Period ◽  
Low Risk ◽  
Gleason Grade

Purpose Active surveillance is now considered a viable treatment option for men with low-risk prostate cancer. However, little is known regarding changes in Gleason grade on serial biopsies over an extended period of time. Patients and Methods Men diagnosed with prostate cancer between 1998 and 2009 who elected active surveillance as initial treatment, with 6 or more months of follow-up and a minimum of six cores at biopsy, were included in analysis. Upgrading and downgrading were defined as an increase or decrease in primary or secondary Gleason score. Means and frequency tables were used to describe patient characteristics, and treatment-free survival rates were determined by life-table product limit estimates. Results Three hundred seventy-seven men met inclusion criteria. Mean age at diagnosis was 61.9 years. Fifty-three percent of men had prostate-specific antigen of 6 ng/mL or less, and 94% had Gleason score of 6 or less. A majority of men were cT1 (62%), had less than 33% of biopsy cores involved (80%), and were low risk (77%) at diagnosis. Median number of cores taken at diagnostic biopsy was 13, mean time to follow-up was 18.5 months, and 29% of men had three or more repeat biopsies. Overall, 34% (129 men) were found to have an increase in Gleason grade. The majority of men who experienced an upgrade (81%) did so by their second repeat biopsy. Conclusion A proportion of men experience an upgrade in Gleason score while undergoing active surveillance. Men who experience early upgrading likely represent initial sampling error, whereas later upgrading may reflect tumor dedifferentiation.

Postoperative Nomogram for Disease Recurrence After Radical Prostatectomy for Prostate Cancer

1999 ◽  
Vol 17 (5) ◽  
pp. 1499-1499 ◽  
Author(s):  
Michael W. Kattan ◽  
Thomas M. Wheeler ◽  
Peter T. Scardino
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Disease Recurrence ◽  
Gleason Grade ◽  
Antigen Level ◽  
Serum Prostate Specific Antigen

PURPOSE: Although models exist that place patients into discrete groups at various risks for disease recurrence after surgery for prostate cancer, we know of no published work that combines pathologic factors to predict an individual's probability of disease recurrence. Because clinical stage and biopsy Gleason grade only approximate pathologic stage and Gleason grade in the prostatectomy specimen, prediction of prognosis should be more accurate when postoperative information is added to preoperative variables. Therefore, we developed a postoperative nomogram that allows more accurate prediction of probability for disease recurrence for patients who have received radical prostatectomy as treatment for prostate cancer, compared with the preoperative nomogram we previously published. PATIENTS AND METHODS: By Cox proportional hazards regression analysis, we modeled the clinical and pathologic data and disease follow-up for 996 men with clinical stage T1a-T3c NXM0 prostate cancer who were treated with radical prostatectomy by a single surgeon at our institution. Prognostic variables included pretreatment serum prostate-specific antigen level, specimen Gleason sum, prostatic capsular invasion, surgical margin status, seminal vesicle invasion, and lymph node status. Treatment failure was recorded when there was either clinical evidence of disease recurrence, a rising serum prostate-specific antigen level (two measurements of 0.4 ng/mL or greater and rising), or initiation of adjuvant therapy. Validation was performed on this set of men and a separate sample of 322 men from five other surgeons' practices from our institution. RESULTS: Cancer recurrence was noted in 189 of the 996 men, and the recurrence-free group had a median follow-up period of 37 months (range, 1 to 168 months). The 7-year recurrence-free probability for the cohort was 73% (95% confidence interval, 68% to 76%). The predictions from the nomogram appeared to be accurate and discriminating, with a validation sample area under the receiver operating characteristic curve (ie, a comparison of the predicted probability with the actual outcome) of 0.89. CONCLUSION: A postoperative nomogram has been developed that can be used to predict the 7-year probability of disease recurrence among men treated with radical prostatectomy.

