scholarly journals Evaluating PSA Density as a Predictor of Biochemical Failure after Radical Prostatectomy: Results of a Prospective Study after a Median Follow-Up of 36 Months

ISRN Urology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Stavros Sfoungaristos ◽  
Petros Perimenis
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Predictive Ability ◽  
Tumor Grade ◽  
Biochemical Failure ◽  
Biochemical Relapse ◽  
Psa Density ◽  
Localized Disease ◽  
A Prospective Study

Purpose. To evaluate the predictive ability of PSA density for biochemical relapse after radical prostatectomy in patients operated for clinically localized disease and to compare its predictive strength with preoperative PSA and Gleason score. Patients and Methods. The study evaluated 244 patients with localized disease who underwent an open retropubic radical prostatectomy between February 2007 and April 2011. PSA was measured every 3 months after surgery with a mean follow-up period of 36 months. Two consecutive rises >0.2 ng/mL were considered as biochemical relapse. Results. Biochemical recurrence was observed in 71 (29.1%). A great correlation was found between relapse and PSA (), PSA density (), Gleason score (), pathological stage (), positive surgical margins (), and invasion of seminal vesicles () and lymph nodes (). We also found that PSA density was associated with adverse pathological findings. In univariate and multivariate analysis both PSA () and PSA density () were found to be significant predictors for relapse in contrast to tumor grade. Conclusion. PSA density is a valuable parameter in estimating the danger of biochemical failure and it may increase predictive potential through the incorporation in preoperative nomograms.

scholarly journals PSA density is superior than PSA and Gleason score for adverse

2013 ◽  
Vol 6 (1) ◽  
pp. 46 ◽  
Author(s):  
Stavros Sfoungaristos ◽  
Petros Perimenis
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Predictive Ability ◽  
Cancer Prognosis ◽  
Psa Density ◽  
Pathologic Features ◽  
Significant Difference

Introduction: Prostate-specific antigen (PSA) and its kinetics have changed prostate cancer screening and diagnosis. The aim of the present study was to evaluate their value in prostate cancer prognosis by determining the predictive potential of PSA density for adverse pathologic features after radical prostatectomy, in terms of positive surgical margins (PSM), extracapsular disease (ECD), seminal vesicle invasion (SVI) and/or lymph node invasion (LNI), and to compare their predictive ability with preoperative PSA and biopsy Gleason score.Methods: We retrospectively analysed 285 patients diagnosed with prostate cancer and underwent a retropubic radical prostatectomy for clinically localized disease. Data concerning preoperative PSA, biopsy Gleason score and PSA density were collected and analyzed. PSA density was calculated by dividing preoperative PSA and the pathological volume of the prostate.Results: There was a significant difference in PSA density valuesbetween patients with PSM, ECD, SVI and LNI. Areas under thecurve for PSA density were higher than those of PSA and Gleason score for all parameters of adverse pathology. In multivariate analyses, it was shown that PSA density and Gleason score were the only statistically significant predictors for PSM and ECD, PSA density and PSA for SVI and only PSA density for LNI.Conclusion: PSA density is an accurate predictor for adverse pathology prediction in patients undergoing radical prostatectomy. Theseresults demonstrate that this parameter is useful to determine the aggressiveness of prostate cancer and can be used as an adjunct in predicting outcomes after surgery.

Comparison of the Efficacy of Local Therapies for Localized Prostate Cancer in the Prostate-Specific Antigen Era: A Large Single-Institution Experience With Radical Prostatectomy and External-Beam Radiotherapy

2002 ◽  
Vol 20 (16) ◽  
pp. 3376-3385 ◽  
Author(s):  
Patrick A. Kupelian ◽  
Mohamed Elshaikh ◽  
Chandana A. Reddy ◽  
Craig Zippe ◽  
Eric A. Klein
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Treatment Modality ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
Biochemical Failure ◽  
External Beam ◽  
Biochemical Relapse ◽  
Definition Of

