scholarly journals Diagnosis of transition zone prostate cancer by multiparametric MRI: added value of MR spectroscopic imaging with sLASER volume selection

2021 ◽  
Vol 28 (1) ◽  
Author(s):  
Neda Gholizadeh ◽  
Peter B. Greer ◽  
John Simpson ◽  
Jonathan Goodwin ◽  
Caixia Fu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Transition Zone ◽  
Sensitivity And Specificity ◽  
Cancer Detection ◽  
Diagnostic Performance ◽  
Spectroscopic Imaging ◽  
Multiparametric Mri ◽  
Low Risk ◽  
Intermediate Risk

Abstract Background Current multiparametric MRI (mp-MRI) in routine clinical practice has poor-to-moderate diagnostic performance for transition zone prostate cancer. The aim of this study was to evaluate the potential diagnostic performance of novel 1H magnetic resonance spectroscopic imaging (MRSI) using a semi-localized adiabatic selective refocusing (sLASER) sequence with gradient offset independent adiabaticity (GOIA) pulses in addition to the routine mp-MRI, including T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and quantitative dynamic contrast enhancement (DCE) for transition zone prostate cancer detection, localization and grading. Methods Forty-one transition zone prostate cancer patients underwent mp-MRI with an external phased-array coil. Normal and cancer regions were delineated by two radiologists and divided into low-risk, intermediate-risk, and high-risk categories based on TRUS guided biopsy results. Support vector machine models were built using different clinically applicable combinations of T2WI, DWI, DCE, and MRSI. The diagnostic performance of each model in cancer detection was evaluated using the area under curve (AUC) of the receiver operating characteristic diagram. Then accuracy, sensitivity and specificity of each model were calculated. Furthermore, the correlation of mp-MRI parameters with low-risk, intermediate-risk and high-risk cancers were calculated using the Spearman correlation coefficient. Results The addition of MRSI to T2WI + DWI and T2WI + DWI + DCE improved the accuracy, sensitivity and specificity for cancer detection. The best performance was achieved with T2WI + DWI + MRSI where the addition of MRSI improved the AUC, accuracy, sensitivity and specificity from 0.86 to 0.99, 0.83 to 0.96, 0.80 to 0.95, and 0.85 to 0.97 respectively. The (choline + spermine + creatine)/citrate ratio of MRSI showed the highest correlation with cancer risk groups (r = 0.64, p < 0.01). Conclusion The inclusion of GOIA-sLASER MRSI into conventional mp-MRI significantly improves the diagnostic accuracy of the detection and aggressiveness assessment of transition zone prostate cancer.

scholarly journals Establishment of an Ultrasound Malignancy Risk Stratification Model for Thyroid Nodules Larger Than 4 cm

2021 ◽  
Vol 11 ◽  
Author(s):  
Xuehua Xi ◽  
Ying Wang ◽  
Luying Gao ◽  
Yuxin Jiang ◽  
Zhiyong Liang ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Low Risk ◽  
Validation Dataset ◽  
Intermediate Risk ◽  
Solid Mass ◽  
Incidence And Mortality ◽  
Risk Stratification Model

