Validation of a genomic-clinical classifier model for predicting clinical recurrence of patients with localized prostate cancer in a high-risk population.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 175-175 ◽  
Author(s):  
Robert B. Jenkins ◽  
Eric J Bergstralh ◽  
Elai Davicioni ◽  
R. Jeffrey Karnes ◽  
Karla V. Ballman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Risk Group ◽  
High Risk Group ◽  
High Risk Population ◽  
Clinical Recurrence ◽  
Clinical Variables ◽  
Subset Analysis

175 Background: The efficient delivery of adjuvant and salvage therapy after radical prostatectomy in patients with prostate cancer is hampered by a lack of biomarkers to assess the risk of clinically significant recurrence and progression. Methods: Mayo Clinic Radical Prostatectomy Registry (RP) patient specimens were selected from a case-control cohort with 14 years median follow-up for training and initial validation of an expression biomarker genomic classifier (GC). An independent, blinded case-cohort study of high-risk RP subjects was used to validate GC, comparing the performance of GC to a multivariate logistic regression clinical model (CM) and GC combined with clinical variables (genomic-clinical classifier, GCC) for predicting clinical recurrence (defined as positive bone or CT scan within 5 years after biochemical recurrence). The concordance index (c-index) and Cox model were used to evaluate discrimination and estimate the risk of clinical recurrence. Results: In the training subset (n=359), both GC and GCC had a c-index of 0.90 whereas CM had a c-index of 0.76. In the internal validation set (n=186), GC and GCC had a c-index of 0.76 and 0.75, while CM had a c-index of 0.69. In an independent high-risk study (n=219), GC and GCC had a c-index of 0.77 and 0.76, while CM had a c-index of 0.68. In subset analysis of Gleason score 7 patients within the high-risk group, GC and GCC showed improved discrimination with c-index of 0.78 and 0.76, respectively compared to 0.70 for CM. In the high-risk group, the risk of recurrence by GC model score quartiles at 5 years after RP was estimated at 1%, 5%, 5% and 18%. Conclusions: The GC model shows improved performance over CM in the prediction of clinical recurrence in a high-risk cohort and in subset analysis of Gleason score 7 patients. The addition of clinical variables to the GC model did not significantly contribute to classifier performance in patients with high-risk features. We are further testing the performance of the GC and GCC models and their usefulness in guiding decision-making (e.g., for the adjuvant therapy setting) in additional studies of prostate cancer clinical risk groups.

scholarly journals Radical prostatectomy as radical cure of prostate cancer in a high-risk group: A single-institution experience

2012 ◽  
Vol 1 (2) ◽  
pp. 337-342 ◽  
Author(s):  
NOBUKI FURUBAYASHI ◽  
MOTONOBU NAKAMURA ◽  
KEN HISHIKAWA ◽  
ATSUSHI FUKUDA ◽  
TAKASHI MATSUMOTO ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Risk Group ◽  
High Risk Group ◽  
Radical Cure ◽  
Single Institution ◽  
Group A

scholarly journals Minimum Variance Algorithm-Based Correlation Analysis between Body Mass Index and the Malignant Degree of Prostate Cancer Mediated under Ultrasound Images

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yong Wei ◽  
Hongru Zhu ◽  
Peng Chen ◽  
Wenren Zuo ◽  
Wenhui Qian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Body Mass Index ◽  
High Risk ◽  
Body Mass ◽  
Gleason Score ◽  
Risk Group ◽  
Minimum Variance ◽  
High Risk Group ◽  
Ultrasound Images ◽  
Group A

