Can Gleason 7 prostate cancer ever be low-risk? Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 57-57
Author(s):  
Kathleen F. McGinley ◽  
Xizi Sun ◽  
Lauren E. Howard ◽  
William J. Aronson ◽  
Martha K. Terris ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Low Risk ◽  
Pathological Features ◽  
Inclusion Criteria ◽  
Logistic Regression Models ◽  
Risk Criteria ◽  
Increased Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Low Volume

57 Background: Overtreatment of low-risk prostate cancer (PC) is a major issue. Increasing use of active surveillance (AS) will ease this burden. Limited data are available on including men with intermediate risk PC (i.e. Gleason 7) into AS protocols. We examined if a subset of men with Gleason 7 (3+4) PC could be reasonable AS candidates. Methods: We used SEARCH to identify men who had radical prostatectomy from 2001-13 with >8 cores on biopsy and complete data. We compared men who fulfilled low-risk disease criteria (cT1c/T2a; biopsy Gleason ≤6; PSA ≤10 ng/mL) with the exception of biopsy Gleason 7 (3+4) vs. men who met all 3 low-risk criteria. Logistic regression models were used to test the association between biopsy Gleason 3+4 vs. ≤6 and pathological features. Biochemical recurrence (BCR) was examined using multivariable Cox hazards analysis adjusted for clinical and demographic features. To examine if there was a subset of men with low-volume Gleason 7 who would have comparable outcomes to low-risk men, we repeated all analyses limiting the percent positive cores to ≤ 33% and positive cores to ≤ 4, ≤ 3, or ≤ 2. Results: 885 men met inclusion criteria: 505 had low-risk PC and 380 had Gleason 7 low-risk PC. Overall, the Gleason 7 low-risk men had increased risk of pathological Gleason ≥4+3 (p<0.001), positive margins (p=0.069), extracapsular extension (p<0.001), and seminal vesicle invasion (p<0.001) on univariable analysis. Men in the Gleason 7 low-risk group had significantly higher BCR risk (HR 1.65, p=0.004). Analyses were repeated using increasingly strict definitions of low-volume PC. With the exception of higher pathological Gleason score (p<0.001), at ≤3 positive cores, there was no difference in adverse pathological features between groups (all p>0.1). Among men with ≤3 positive cores who met the other low-risk criteria (cT1c/T2a; PSA ≤10 ng/mL), BCR risk was similar in men with Gleason 6 or Gleason 7 (3+4) (HR 1.30; p=0.347) PC. Conclusions: Among men with PSA≤10 ng/mL and stage cT1c/T2a, those with Gleason 7 (3+4) PC in ≤3 positive cores have similar rates of adverse pathology and BCR as men with Gleason ≤6 PC. This finding may expand inclusion criteria of AS protocols to reduce PC overtreatment.

scholarly journals Assessment of PSIM (Prostatic Systemic Inflammatory Markers) Score in Predicting Pathologic Features at Robotic Radical Prostatectomy in Patients with Low-Risk Prostate Cancer Who Met the Inclusion Criteria for Active Surveillance

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 355
Author(s):  
Matteo Ferro ◽  
Gennaro Musi ◽  
Deliu Victor Matei ◽  
Alessandro Francesco Mistretta ◽  
Stefano Luzzago ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Active Surveillance ◽  
Inflammatory Markers ◽  
Low Risk ◽  
Inclusion Criteria ◽  
Robotic Radical Prostatectomy ◽  
Lymphocyte Ratio ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Background: circulating levels of lymphocytes, platelets and neutrophils have been identified as factors related to unfavorable clinical outcome for many solid tumors. The aim of this cohort study is to evaluate and validate the use of the Prostatic Systemic Inflammatory Markers (PSIM) score in predicting and improving the detection of clinically significant prostate cancer (csPCa) in men undergoing robotic radical prostatectomy for low-risk prostate cancer who met the inclusion criteria for active surveillance. Methods: we reviewed the medical records of 260 patients who fulfilled the inclusion criteria for active surveillance. We performed a head-to-head comparison between the histological findings of specimens after radical prostatectomy (RP) and prostate biopsies. The PSIM score was calculated on the basis of positivity according to cutoffs (neutrophil-to-lymphocyte ratio (NLR) 2.0, platelets-to-lymphocyte ratio (PLR) 118 and monocyte-to-lymphocyte-ratio (MLR) 5.0), with 1 point assigned for each value exceeding the specified threshold and then summed, yielding a final score ranging from 0 to 3. Results: median NLR was 2.07, median PLR was 114.83, median MLR was 3.69. Conclusion: we found a significantly increase in the rate of pathological International Society of Urological Pathology (ISUP) ≥ 2 with the increase of PSIM. At the multivariate logistic regression analysis adjusted for age, prostate specific antigen (PSA), PSA density, prostate volume and PSIM, the latter was found the sole independent prognostic variable influencing probability of adverse pathology.