PURPOSE: To review biochemical relapse-free survival (bRFS) rates after either external-beam radiotherapy (RT) or radical prostatectomy (RP) for localized prostate cancer. PATIENTS AND METHODS: All 1,682 patients had pretreatment prostate-specific antigen (PSA) levels and biopsy Gleason scores (bGS) assigned. No adjuvant therapy was administered after local treatment. RP was the treatment in 1,054 patients (63%) and RT in 628 patients (37%). Median follow-up was 51 months (range, 1 to 134). The median follow-up for RP versus RT patients was 50.5 v 51.0 months. Biochemical relapse was considered detectable PSA levels (> 0.2 ng/mL) in RP patients and three consecutive rising PSA levels in RT patients. The analysis was repeated with a more stringent definition of biochemical control after either RP or RT—namely, reaching and maintaining a PSA level ≤ 0.5 ng/mL—and excluding patients receiving any androgen deprivation (AD). RESULTS: Eight-year bRFS rates for RP versus RT were 72% and 70%, respectively (P = .010). Multivariate analysis indicated T stage (P < .001), pretreatment PSA (P < .001), bGS (P < .001), year of therapy (P < .001), and neoadjuvant AD (P = .019) to be the only independent predictors of relapse. Age (P = .78), race (P = .29), prior transurethral resection of prostate (P = .81), and treatment modality (P = .96) were not independent predictors of treatment failure. Fifty-one percent of RP patients had favorable tumors (T1 to T2A, pretreatment PSA ≤ 10 ng/mL, bGS ≤ 7), compared with only 34% of RT patients (P < .001). Repeat analysis with a stringent definition of biochemical failure and excluding patients receiving AD indicated no impact of treatment modality on outcome. CONCLUSION: Eight-year biochemical failure rates were identical between RT and RP in any subgroup. Outcome is determined mainly by pretreatment PSA levels, bGS, clinical T stage, and, for RT patients, radiation dose.

scholarly journals Factors Related to Biochemical Relapse in Patients Undergoing Radical Prostatectomy with Lymphadenectomy.

2019 ◽  
Vol 2 (1) ◽  
pp. 01-04
Author(s):  
Grimar de Oliveira Paula ◽  
João Emerson de Alencar Santos ◽  
Luiz Carlos de Araújo Souza
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Clinical Stage ◽  
Surgical Specimen ◽  
Pathological Staging ◽  
Bcr Method ◽  
Transrectal Prostate Biopsy ◽  
Age Range

Objectives - Analyze the prevalence of biochemical recurrence (BCR) in patients submitted to radical prostatectomy with lymphadenectomy (RP-LD) the most prevalent clinical and pathological staging in the BCR and to correlate the sum of the Gleason score (GS) in the surgical specimen in patients who presented BCR. Method - Analysis of 100 patients diagnosed with prostate adenocarcinoma who performed RP-LD between 2013 to 2017. All subjects underwent transrectal prostate biopsy due to PSA or rectal examination and RP-LD. The lymphadenectomy considered in the study was the iliac-obturator, and the surgical pieces were analyzed to determine the pathological staging and its descriptors. All patients who had two or more PSA measurements >0.2 ng/ml and who had undergone RP-LD were considered postoperative. Results -About 22% of the patients submitted to RP-LD presented BCR. Patients with BCR had a 59-76 age range, mean age of 66.27 years, and median age of 63.50 years. The most prevalent preoperative PSA in patients with BCR was between 10-20 ng/ml (40.90%) and the most prevalent clinical stage was cT2 (59.10%). Regarding the Gleason score, the BCR patients had the most prevalent 6 (36.37%) score in the biopsy and score 7 (4 + 3) (36.37%) in the surgical specimen. All patients (100%) with BCR presented perineural invasion, with pT3 staging (81.81%) and pN0 (77.28%) being the most prevalent in patients with BCR. Patients with BCR presented a correlation (p<0.05) between the increase in the sum of pathological GS and the increase in pTN staging. Conclusion - All these variables were important in the determination of BCR in patients submitted to RP-LD, thus demonstrating the importance of this information in the analysis of the prognosis and in the follow-up of these patients.

scholarly journals Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer

2013 ◽  
Vol 7 (1-2) ◽  
pp. 93 ◽  
Author(s):  
Stavros Sfoungaristos ◽  
Petros Perimenis
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Secondary Analysis ◽  
Intraepithelial Neoplasia ◽  
Treatment Modalities ◽  
Psa Density ◽  
Group 2

Introduction: Preoperative Gleason score is crucial, in combination with other preoperative parameters, in selecting the appropriate treatment for patients with clinically localized prostate cancer. The aim of the present study is to determine the clinical and pathological variables that can predict differences in Gleason score between biopsy and radical prostatectomy.Methods: We retrospectively analyzed the medical records of 302 patients who had a radical prostatectomy between January 2005 and September 2010. The association between grade changes and preoperative Gleason score, age, prostate volume, prostate-specific antigen (PSA), PSA density, number of biopsy cores, presence of prostatitis and high-grade prostatic intraepithelial neoplasia was analyzed. We also conducted a secondary analysis of the factors that influence upgrading in patients with preoperative Gleason score ≤6 (group 1) and downgrading in patients with Gleason score ≤7 (group 2).Results: No difference in Gleason score was noted in 44.3% of patients, while a downgrade was noted in 13.7% and upgrade in 42.1%. About 2/3 of patients with a Gleason score of ≤6 upgraded after radical prostatectomy. PSA density (p = 0.008) and prostate volume (p = 0.032) were significantly correlated with upgrade. No significant predictors were found for patients with Gleason score ≤7 who downgraded postoperatively.Conclusion: Smaller prostate volume and higher values of PSA density are predictors for upgrade in patients with biopsy Gleason score ≤6 and this should be considered when deferred treatment modalities are planned.