This study was to explore the correlation between the malignant degree of prostate cancer (PCa) and body mass index (BMI) mediated by ultrasound images under multioperator algorithm (MOA) based on minimum variance (MV) algorithm. MOA was established by optimizing the smoothing technique and diagonal loading algorithms of MV, and its quality and processing speed of ultrasound images were compared with other algorithms. Ninety two patients were selected as the subjects investigated, who had transrectal prostate biopsy mediated by ultrasound to be diagnosed as PCa in the hospital. Based on Gleason score and prostate specific antigen (PSA) value, all patients were divided into a high-risk PCa group (a high-risk group) and a non-high-risk PCa group (a non-high-risk group). The proportion of obese patients in the two groups was compared. The logistic regression analysis method was applied to analyze related factors of PCa development, and Pearson correlation was for analyzing the correlation between Gleason score and BMI of patients. The results showed that the number of patients in the high-risk group was greater than that of the non-high-risk group ( P  < 0.05), while the proportion of nonobese patients in the non-high-risk group was markedly higher than that of the higher-risk group ( P  < 0.01). Both PSA and BMI were obviously correlated with the development of high-risk PCa ( P  < 0.05), and there was an extreme positive correlation between BMI and Gleason score (r = 0.661 and P  = 0.007). It indicated that MOA was established based on conventional MV, which could increase the ultrasonic image quality and calculation speed. Besides, BMI was a risk factor of high-risk PCa and was positively correlated with malignant degree of PCa, which provided a referable evidence for clinical evaluation of malignant degree of PCa.

Use of the Prostate Health Index for the Detection of Aggressive Prostate Cancer at Radical Prostatectomy

2015 ◽  
Vol 95 (4) ◽  
pp. 390-399 ◽  
Author(s):  
Luigi Mearini ◽  
Elisabetta Nunzi ◽  
Carla Ferri ◽  
Guido Bellezza ◽  
Carolina Lolli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Health Index ◽  
Final Pathology ◽  
High Risk Disease ◽  
Prostate Health Index ◽  
Prostate Health

Introduction: In current study, we compared the accuracy of the PSA isoform p2PSA and its derivatives, the percentage of p2PSA to free PSA (%p2PSA) and the Prostate Health Index (PHI) in the detection of prostate cancer (PC) characteristics at the final pathology with respect to reference standards. Materials and Methods: This was an observational prospective study evaluating 43 consecutive PC patients treated with laparoscopic/robotic radical prostatectomy (RP). Logistic regression models were fitted to test the predictors of pT3 stage, pathologic Gleason score ≥8 or Gleason score upgrading, margin status, lymph node invasion, and the presence of high-risk disease (pT3 disease and/or Gleason score ≥8 and/or positive lymph node). The comparative base model included tPSA, clinical stage, biopsy Gleason score, and percentage of positive core. Results: Seventeen patients (39.5%) were affected by pT3 disease or had a pathologic Gleason score ≥8; positive margins were detected in 12 patients (27.9%), lymph node invasion was found in 2 patients (4.7%), and 15 patients (34.8%) harbored high-risk disease. In the univariate analysis, p2PSA, %p2PSA, and PHI were significant predictors of pT3 disease, pathologic Gleason score, and the presence of high-risk disease (all p < 0.05), whereas only PHI was an independent predictor of pT3 disease, margin status, and presence of high-risk disease, increasing the accuracy of a base multivariable model by 6.3% (p < 0.05) and 4.2% (p < 0.05) for the prediction of pT3 and high-risk disease, respectively. Conclusions: p2PSA and its derivatives, primarily PHI, were significant predictors of unfavorable PC characteristics as detected at the final pathology, thus improving the clinical performance of standard prognostic factors for aggressive disease.

scholarly journals A model for predicting carotid instability plaque in high risk group of stroke individuals

2019 ◽  
Author(s):  
Junxiong Yin ◽  
Chuanyong Yu ◽  
Hongxing Liu ◽  
Mingyang Du ◽  
Feng Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Predictive Model ◽  
Doppler Ultrasound ◽  
Scoring System ◽  
Risk Group ◽  
High Risk Group ◽  
High Risk Population ◽  
Auc Value ◽  
Validation Set