Active Surveillance Program for Prostate Cancer: An Update of the Johns Hopkins Experience

2011 ◽  
Vol 29 (16) ◽  
pp. 2185-2190 ◽  
Author(s):  
Jeffrey J. Tosoian ◽  
Bruce J. Trock ◽  
Patricia Landis ◽  
Zhaoyong Feng ◽  
Jonathan I. Epstein ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Surveillance Program ◽  
Program Outcomes ◽  
Curative Intent

Purpose We assessed outcomes of men with prostate cancer enrolled in active surveillance. Patients and Methods Since 1995, a total of 769 men diagnosed with prostate cancer have been followed prospectively (median follow-up, 2.7 years; range, 0.01 to 15.0 years) on active surveillance. Enrollment criteria were for very-low-risk cancers, defined by clinical stage (T1c), prostate-specific antigen density < 0.15 ng/mL, and prostate biopsy findings (Gleason score ≤ 6, two or fewer cores with cancer, and ≤ 50% cancer involvement of any core). Curative intervention was recommended on disease reclassification on the basis of biopsy criteria. The primary outcome was survival free of intervention, and secondary outcomes were rates of disease reclassification and exit from the program. Outcomes were compared between men who did and did not meet very-low-risk criteria. Results The median survival free of intervention was 6.5 years (range, 0.0 to 15.0 years) after diagnosis, and the proportions of men remaining free of intervention after 2, 5, and 10 years of follow-up were 81%, 59%, and 41%, respectively. Overall, 255 men (33.2%) underwent intervention at a median of 2.2 years (range, 0.6 to 10.2 years) after diagnosis; 188 men (73.7%) underwent intervention on the basis of disease reclassification on biopsy. The proportions of men who underwent curative intervention (P = .026) or had biopsy reclassification (P < .001) were significantly lower in men who met enrollment criteria than in those who did not. There were no prostate cancer deaths. Conclusion For carefully selected men, active surveillance with curative intent appears to be a safe alternative to immediate intervention. Limiting surveillance to very-low-risk patients may reduce the frequency of adverse outcomes.

scholarly journals Neuroendocrine differentiation in prostate cancer

2004 ◽  
Vol 61 (5) ◽  
pp. 513-518 ◽  
Author(s):  
Snezana Cerovic ◽  
Goran Brajuskovic ◽  
Vinka Maletic-Vukotic ◽  
Sava Micic
Keyword(s):  
Prostate Cancer ◽  
Clinical Stage ◽  
Prognostic Significance ◽  
Specific Antigen ◽  
Neuron Specific Enolase ◽  
Neuroendocrine Differentiation ◽  
Current Evidence ◽  
Gleason Grade ◽  
Preoperative Serum ◽  
Significant Expression

Background. In numerous recent studies attention has been focused to neuroendocrine differentiation (NED) in prostate cancer (PC). Focal NED is present in almost all PCs, but it is prominent in only 5-10% of the carcinomas. The prognostic significance of focal NED in PC is controversial, but current evidence suggests its influence on the onset and/or conversion of hormon resistant tumor phenotype. The aim of this study was to evaluate the relationship between NED status, based only on immunohistochemical use of neuroendocrine (NE) markers, with PC grade and stage, and preoperative serum levels of prostate-specific antigen (PSA). Methods. The study included the biopsy material of 73 untreated PC patients (pts.) obtained by transurethral resection (TUR) (37 pts.), and radical retropubic prostatectomy (RRP) (36 pts.). Two representative tissue samples (tipically the block containing the largest amount of neoplasm) were selected for immunohistochemical (IMM) staining. NE cells were identified using a panel of IMM markers: chromogranin A, neuron-specific enolase, and serotonin. The level of PC exocrine differentiation was detected by monoclonal antibodies against PSA. Results. Significant expression of NE cells was demonstrated in 26 (70.2%) pts. with PC after TUR. In this group, serum preoperative PSA values ranged from 0.1 to 9.6 ng/ml. The majority of pts. with NED had low differentiated PC with Gleason grade score (GGS) >7, and normal PSA values below 4 ng/ml (77%), in clinical stage D (54%). Statistically significant correlation (p<0.01) of positive NED with higher stage and grade and low PSA values was established. Among the pts. with localized PC in whom RRP was performed (n=36), significant expression of NE cells was found in 15 pts. (41.7%), 8 (53.3%) in pT2 stage, and 7 (46.7%) in pT3 stage. Significant correlation between NED with preoperative PSA values and stage of PC in pts. with RRP was not found. Conclusion. We demonstrated the significant NED in poorly differentiated PC in patients in the advanced stage of the disease. The expression of NED in organ-confined PC did not correlate with tumor stage, but it correlated with tumor grade (GGS?7).