scholarly journals Natural history of prostate cancer on active surveillance: stratification by MRI using the PRECISE recommendations in a UK cohort

2020 ◽  
Author(s):  
Francesco Giganti ◽  
Armando Stabile ◽  
Vasilis Stavrinides ◽  
Elizabeth Osinibi ◽  
Adam Retter ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Rank Test ◽  
Gleason Grade ◽  
Clinical Progression ◽  
Radiological Progression ◽  
Grade Group ◽  
Psa Density

Abstract Objectives The PRECISE recommendations for magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer (PCa) include repeated measurement of each lesion, and attribution of a PRECISE radiological progression score for the likelihood of clinically significant change over time. We aimed to compare the PRECISE score with clinical progression in patients who are managed using an MRI-led AS protocol. Methods A total of 553 patients on AS for low- and intermediate-risk PCa (up to Gleason score 3 + 4) who had two or more MRI scans performed between December 2005 and January 2020 were included. Overall, 2161 scans were retrospectively re-reported by a dedicated radiologist to give a PI-RADS v2 score for each scan and assess the PRECISE score for each follow-up scan. Clinical progression was defined by histological progression to ≥ Gleason score 4 + 3 (Gleason Grade Group 3) and/or initiation of active treatment. Progression-free survival was assessed using Kaplan-Meier curves and log-rank test was used to assess differences between curves. Results Overall, 165/553 (30%) patients experienced the primary outcome of clinical progression (median follow-up, 74.5 months; interquartile ranges, 53–98). Of all patients, 313/553 (57%) did not show radiological progression on MRI (PRECISE 1–3), of which 296/313 (95%) had also no clinical progression. Of the remaining 240/553 patients (43%) with radiological progression on MRI (PRECISE 4–5), 146/240 (61%) experienced clinical progression (p < 0.0001). Patients with radiological progression on MRI (PRECISE 4-5) showed a trend to an increase in PSA density. Conclusions Patients without radiological progression on MRI (PRECISE 1-3) during AS had a very low likelihood of clinical progression and many could avoid routine re-biopsy. Key Points • Patients without radiological progression on MRI (PRECISE 1–3) during AS had a very low likelihood of clinical progression and many could avoid routine re-biopsy. • Clinical progression was almost always detectable in patients with radiological progression on MRI (PRECISE 4–5) during AS. • Patients with radiological progression on MRI (PRECISE 4–5) during AS showed a trend to an increase in PSA density.

Positive margin length and Gleason grade of tumor focus at the margin predict for biochemical failure after radical prostatectomy in patients with pT2 prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 103-103 ◽  
Author(s):  
Jenny N. Nguyen ◽  
Brian Francis Chapin ◽  
Ina N. Prokhorova ◽  
Xuemei Wang ◽  
John W. Davis ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Multivariable Analysis ◽  
Positive Margin ◽  
Biochemical Failure ◽  
Cancer Center ◽  
Adjuvant Radiation ◽  
Gleason Grade ◽  
Tumor Focus

103 Background: While three prospective trials have demonstrated benefit from adjuvant radiation (XRT) after radical prostatectomy (RP) in patients with positive surgical margins (PSM), its use varies amongst physicians. Many rely on clinical acumen to determine the optimal strategy for application of XRT post RP. We aim to determine if the length of PSM and highest Gleason grade (GG) of tumor at the PSM (hGGPSM) can be used to identify patients at greatest risk of biochemical failure (BCF) post RP. Methods: A retrospective review of all RP patients at The University of Texas MD Anderson Cancer Center from 2002 to 2010 was performed. After a single pathologist review, patients with organ confined disease (pT2), pathologic N0/Nx and a PSM were included. BCF was defined as 2 sequential PSA values of ≥0.2 or any detectable PSA prompting XRT. Patients receiving adjuvant XRT or with <12 months follow-up were excluded. Results: 205 patients met the inclusion criteria. Median PSA was 5.3 ng/mL (0.5-33) and median follow-up was 64 months (13-130). The majority were low clinical stage (cT1c: 65%), low (11%)/intermediate (82%) grade and had a single site of a PSM (90%). BCF occurred in 47 patients for a 5 yr BCF free survival (BCFFS) of 69%. PSM length was significantly associated with BCFFS (≤1mm vs >1, p=0.02). When accounting for hGGPSM, Gl 3 tumors were less likely to experience BF (5 yr BCFFS-96%) regardless of PSM length, while BCFFS for Gl >3 tumors were significantly lower dependent upon length of PSM ( ≤1mm vs >1mm, p=0.03). On multivariable analysis length of PSM (p=0.05) and hGGPSM (p=0.007) remained independent predictors of BCF (Table). Conclusions: Length of PSM and hGGPSM are independent predictors of BCF. These should be considered when evaluating patients for adjuvant XRT and in risk stratifying patients in prospective clinical trials. [Table: see text]