Abstract Objective: To establish a predictive model of carotid vulnerable plaque through systematic screening of high-risk population for stroke.Patients and methods: All community residents who participated in the screening of stroke high-risk population by the China National Stroke Screening and Prevention Project (CNSSPP). A total of 19 risk factors were analyzed. Individuals were randomly divided into Derivation Set group and Validation Set group. According to carotid ultrasonography, the derivation set group patients were divided into instability plaque group and non-instability plaque group. Univariate and multivariable logistic regression were taken for risk factors. A predictive model scoring system were established by the coefficient. The AUC value of both derivation and validation set group were used to verify the effectiveness of the model.Results: A total of 2841 high-risk stroke patients were enrolled in this study, 266 (9.4%) patients were found instability plaque. According to the results of Doppler ultrasound, Derivation Set group were divided into instability plaque group (174 cases) and non-instability plaque group (1720 cases). The independent risk factors for carotid instability plaque were: male (OR 1.966, 95%CI 1.406-2.749)，older age (50-59, OR 6.012, 95%CI 1.410-25.629; 60-69, OR 13.915, 95%CI 3.381-57.267;≥70, OR 31.267, 95%CI 7.472-130.83) , married(OR 1.780, 95%CI 1.186-2.672)，LDL-c(OR 2.015, 95%CI 1.443-2.814), and HDL-C(OR 2.130, 95%CI 1.360-3.338). A predictive scoring system was created, range 0-10. The cut-off value of prediction model score is 6.5. The AUC value of derivation and validation set group were 0.738 and 0.737.Conclusion：For a high risk group of stroke individual, We provide a model that could distinguishing those who have a high probability of having carotid instability plaque. When resident’s predictive model score exceeds 6.5, the incidence of carotid instability plaque is high, carotid artery Doppler ultrasound would be checked immediately. This model can be helpful in the primary prevention of stroke.

Molecular Load of Pathologically Occult Metastases in Pelvic Lymph Nodes Is an Independent Prognostic Marker of Biochemical Failure After Localized Prostate Cancer Treatment

2006 ◽  
Vol 24 (19) ◽  
pp. 3081-3088 ◽  
Author(s):  
Anna C. Ferrari ◽  
Nelson N. Stone ◽  
Ralf Kurek ◽  
Elizabeth Mulligan ◽  
Roy McGregor ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Lymph Nodes ◽  
Prognostic Marker ◽  
Risk Group ◽  
High Risk Group ◽  
Biochemical Failure ◽  
Localized Prostate Cancer ◽  
Pelvic Lymph Nodes ◽  
Independent Prognostic Marker

Purpose Thirty percent of patients treated with curative intent for localized prostate cancer (PC) experience biochemical recurrence (BCR) with rising serum prostate-specific antigen (sPSA), and of these, approximately 50% succumb to progressive disease. More discriminatory staging procedures are needed to identify occult micrometastases that spawn BCR. Patients and Methods PSA mRNA copies in pathologically normal pelvic lymph nodes (N0-PLN) from 341 localized PC patients were quantified by real-time reverse-transcriptase polymerase chain reaction. Based on comparisons with normal lymph nodes and PLN with metastases and on normalization to 5 × 106 glyceraldehyde-3′-phosphate dehydrogenase mRNA copies, normalized PSA copies (PSA-N) and a threshold of PSA-N 100 or more were selected for continuous and categorical multivariate analyses of biochemical failure-free survival (BFFS) compared with established risk factors. Results At median follow-up of 4 years, the BFFS of patients with PSA-N 100 or more versus PSA-N less than 100 was 55% and 77% (P = .0002), respectively. The effect was greatest for sPSA greater than 20 ng/mL, 25% versus 60% (P = .014), Gleason score 8 or higher, 21% versus 66% (P = .0002), stage T3c, 18% versus 64% (P = .001), and high-risk group (50% v 72%; P = .05). By continuous analysis PSA-N was an independent prognostic marker for BCR (P = .049) with a hazard ratio of 1.25 (95% CI, 1.001 to 1.57). By categorical analysis, PSA-N 100 or more was an independent variable (P = .021) with a relative risk of 1.98 (95% CI, 1.11 to 3.55) for BCR compared with PSA-N less than 100. Conclusion PSA-N 100 or more is a new, independent molecular staging criterion for localized PC that identifies high-risk group patients with clinically relevant occult micrometastases in N0-PLN, who may benefit from additional therapy to prevent BCR.