BackgroundThe incidence and mortality of thyroid cancer, including thyroid nodules &gt; 4 cm, have been increasing in recent years. The current evaluation methods are based mostly on studies of patients with thyroid nodules &lt; 4 cm. The aim of the current study was to establish a risk stratification model to predict risk of malignancy in thyroid nodules &gt; 4 cm.MethodsA total of 279 thyroid nodules &gt; 4 cm in 267 patients were retrospectively analyzed. Nodules were randomly assigned to a training dataset (n = 140) and a validation dataset (n = 139). Multivariable logistic regression analysis was applied to establish a nomogram. The risk stratification of thyroid nodules &gt; 4 cm was established according to the nomogram. The diagnostic performance of the model was evaluated and compared with the American College Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), Kwak TI-RADS and 2015 ATA guidelines using the area under the receiver operating characteristic curve (AUC).ResultsThe analysis included 279 nodules (267 patients, 50.6 ± 13.2 years): 229 were benign and 50 were malignant. Multivariate regression revealed microcalcification, solid mass, ill-defined border and hypoechogenicity as independent risk factors. Based on the four factors, a risk stratified clinical model was developed for evaluating nodules &gt; 4 cm, which includes three categories: high risk (risk value = 0.8-0.9, with more than 3 factors), intermediate risk (risk value = 0.3-0.7, with 2 factors or microcalcification) and low risk (risk value = 0.1-0.2, with 1 factor except microcalcification). In the validation dataset, the malignancy rate of thyroid nodules &gt; 4 cm that were classified as high risk was 88.9%; as intermediate risk, 35.7%; and as low risk, 6.9%. The new model showed greater AUC than ACR TI-RADS (0.897 vs. 0.855, p = 0.040), but similar sensitivity (61.9% vs. 57.1%, p = 0.480) and specificity (91.5% vs. 93.2%, p = 0.680).ConclusionMicrocalcification, solid mass, ill-defined border and hypoechogenicity on ultrasound may be signs of malignancy in thyroid nodules &gt; 4 cm. A risk stratification model for nodules &gt; 4 cm may show better diagnostic performance than ACR TI-RADS, which may lead to better preoperative decision-making.

scholarly journals Accuracy of high b-value diffusion-weighted MRI for prostate cancer detection: a meta-analysis

2017 ◽  
Vol 59 (1) ◽  
pp. 105-113 ◽  
Author(s):  
Keith Craig Godley ◽  
Tom Joseph Syer ◽  
Andoni Paul Toms ◽  
Toby Oliver Smith ◽  
Glyn Johnson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Cancer Detection ◽  
Diagnostic Performance ◽  
Visual Assessment ◽  
B Value ◽  
B Values ◽  
Prostate Cancer Detection ◽  
High B Value

Background The diagnostic accuracy of diffusion-weighted imaging (DWI) to detect prostate cancer is well-established. DWI provides visual as well as quantitative means of detecting tumor, the apparent diffusion coefficient (ADC). Recently higher b-values have been used to improve DWI’s diagnostic performance. Purpose To determine the diagnostic performance of high b-value DWI at detecting prostate cancer and whether quantifying ADC improves accuracy. Material and Methods A comprehensive literature search of published and unpublished databases was performed. Eligible studies had histopathologically proven prostate cancer, DWI sequences using b-values ≥ 1000 s/mm2, less than ten patients, and data for creating a 2 × 2 table. Study quality was assessed with QUADAS-2 (Quality Assessment of diagnostic Accuracy Studies). Sensitivity and specificity were calculated and tests for statistical heterogeneity and threshold effect performed. Results were plotted on a summary receiver operating characteristic curve (sROC) and the area under the curve (AUC) determined the diagnostic performance of high b-value DWI. Results Ten studies met eligibility criteria with 13 subsets of data available for analysis, including 522 patients. Pooled sensitivity and specificity were 0.59 (95% confidence interval [CI], 0.57–0.61) and 0.92 (95% CI, 0.91–0.92), respectively, and the sROC AUC was 0.92. Subgroup analysis showed a statistically significant ( P = 0.03) improvement in accuracy when using tumor visual assessment rather than ADC. Conclusion High b-value DWI gives good diagnostic performance for prostate cancer detection and visual assessment of tumor diffusion is significantly more accurate than ROI measurements of ADC.

scholarly journals Influence of Biopsy Gleason Score on the Risk of Lymph Node Invasion in Patients With Intermediate-Risk Prostate Cancer Undergoing Radical Prostatectomy

2021 ◽  
Vol 8 ◽  
Author(s):  
Mike Wenzel ◽  
Felix Preisser ◽  
Benedikt Hoeh ◽  
Maria N. Welte ◽  
Clara Humke ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
International Society ◽  
Low Risk ◽  
Intermediate Risk ◽  
Risk Prostate Cancer ◽  
Biopsy Gleason Score