Role of Bilateral Pelvic Lymphadenectomy in Prostatic Cancer

1997 ◽  
Vol 64 (3) ◽  
pp. 348-350
Author(s):  
A. Fandella ◽  
L. Maccatrozzo ◽  
F. Merlo ◽  
L. Faggiano ◽  
P. Cecchin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Elevated Serum ◽  
Lymph Node Involvement ◽  
Radical Retropubic Prostatectomy ◽  
Low Risk ◽  
Retropubic Prostatectomy ◽  
Node Involvement

Objectives: to identify a group of patients with prostate cancer for whom open staging pelvic lymph node dissection (PLND) could be superfluous. Methods: the medical records of all patients presenting with prostate cancer from January 1992 to December 1996 were reviewed. A total of 118 patients with clinically localized disease were selected to undergo radical retropubic prostatectomy (RRP) preceded by open PLND. Final nodal status was correlated with the value of the preoperative serum prostate specific antigen (PSA) concentration, clinical stage (TNM), and grading (by OMS) to evaluate the predictivity of nodal involvement. We identified 3 groups: PSA <10 ng/ml, T1–2, G1-2, = 1st very low risk, PSA 10 −15, T1-2 - G1-2 = 2nd low risk, PSA <15 T3 or G3 or PSA >15 every T and G = 3rd high risk. Results: overall, only 21 patients (18%) had lymph node metastases. Lymph node involvement was significantly correlated with elevated serum PSA values, high grading, and advanced clinical stage. 35 patients belonged to the first 2 groups, presenting with low PSA and favorable clinical stage and grade, none with lymph node involvement. These patients could have avoided PLND with a very low risk of missing something. Conclusions: open staging PLND may no longer be justified on a routine basis in patients undergoing radical retropubic prostatectomy.

Hypofractionated radiation therapy in low-risk prostate cancer: Outcome, toxicity, and sexual function.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16575-e16575
Author(s):  
Luca Marinelli ◽  
Chiara Reverberi ◽  
Mattia Falchetto Osti ◽  
Vitaliana De Sanctis ◽  
Manuela Giuliani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sexual Function ◽  
Clinical Stage ◽  
Low Risk ◽  
Long Term Results ◽  
Chi Square ◽  
Gu Toxicity ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

e16575 Background: To evaluate efficacy, toxicity of image-guided hypofractionated radiotherapy (HFRT) in patients with low-risk prostate cancer. Methods: Eighty-five low-risk prostate cancer patients (Gleason score ≤6, clinical stage T1/T2a-b N0 M0, and PSA ≤10 ng/mL) were treated with HFRT from March 2007 to November 2015. All patients were staged with multi-parametric contrast-enhanced MRI. Clinical target volume (CTV) encompassed prostate with proximal seminal vescicles. Margin from CTV to PTV was 5 mm in all directions. Patients received a total dose of 60 Gy in 20 fractions with 3D-CRT. Daily cone beam CT (IGRT) was executed. RTOG/EORTC morbidity Scoring Scale was used for evaluate toxicities. Results: Median follow-up was 54 months (range 11-116 months). The actuarial 8-years Overall Survival was 97.1%. Eight-years Cancer Specific Survival was 100%, 8-years Biochemical Relapse Free Survival was 98.8%, no patients presented clinical local recurrence. Median of PSA at diagnosis was 3.27 ng/mL (range 1.69-9.98 ng/mL) and at the last follow-up was 0.39 ng/mL (range 0.01-2.26 ng/mL). Acute grade 1-2 gastrointestinal (GI) toxicity occurred in 13 patients (15.3%), grade 1-2 genitourinary (GU) toxicity in 33 cases (38.8%). Grade 3 GU toxicity occurred in 2 patients (2.4%). Grade 1-2 GI and GU late toxicities were observed in 4 (4.7 %) and 25 (29.4 %) patients, respectively. Sexual functionality was qualitatively evaluated, scoring 0 for absence, 1 for presence of erection but insufficient for intercourse, 2 for a sufficient one. Before RT, 4.7 % had score 0, 47.1% had score 1 and 48.2% had score 2. After RT, 34.1% of patients presented score 0, 51.8% score 1 and 14.1% score 2 (Chi-square p = 0,004). After treatment, patients with < 70 years presented score 0 in 4.7% of patients, score 1 in 20% and score 2 in 8.2%. Those with > 70 years, 29.4% presented score 0, 31.8% score 1 and 5.9% score 2 (Chi square p = 0.011). Conclusions: Long-term results of our study demonstrated that HFRT in low-risk prostate cancer is efficacy and well tolerated. HFRT significantly worsened sexual function, even if patients with age < 70 years had a higher probability to maintain any form of sexual function after therapy.

scholarly journals Correlation of serum prostate specific antigen with clinical, radiological and pathological variables in patients with prostate enlargement