Actual total hospital costs of primary localized prostate cancer treatments analyzed by risk group.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15164-e15164
Author(s):  
Hugh J. Lavery ◽  
Adam W. Levinson ◽  
Adrien Phalen ◽  
Nelson Stone ◽  
Richard Stock ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Risk Group ◽  
Hospital Costs ◽  
Localized Prostate Cancer ◽  
Total Hospital ◽  
Total Cost ◽  
Primary Procedure ◽  
Risk Patients

e15164 Background: Radical prostatectomy (RP) and radiotherapy (RT) provide comparable HRQOL and oncologic outcomes of localized prostate cancer (PCa), yet no studies have evaluated their relative costs when investigated by risk group. We evaluated hospital costs associated with modern PCa therapies at a multidisciplinary program. Methods: Institutional billing data was queried for hospital patients from 2005 to 2009 with a primary admission for prostate cancer and primary procedure codes for RP, brachytherapy (BT), intensity modulated RT (IMRT) or combination treatment. All hospital costs related to the primary procedure were analyzed as assigned by the hospital. Costs were adjusted to 2009 USD and analyzed per patient and pretreatment D’Amico risk group. Results: 1969 localized PCa patients with a median age of 62 were identified with complete clinical information. There was a marked increase in the use of robotic-assisted laparoscopic prostatectomy (RALP) starting in 2007. The median total hospital costs for IMRT monotherapy ($16,673), BT+IMRT ($22,145) and RP+ adjuvant IMRT ($24,380) combination therapies were significantly higher than any other treatment type, although these patients had worse pathologic features. BT was the least expensive treatment with a total cost of $7,506, but was not routinely used as monotherapy for high-risk patients. The total cost of RALP ($7,676) was lower than open radical prostatectomy (RRP) ($8,991, p<0.001) and similar to laparoscopic radical prostatectomy (LRP) ($7,769).These trendsremained consistent when stratified by risk group (Table). Conclusions: In a high volume setting, RALP and BT are the least expensive modalities for treating low and intermediate risk PCa. For high risk patients, all forms of RP and IMRT alone were less expensive than combination therapy. [Table: see text]

Patterns of referral for adjuvant radiotherapy after radical prostatectomy in men with prostate cancer: A population-based analysis.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 140-140
Author(s):  
Harvey Quon ◽  
Derek Suderman ◽  
Kimi Guilbert ◽  
Pascal Lambert
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Odds Ratio ◽  
Adjuvant Radiotherapy ◽  
Randomized Trials ◽  
Radiation Oncologist ◽  
Before And After ◽  
Margin Positive

140 Background: Randomized trials have shown improved biochemical disease free survival after adjuvant radiotherapy (ART) in patients with pT3 or margin positive disease after radical prostatectomy for prostate cancer. This study examines the rates of referral to a radiation oncologist for patients with high risk pathologic features after prostatectomy. Also, the impact of the presentation of these randomized trials will be examined. Methods: All men diagnosed in the province of Manitoba with prostate adenocarcinoma between 2003 and 2008 who underwent radical prostatectomy were identified through a central cancer registry database. Manual chart review was performed and detailed demographic and clinico-pathologic data were analyzed to determine their influence on referral to a radiation oncologist within 6 months of surgery. Analysis of referral rates before and after the presentation of 2 randomized trials were also examined. Results: A total of 1080 patient records of men undergoing prostatectomy for prostate cancer were reviewed. Of these, 546 (50.6%) men had at least one high risk pathologic feature. This includes pT2 margin positive disease in 298/546 (54.6%), pT3a in 154/546 (28.2%), and pT3b in 94/546 (17.2%). Multivariable logistic regression was performed adjusting for age, distance from cancer centre, Gleason score, T stage, perineural invasion, and margin status. Gleason score 8-10 (p<0.0001), higher pathologic T stage (p<0.0001), and farther distance (p=0.0028) were associated with referral for ART. Age and margin status were not significantly associated. Men with pT3a (odds ratio 3.35) and pT3b disease (odds ratio 5.32) were more likely to be referred than pT2 margin positive disease (p<0.0001). There were 78/546 (14.3%) patients with a high risk factor who were referred for ART within 6 months of surgery. The rates of referral were not significantly different before and after the presentation of randomized trials (p=0.60). Conclusions: Men with higher pathologic stage (pT3) and grade (Gleason 8-10) are more likely to receive ART. However, referral for ART did not increase significantly after presentation of the randomized trials and remains underutilized.

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