Objective: To analyze the influence of biopsy Gleason score on the risk for lymph node invasion (LNI) during pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy (RP) for intermediate-risk prostate cancer (PCa).Materials and Methods: We retrospectively analyzed 684 patients, who underwent RP between 2014 and June 2020 due to PCa. Univariable and multivariable logistic regression, as well as binary regression tree models were used to assess the risk of positive LNI and evaluate the need of PLND in men with intermediate-risk PCa.Results: Of the 672 eligible patients with RP, 80 (11.9%) men harbored low-risk, 32 (4.8%) intermediate-risk with international society of urologic pathologists grade (ISUP) 1 (IR-ISUP1), 215 (32.0%) intermediate-risk with ISUP 2 (IR-ISUP2), 99 (14.7%) intermediate-risk with ISUP 3 (IR-ISUP3), and 246 (36.6%) high-risk PCa. Proportions of LNI were 0, 3.1, 3.7, 5.1, and 24.0% for low-risk, IR-ISUP1, IR-ISUP 2, IR-ISUP-3, and high-risk PCa, respectively (p &lt; 0.001). In multivariable analyses, after adjustment for patient and surgical characteristics, IR-ISUP1 [hazard ratio (HR) 0.10, p = 0.03], IR-ISUP2 (HR 0.09, p &lt; 0.001), and IR-ISUP3 (HR 0.18, p &lt; 0.001) were independent predictors for lower risk of LNI, compared with men with high-risk PCa disease.Conclusions: The international society of urologic pathologists grade significantly influence the risk of LNI in patients with intermediate- risk PCa. The risk of LNI only exceeds 5% in men with IR-ISUP3 PCa. In consequence, the need for PLND in selected patients with IR-ISUP 1 or IR-ISUP2 PCa should be critically discussed.

Circulating miR-337-3p as a novel biomarker for prostate cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5087-5087
Author(s):  
Manuel Valladares Ayerbes ◽  
Vanessa Medina Villaamil ◽  
Sara Martinez Breijo ◽  
Isabel Santamarina Cainzos ◽  
Guadalupe Aparicio ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Healthy Volunteers ◽  
Roc Curve ◽  
Low Risk ◽  
Study Phase ◽  
Intermediate Risk ◽  
Healthy Controls ◽  
Aberrant Expression ◽  
Blood Samples

5087 Background: Recent studies have demonstrated that the aberrant expression of microRNAs (miRNAs)is related with the development of prostate cancer (PCa). Detection of circulating tumor cells (CTC) may provide diagnostic and prognostic information inPCa. The purpose is identifying circulating miRNAs potentially useful for CTC detection in patients with PCa. Methods: In the first study phase we examined blood levels of 92 miRNAs in 49 patients grouped in pools by risk classification: low-risk 42.8%, intermediate-risk 22.5% and high-risk 34.7% and healthy volunteers (N=10) using SYBR-green-based microARN RT-qPCR arrays (Exiqon). Prostate cancer diagnosis was obtained by transrectalultrasound guided biopsy of 10 cores, PSA and digital rectal examination was done previously. In the second study phase using quantitative real-time polymerase chain reaction (qPCR) by TaqMan Human MicroRNAAssays (Life Technologies), we compared the expression levels of miRNAs in blood samples from 34 patients of low-risk, 31 of intermediate-risk, 18 of high-risk localized disease and 22 healthy volunteers paired by age with cases. Receiver-operator characteristic (ROC) curve was used. Results: Blood samples from patients with low, intermediate, high-risk and healthy controls exhibit distinct circulating miRNA signatures. microRNAsdifferential expressed between risk groups (p<0.01) (low, intermediate and high) and control group: 0microARNs upregulated (MU), 12 MU and 68 MU respectively. Highlight the significantlyoverexpression in the intermediate risk group and maintained at the high-risk of microRNAs: 337-3p[247 PicTar predictions (PTP)], 330-3p (307 PTP) and 218 (551 PTP). Preliminary results of the second study phase showed that the median level of miRNA,337-3p was significantly higher in patients with high-risk than that in healthy controls (p=.001). ROC curve analyses indicated that this blood miRNA may beuseful for discriminating patients with high-risk from healthy controls (AUC=.724). Conclusions: miRNAs in the circulation are relatively stable, very accessible, low invasive and easily testable biomarkers. Our preliminary promisingresults suggest miR-337-3p as novel stable blood-based marker for PCa detection.

Are men with favorable intermediate-risk prostate cancer candidates for active surveillance?