2019 ◽  
Vol 6 (12) ◽  
pp. 4408
Author(s):  
Tinku Antony ◽  
Raghav Talwar ◽  
Tina Thomas ◽  
Vikram Trehan ◽  
Shrikant Manwantkar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Threshold Level ◽  
Gleason Grade ◽  
Chi Square ◽  
Abdominal Ultrasonography ◽  
Prostate Enlargement

Background: Prostate enlargement encompasses a spectrum of disorders ranging from benign to malignant. For diagnostic prostatic biopsies no clear prostate specific antigen (PSA) threshold level exists. The study correlates PSA with various clinical data (age of patient, international prostate severity score (IPSS), digital rectal examination (DRE) finding), radiological data (prostate volume) and pathological data (Gleason grade, prostate cancer stage) to aid decision making on treatment of prostate enlargement.Methods: 101 men aged more than 50 years with fresh LUTS and grade 1 or more prostate enlargement on DRE were enrolled. They were worked up with transabdominal ultrasonography, serum PSA and prostate biopsy (when indicated). A descriptive statistical analysis was done for correlation by applying Pearson’s Chi square test for significance.Results: Mean serum PSA value was found to increase with age and higher IPSS score. Mean serum PSA levels were found to rise with grade of prostatomegaly. No significant correlation was seen between serum PSA values and Gleason grade or clinical stage of prostate cancer.Conclusions: Serum PSA levels has a significant correlation with age. With increasing age there is increase in serum PSA levels. Serum PSA levels has a significant correlation with International prostate symptom severity scoring. Serum PSA levels has a significant correlation with prostate size measured by trans-abdominal ultrasonography. Serum PSA levels does not show significant correlation with Gleason score or clinical stage of prostate cancer.

Adjuvant docetaxel chemotherapy with abbreviated hormonal therapy in patients with high-risk prostate cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15589-15589
Author(s):  
N. Colocci ◽  
C. R. King ◽  
J. D. Brooks ◽  
H. S. Gill ◽  
J. C. Presti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Pilot Trial ◽  
Gleason Grade ◽  
Study Results ◽  
Lhrh Analog

15589 Background: We conducted a pilot adjuvant docetaxel and abbreviated androgen deprivation study (ADT) in patients with high-risk localized prostate cancer. Study objectives were to evaluate toxicity, feasibility of 6 months of ADT and 3 months of docetaxel treatment, and incidence of serum PSA relapse at 2 years compared to historical controls. Methods: Eligible patients had radical prostatectomy or radiation therapy for high-risk disease (pathologic node positive disease, capsule involvement, extra-capsular extension, seminal vesicle involvement, positive surgical margins, Gleason score = 8, clinical stage T2c or T3, serum PSA >20, or pre-op PSA > 15 plus any high-risk feature). Patients were treated with taxotere 35 mg/m2 weekly 3 out of every 4 weeks for 3 months, and an LHRH analog for 6 months concurrently. In this high-risk cohort, we estimated the risk of PSA recurrence to be as high as 65% in 2 years. To detect a reduction in recurrence rates after surgery or radiation by 40% at a power of 80% and a 2-sided alpha of 0.05, a total of 21 patients were needed in this pilot Phase II study. Results: Twentyone patients were enrolled between 9/04–9/05. The median age was 59.5 years (48–72). Ten patients had a radical prostatectomy and 11 had radiation therapy. All patients received 6 months of LHRH analog therapy. Median pre- treatment PSA was 9.5 ng/ml (4–120). Mean Gleason grade was 8 (7–9); 65% of the patients had >50% biopsies positive. Treatment was well tolerated. Acute toxicity included 1 grade IV hyperglycemia. There was 1 dose reduction and 1 treatment delay. One patient had grade III elevation in serum AST which was transient. Grade I/II toxicities were common and included fatigue, diarrhea, insomnia, and pedal edema. Median follow up is 20 months. Five patients have relapsed. One (of 11) patients treated with radiation has relapsed with metastatic bone disease at 9 months. Four (of 10) patients who underwent prostatectomy have had a serologic relapse at 14, 14, 17 and 21 months, respectively. Conclusions: These data suggest that adjuvant weekly taxotere with abbreviated course of ADT is feasible and well tolerated. In this pilot trial, at a median follow up of 20 months, 23% of patients have relapsed. Longer follow up is required and is ongoing. No significant financial relationships to disclose.

Sign in / Sign up

Export Citation Format

Share Document