Evaluation of length, maximum Gleason score, and extension of disease at positive surgical margins during radical prostatectomy.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 98-98
Author(s):  
Hooman Djaladat ◽  
Mehrdad Alemozaffar ◽  
Christina Day ◽  
Manju Aron ◽  
Jie Cai ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Cox Regression ◽  
Surgical Margin ◽  
Oncologic Outcomes ◽  
Positive Surgical Margin ◽  
Extracapsular Extension ◽  
Clinical Recurrence ◽  
The Impact

98 Background: Positive surgical margin (PSM) found following radical prostatectomy (RP) is known to affect subsequent recurrence and survival. The extent of PSM has been shown to impact clinical outcomes. We examined the effect of length of PSM, extent of disease at PSM and maximum Gleason score at PSM on oncologic outcomes. Methods: A retrospective review of 3971 patients undergoing RP for prostate cancer at our institution between1978-2009 revealed 1053 patients with PSM, out of whom 814 received no hormone therapy. The initial 175 patients were selected to maximize available follow-up, and their slides were re-reviewed for following parameters: length of PSM (mm), maximum Gleason score at PSM, and maximal extension of PSM (intraprostatic incision vs. extracapsular extension). Data was available in 107 patients who are the subject of this study. Multivariable Cox regression models were used to evaluate the impact of above features as well as age, preoperative PSA, pathologic Gleason score, stage and adjuvant radiotherapy on biochemical and clinical recurrence-free survival (RFS), and overall survival (OS). Results: Median follow-up was 17.6 years. Maximum extension of PSM was limited to intraprostatic incision in 63 (58.9%) and extracapsular in 44(41.1%) patients. Median length of PSM was 4 mm (range 1-55 mm); 41 (38.3%) with <3mm and 66 (61.7%) with >4mm. Maximum Gleason score at PSM was <6 in 70 (66.0%) and >7 in 36 (34%) patients. 10-yr PSA RFS, clinical RFS, and OS were 60.2%, 80.7%, and 60.2%, respectively. Multivariable Cox regression modeling showed the length of PSM >4mm and extracapsular extension as independent predictors of PSA RFS and clinical RFS. Age and extracapsular extension were independent predictors of OS. Conclusions: PSM >4mm and extracapsular extension have a higher risk of PSA and clinical recurrence after RP. These findings can help decision-making regarding adjuvant therapy in patients with PSM and should be reported by pathologists in addition to the presence of PSM. [Table: see text]

Standard versus saturation biopsy before primary focal cryosurgery of the prostate: Does it matter?

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 123-123
Author(s):  
Jamie Sungmin Pak ◽  
Philippa J. Cheetham ◽  
Aaron Katz ◽  
Sven Wenske
Keyword(s):  
Core Biopsy ◽  
Clinical Stage ◽  
Local Therapy ◽  
Tumor Grade ◽  
Biochemical Failure ◽  
Consecutive Series ◽  
Primary Concern ◽  
Saturation Biopsy ◽  
Chi Square Analysis

123 Background: Primary focal cryosurgery (PFC) has emerged as a viable option for local therapy in prostate cancer (PCa), most suitable for patients with clinical stage T1c-T3 disease of any tumor grade in whom potency is not of primary concern and who are not suitable for radical prostatectomy or radiation therapy. Success of 5-year biochemical recurrence (BCR)-free survival, depending on criteria, ranges from 60% to 90% in the literature. We hypothesize that saturation biopsy before PFC leads to lower rates of BCR compared to standard 12-core biopsy. Methods: We compiled a consecutive series of patients who underwent PFC at our institution for localized PCa. Parameters including demographics, PSA levels, and Gleason scores before primary treatment and at time of recurrence were assessed. Biochemical failure was defined by both Phoenix (PD) and Stuttgart (SD) definitions. Chi-square analysis was performed to compare outcomes. Results: One hundred and forty-seven patients underwent PFC at our institution between August 2000 and January 2014. Forty-five patients were excluded due to incomplete follow-up data and/or missing biopsy information. Median follow-up was 40.3 months (0.8-116, IQR 41). Conclusions: Zero of the six patients who underwent a saturation biopsy before PFC experienced biochemical failure or progression. This in contrast to those who underwent a standard 12-core biopsy before PFC, of which 19% experienced biochemical failure by PD and 26% by SD, and 6% underwent progression. This may be due to more informed selection for local therapy and more comprehensive assessment of the extent of tumor for treatment planning. Though these differences were not statistically significant in our study, we believe that our results lay the groundwork for a larger study to assess differences in outcomes after PFC depending on the extent of biopsy before treatment. [Table: see text]

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