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 82-82
Author(s):  
Ann Caroline Raldow ◽  
Danjie Zhang ◽  
Ming-Hui Chen ◽  
Michelle H. Braccioforte ◽  
Brian Joseph Moran ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Active Surveillance ◽  
Locally Advanced ◽  
Low Risk ◽  
P Value ◽  
High Dose ◽  
Intermediate Risk ◽  
Increased Risk ◽  
Risk Prostate Cancer

82 Background: Active surveillance (AS) is considered appropriate for patients with low-risk prostate cancer (PC) and a life expectancy of at least 10 years. However, with grade migration following the 2005 International Society of Urologic Pathology consensus conference, AS may also be an initial option for men with favorable intermediate-risk PC. We estimated and compared the risk of PC-specific mortality (PCSM) following high dose radiation therapy and androgen deprivation therapy as appropriate amongst men with low, favorable intermediate, unfavorable intermediate, and high-risk PC. Methods: The study consisted of 6,595 consecutively treated men (median age: 68 years) with localized or locally advanced PC at the Chicago PC Center between 1997 and 2013. Fine and Gray competing risks regression analyses (table) were used to assess the risk of PCSM in men with favorable intermediate, unfavorable intermediate or high-risk compared to low-risk PC, adjusting for age at and year of treatment. Results: After median follow-up of 7.76 years, 820 men died: 72 of PC. While men with favorable intermediate-risk did not have significantly increased risk of PCSM as compared to low-risk PC (adjusted hazard ratio (HR) 1.28, 0.63-2.62 95% confidence interval (CI), p-value 0.49), men with high (adjusted HR 9.91, 5.48-17.94 95% CI, p-value <0.0001) or unfavorable intermediate-risk PC (adjusted HR 3.17, 1.60-6.30, p-value 0.001) did. Eight-year point estimates of PCSM were low: 0.68% [0.32-1.31% 95% CI] and 0.44% [0.25-0.75% 95% CI] for men with favorable intermediate and low-risk PC, respectively. Conclusions: Men with low and favorable intermediate-risk PC have similar and low estimates of PCSM during the first decade following standard management. These results provide evidence to support AS as an initial approach for men with favorable intermediate-risk PC. [Table: see text]

Use of multiparametric MRI to alter management pathways: Treatment patterns of prostate cancer in the targeted biopsy era.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 56-56
Author(s):  
Raju Chelluri ◽  
Thomas P Frye ◽  
Arvin George ◽  
Michele Fascelli ◽  
Richard Ho ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Focal Therapy ◽  
Multiparametric Mri ◽  
Treatment Patterns ◽  
Low Risk ◽  
Treatment Modalities ◽  
Treatment Pathways ◽  
Additional Tool ◽  
Treatment Information

56 Background: As the use of multiparametric MRI (mpMRI) to diagnose prostate cancer (PCa) becomes established, better knowledge of treatment patterns is needed to counsel patients. Prior studies have shown 40-55% undergo Radical Prostatectomy (RP), while only 6% prefer Active Surveillance (AS), and that stratification by risk does not greatly alter treatment pathways. We aim to delineate the distribution of PCa treatment modalities in the MRI/US fusion-guided prostate biopsy (FB) era. Methods: A retrospective review was performed of all patients who underwent FB at the NIH from 2010 to present. Demographics, Gleason scores, MRI Suspicion scores and treatment outcomes were recorded. Patients were stratified according to D’Amico Risk Criteria, and outcomes were coded into four categories: AS; RP; Radiation (XRT, Brachytherapy); and Other (Systemic or Focal therapy). Results: 839 men were reviewed. Mean age was 62.6 years old and mean PSA was 9.7 ng/mL. Total cancer detection rate was 70% (n = 589). Of FB positive men, 474 had treatment information available. Overall 225 (47.5%) entered AS, 158 (33.3%) underwent RP, 61 (12.9%) received XRT, and 30 (6.3%) received other intervention. Subgroup analysis by MRI suspicion score (Table) showed 47.4% frequency of RP in the high vs. 30.9% and 19.4% for moderate and low suspicion groups, respectively. Analysis by D’Amico Risk (Table) showed 86% of low risk men chose AS vs. 0% of high risk men. Conversely 9.7% of low, 44.5% of intermediate and 55.7% of high risk men underwent RP. Conclusions: FB was associated with a higher rate of AS choice as a treatment modality for low risk disease. However most patients with clinically significant PCa still chose RP as their treatment. FB is an additional tool that allows the urologist to better counsel patients and provides individualized treatment for PCa. [Table: see text]