CURRENTLY USED CRITERIA FOR ACTIVE SURVEILLANCE IN MEN WITH LOW RISK PROSTATE CANCER. AN ANALYSIS OF PATHOLOGICAL FEATURES

2008 ◽  
Vol 179 (4S) ◽  
pp. 152-152
Author(s):  
Nazareno Suardi ◽  
Felix KH Chun ◽  
Claudio Jeldres ◽  
Alexander Haese ◽  
Alberto Briganti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Low Risk ◽  
Pathological Features ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Outcomes of serial MRI/ultrasound fusion targeted biopsy in men with very low-risk and low-risk prostate cancer managed with active surveillance.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 114-114
Author(s):  
Walter Hsiang ◽  
Kamyar Ghabili ◽  
Jamil Syed ◽  
Kevin Nguyen ◽  
Alfredo Suarez-Sarmiento ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Active Surveillance ◽  
Low Risk ◽  
Fusion Biopsy ◽  
Logistic Regression Models ◽  
Psa Density ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Systematic Biopsy

114 Background: The utility of serial magnetic resonance imaging (MRI)/ultrasound (US) fusion targeted prostate biopsy in men with prostate cancer (PCa) on active surveillance (AS) have not been clearly defined. We sought to investigate the rate of Gleason upgrading both on sequential fusion targeted and systematic biopsies among men with low-risk PCa managed with AS. Methods: We retrospectively queried an institutional database of 800 patients undergoing MRI/US fusion biopsy to identify 209 patients on AS with at least two fusion biopsies between December 2013 and November 2016. Men with National Comprehensive Cancer Network (NCCN) very low-risk and low-risk criteria were included. Gleason upgrade was defined as detection of Gleason score >=3+4. The proportion of patients experiencing upgrade on systematic, fusion, or both biopsy techniques was tabulated. Associations of clinical, pathologic, and imaging factors with biopsy upgrade were analyzed by logistic regression. Results: Of 209 patients undergoing MRI/US fusion biopsy, 73 (35.0%) had at least two targeted biopsies (66% very low-risk and 34% low-risk PCa). The time between biopsies was 12.6 months (11.2-17.7). The median PSA and PSA density were 5.4 ng/mL (4.2-7.1) and 0.11 ng/mL/mL (0.07-0.18), respectively. 21 (29%) patients experienced Gleason upgrade on subsequent biopsy. Of those, 6 (8%), 5 (7%), and 10 (14%) had upgrade on systematic biopsy only, fusion biopsy only, and both systematic and fusion biopsy, respectively. Patients with upgrade on subsequent biopsy had higher PSA (p=0.02) and PSA density (p=0.02), and were among low-risk disease population (p=0.03). In logistic regression models, greater number of positive cores in systematic biopsy (OR 1.88; 95% CI 1.23-2.92; p=0.005) was associated with the total Gleason upgrade on repeated biopsy. Conclusions: In men with favorable risk prostate cancer managed with AS, Gleason upgrade was detected in a 29% of patients on a second MRI/US fusion biopsy including both targeted and systematic regions. These findings support the continued use of both MRI fusion and systematic biopsy during surveillance due to risks of reclassification over time.

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