Comparison of clinical outcomes with IMRT and proton therapy for prostate cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16555-e16555
Author(s):  
Nancy P. Mendenhall ◽  
William Wong ◽  
Curtis Bryant ◽  
Sujay A. Vora ◽  
Randal H. Henderson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Clinical Outcomes ◽  
Ultrasound Image ◽  
Low Risk ◽  
Intermediate Risk ◽  
Image Guided ◽  
Frequent Use ◽  
Gu Toxicity ◽  
Risk Patients

e16555 Background: The ProtecT trial underscores the importance of treatment in men with prostate cancer and life expectancies > 10 years and the validity of radiation therapy (RT). RT can be given with photons or protons (PT). To address the controversy of which is better, clinical outcomes of photon-based intensity modulated RT (IMRT) and PT cohorts from 2 institutions were directly compared. Methods: Under respective IRB approvals, data from 2 cohorts were analyzed. The first was 301 men treated with ultrasound image guided IMRT from 2000-05 to 75.6 Gy in 42 fractions. The second was 1214 men treated with fiducial image guided PT from 2006-10 to 78 CGE in 39 fractions. Median age and followup were 74 y and 7.2 y for IMRT and 66 y and 5.6 y for PT. Hormone therapy (ADT) was used with IMRT and PT, respectively, in 3% and 7% of low-risk patients, 25% and 9.9% of intermediate-risk, and 91% and 57.8% of high-risk. Comparative endpoints were age-stratified 5-year (5Y) survival (OS), ≥ grade 3 gastrointestinal (GI) and urologic (GU) toxicity, and 5Y freedom from biochemical progression (FFBP). Results: There was a lower prevalence of GI (1.3% vs 0.1%, p = 0.0065) and GU (4.3% vs 0.1%, p < 0.0001) toxicity at last follow-up in the PT group. In the IMRT and PT cohorts, OS rates were 90.8% and 88.7% in men ≥75 (p = 0.4083). In men < 75, OS rates were 91.6% and 97.5% in the IMRT and PT low-risk patients (p = 0.003), 92.1% and 95.5% in the IMRT and PT intermediate-risk (p = 0.0535), and 92.0% and 90.0% (p = 0.4975) in the IMRT and PT high-risk. In the IMRT and PT cohorts, respectively, FFBP rates were 92.2% and 98.9% for low-risk patients (p < 0.0001), 87.3% and 94.5% for intermediate-risk patients(p = 0.0226), and 80.3% and 74.4% for high-risk patients (p = 0.5154). Conclusions: In this retrospective comparison of outcomes in cohorts of men treated with IMRT and PT for prostate cancer, FFBP rates were better with PT for men with low- and intermediate-risk disease and similar in men with high-risk disease despite longer and more frequent use of ADT in the IMRT cohort. This study underscores the difficulty of comparing retrospective series, with differences noted in age, RT dose, and ADT use between cohorts. However, the magnitude of improvement with PT is intriguing and warrants prospective testing.

Prostate cancer–specific mortality after definitive radiation therapy: Who dies of disease?

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 181-181
Author(s):  
M. M. Kim ◽  
K. E. Hoffman ◽  
L. B. Levy ◽  
S. J. Frank ◽  
S. Choi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
High Risk Disease ◽  
Specific Mortality ◽  
Risk Patients ◽  
Cancer Specific Mortality

181 Background: A competing risks analysis was undertaken to identify patient subgroups at greatest risk of dying from prostate cancer (CAP) after treatment with definitive external beam radiation therapy (RT) +/− androgen deprivation therapy (ADT) in the PSA era, and to determine which factors predict for survival from disease. Methods: A total of 2,675 men with localized CAP treated with RT +/− ADT at M. D. Anderson Cancer Center from 1987-2007 were evaluated. Prostate cancer-specific mortality (PCSM) and other cause mortality rates were calculated after stratifying patients according to NCCN risk group, RT dose, use of ADT, and age at treatment. In total, 21% had low-risk, 40% had intermediate-risk, and 39% had high-risk disease. Multivariate analysis (MVA) was performed using Cox regression modeling. Results: Median age was 68.5 years and median follow-up was 6.4 years. For patients with low-risk disease, only 0.2% died of CAP 10 years after treatment. None of the low-risk patients <70 years old who received ≥72 Gy died of CAP. The majority of deaths in the intermediate-risk group were also due to other causes; men ≥70 years old who received <72 Gy had the highest 10-year PCSM (5%). High-risk patients <70 years old who received <72 Gy without ADT had similar 10-year rates of CAP (15.2%) and non-CAP (18.5%) mortality. Men with high-risk disease <70 years old treated with higher doses >72 Gy were twice as likely to die from non-CAP causes (15.9%) than die from CAP (8.6%). In older men ≥70 years old with high risk disease, dose-escalation with ADT reduced 10-year PCSM from 14% to 4%, and most deaths were due to other causes (41% and 20%). On MVA, dose (p=0.002), ADT (p=0.007), PSA (p<0.0001) and Gleason score (p<0.0001) were predictive of PCSM in the high-risk group. Conclusions: Men with low- and intermediate-risk CAP treated with definitive RT are unlikely to die of disease. PCSM is higher in men with high-risk disease but can be reduced with dose escalation and ADT, although patients are still twice as likely to die of other causes. No significant financial relationships to disclose.

scholarly journals Presenting stage and risk group in men dying of prostate cancer

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
S. Parimi ◽  
S. Bondy ◽  
M. Aparicio ◽  
K. Sunderland ◽  
J. Cho ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
British Columbia ◽  
High Risk ◽  
Gleason Score ◽  
Metastatic Disease ◽  
Risk Group ◽  
Specific Antigen ◽  
Population Based ◽  
Low Risk ◽  
Intermediate Risk

Introduction Prostate cancer remains the 3rd leading cause of cancer-related mortality in Canadian men, and yet screening for prostate cancer continues to be controversial because the majority of men diagnosed with prostate cancer do not die of the disease. It also remains uncertain whether treatment of cases that can be treated with curative intent alters the mortality rate. There are very few studies describing the presenting stage, risk groups, and survival after diagnosis for men dying of prostate cancer in the literature. In this study, we explored these characteristics for all men who died of prostate cancer in British Columbia between 2013 and 2015. Methods The population-based BC Cancer databases were used to identify all patients diagnosed between Jan­uary 2013 and December 2015 who died of prostate cancer. Patient, tumour, and treatment characteristics were collected, and the risk grouping for each tumour was determined. The proportion of cases in each risk group at the time of diagnosis was determined. Survival time from diagnosis to death was calculated for all patients and for each risk group using the Kaplan–Meier method. Results A total of 1256 patients died of prostate cancer. Of patients who presented with metastatic disease, 57.2% presented with a Gleason score of 8 or more, compared with only 35.7% of patients who presented with nonmetastatic disease (p < 0.0001). The presenting stage and risk group of those dying of prostate cancer were as follows: 32% met­astatic disease, 3% regional (defined as node-positive), 39% localized high risk, 9% localized intermediate risk, 4% localized low risk, 6% localized not otherwise specified, and 7% unknown. Therefore, 80.3% of those with a known risk group presented with either localized high-risk, regional, or metastatic disease at diagnosis. The median survival times from diagnosis to death were 12 years for localized low-risk, 10 years for localized intermediate-risk, 6.5 years for localized high-risk, 4 years for regional, and 1.7 years for metastatic disease at diagnosis. Conclusions This population-based analysis demonstrates that patients with localized high-risk, regional, or metastatic disease at diagnosis constitute the overwhelming majority of patients who die of prostate cancer in British Columbia. Unless these disease states can reliably be identified at an earlier low- or intermediate-risk localized state in the future, it is unlikely that treatment of localized low- and intermediate-risk cancer will have an impact on sur­vival. Furthermore, patients with de novo metastatic disease had identifiable risk factors of a higher prostate-specific antigen and Gleason score. Further studies are required to confirm these results.

Sign in / Sign up

Export Citation Format

Share Document