Racial variations in upgraded gleason scores of active surveillance candidates.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e548-e548
Author(s):  
Krishna Pandya ◽  
Allison H. Feibus ◽  
Andrew B. Sholl ◽  
Jonathan L. Silberstein
Keyword(s):  
African American ◽  
Active Surveillance ◽  
Gleason Score ◽  
Low Risk ◽  
High Grade ◽  
Total Cohort ◽  
Median Serum ◽  
Increased Risk ◽  
Significant Difference ◽  
Racial Variations

e548 Background: Currently, active surveillance is an appropriate option for patients who have low risk PCa as determined by the NCCN as Gleason Score (GS) ≤ 6 and a PSA <10. Methods: Following IRB approval, we determined that 141 men from our database had low risk PCa and were eligible for AS, but underwent radical prostatectomy (RP). We performed a retrospective review of these patients examining GS upon RP. Disease upgrading on RP was considered Gleason score ≥ 7. A two-tailed t-test was performed to examine whether African American (AA) patients had greater incidence of upgrading on RP than non-African American patients. Results: Of the 141 patients identified (36 AA, 105 non-AA) there were no significant differences in age at RP (59 AA, 59 non-AA), median PSA (5.5 ng/dL AA, 5.4 ng/dL non-AA), and number of positive cores (3 AA, 3 non-AA) at biopsy when stratified by race. A total of 85 patients (19 AA, 66 non-AA) were found to have an upgraded GS at the time of RP; again without significant difference with respect to age (60 AA, 61 non-AA), serum PSA (5.3 AA, 5.35 non-AA), total cores taken at biopsy (12 AA, 12 non-AA) and median positive cores (3.5 AA, 3 non-AA). Of the 85 patients upgraded, 66 (12 AA, 54 non-AA) were 3+4 and the remainder were ≥ 4+3. There was no significant racial variation for patients upgraded to Gleason 3+4 (p>0.05). Next we reviewed the presence of tertiary pattern 5 within these 3+4 patients and found it present in 1 patient who was AA. For the 19 patients with ≥ 4+3 upgrading, with respect to race (7 AA, 12 non-AA, p = .08) there were no significant differences in age, serum PSA, median positive and total cores taken at biopsy. However, when comparing these 19 upgraded ≥ 4+3 patients to the total cohort, they had a higher median serum PSA (6.16 ng/dLvs 5.4 ng/dL) and higher positive cores (4 vs 3) on biopsy. For these 19 patients, upgrading resulted in reclassification from low to high-grade (GS ≥ 8) PCa in 7 patients. Conclusions: African American patients with low risk PCa have do not have an increased risk of significant upgrading at RP when compared with other races, and further investigation is needed to identify factors that contribute to upgrading.

Gleason score upgrade among 10,282 men who underwent surgery as initial treatment in 2010: A population-based study.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 72-72
Author(s):  
Hong Zhang ◽  
Edward M. Messing ◽  
Hamza Ahmed ◽  
Yuhchyau Chen
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Specific Antigen ◽  
Low Risk ◽  
Categorical Variables ◽  
Intermediate Risk ◽  
Time Of Surgery ◽  
Significant Difference ◽  
Risk Prostate Cancer

72 Background: Active surveillance is now accepted initial management for men who have localized prostate cancer with low risk of disease progression. Many criteria have been used for patient identification, including Gleason score (GS) obtained from prostate biopsy. Because of concerns of sampling error, some have recommended repeated biopsy before committing to active surveillance. However, there is limited information about the risk of missing high grade disease using the current standard biopsy approach. This study seeks to compare GS difference from biopsy and surgery to provide an estimated rate of GS upgrade. Methods: The Surveillance, Epidemiology, and End Results (SEER) program was used to identify men with American Joint Committee on Cancer stage T1-2cN0M0 prostate cancer diagnosed between January 2010 and December 2010. Patients who underwent prostatectomy were selected for further analysis. Based on prostate-specific antigen (PSA) levels and GS, cases were divided into low (PSA <=10 and GS <=6) and intermediate (10<PSA<=20 or GS=7) risk groups. The rates of GS upgrade were reported for each group. Chi-square tests were used to assess differences in categorical variables (e.g. age and race) between groups of GS upgrade and no change/downgrade. Results: A total of 10,282 men were evaluated, with 9.2% (n=942) having low-risk disease, and 90.8% (n=9340) having intermediate-risk disease. Among men with low-risk prostate cancer, 22.3% (n=210) had GS upgrade and 0.8% (n=8) had GS 8 disease. Among men with intermediate risk disease, 26.2% (n=2446) had GS upgrade and 2.3% (n=214) had GS 8 disease. There was no statistically significant difference in either age or race distribution among men who had GS upgrade versus no change or downgrade at the time of surgery. Conclusions: A substantial number of low- and intermediate-risk prostate cancer patients had GS upgrade at the time of surgery, but few had upgraded to GS 8 high risk disease. These observations suggest that repeat biopsy prior to active surveillance may not be necessary.

Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low- or intermediate-risk disease.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 198-198
Author(s):  
N. D. Arvold ◽  
M. Chen ◽  
J. W. Moul ◽  
B. J. Moran ◽  
D. E. Dosoretz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Specific Antigen ◽  
Low Risk ◽  
Study Cohort ◽  
Intermediate Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference

198 Background: Radical prostatectomy (RP) and brachytherapy (BT) are widely utilized treatments for favorable-risk prostate cancer (PC). We estimated the risk of PC-specific mortality (PCSM) following RP or BT in men with low- or intermediate-risk PC using prospectively collected data. Methods: The study cohort comprised 5,760 men with low-risk PC (prostate-specific antigen [PSA] level ≤ 10 ng/mL, clinical category T1c or 2a, and Gleason score ≤ 6), and 3,079 men with intermediate-risk PC (PSA level 10-20 ng/mL, clinical T2b or T2c, or Gleason score 7). Competing risks multivariable regression was performed to assess risk of PCSM after RP or BT, adjusting for age, treatment year, cardiovascular comorbidity, and known PC prognostic factors. Results: There was no significant difference in the risk of PCSM among men with low-risk PC (11 vs. 6 deaths: adjusted hazard ratio [AHR], 1.62; 95% CI, 0.59–4.45; P = 0.35) who received BT compared to RP. However among men with intermediate-risk PC, despite significantly shorter median follow-up for men undergoing BT as compared to RP (4.1 vs. 7.2 years, P < 0.001), there was a trend toward an increased risk of PCSM (18 vs. 9 deaths: AHR, 2.30; 95% CI, 0.95–5.58; P = 0.07) for men treated with BT. Conclusions: The risk of PCSM among men with low-risk PC was not significantly different following RP or BT, however there may be a reduced risk of PCSM after RP as compared to BT in men with intermediate-risk PC. [Table: see text] No significant financial relationships to disclose.

scholarly journals Omega-3 Fatty Acids Survey in Men under Active Surveillance for Prostate Cancer: from Intake to Prostate Tissue Level

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1616 ◽  
Author(s):  
Hanane Moussa ◽  
Molière Nguile-Makao ◽  
Karine Robitaille ◽  
Marie-Hélène Guertin ◽  
Janie Allaire ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Fatty Acids ◽  
Active Surveillance ◽  
Experimental Studies ◽  
Low Risk ◽  
Prostate Tissue ◽  
High Grade ◽  
Protective Effects ◽  
Omega 3 Fatty Acids ◽  
Omega 3

Dietary omega-3 fatty acids (ω3), particularly long-chain ω3 (LCω3), have protective effects against prostate cancer (PCa) in experimental studies. Observational studies are conflicting, possibly because of the biomarker used. This study aimed at evaluating associations between grade reclassification and ω3 levels assessed in prostatic tissue, red blood cells (RBC), and diet. We conducted a validation cross-sectional study nested within a phase II clinical trial. We identified 157 men diagnosed with low-risk PCa who underwent a first active surveillance repeat prostate biopsy session. Fatty acid (FA) intake was assessed using a food frequency questionnaire and their levels measured in prostate tissue and RBC. Associations were evaluated using logistic regression. At first repeat biopsy session, 39 (25%) men had high-grade PCa (grade group ≥2). We found that high LCω3-eicosapentaenoic acid (EPA) level in prostate tissue (odds ratio (OR) 0.25; 95% (confidence interval (CI) 0.08–0.79; p-trend = 0.03) was associated with lower odds of high-grade PCa. Similar results were observed for LCω3 dietary intake (OR 0.30; 95% CI 0.11-0.83; p-trend = 0.02) but no association for RBC. LCω3-EPA levels in the target prostate tissue are inversely associated with high-grade PCa in men with low-risk PCa, supporting that prostate tissue FA, but not RBC FA, is a reliable biomarker of PCa risk.

High-grade proteinuria associated with bevacizumab in patients with renal cell cancer and non-renal cell cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16089-e16089
Author(s):  
C. Y. Kim ◽  
D. Chu ◽  
L. Baer ◽  
S. Wu
Keyword(s):  
Renal Cell Cancer ◽  
Renal Cell ◽  
Cell Cancer ◽  
Significant Risk ◽  
Close Monitoring ◽  
Tumor Type ◽  
High Grade ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Significant Difference

e16089 Background: Bevacizumab is a humanized monoclonal antibody that inhibits vascular endothelial growth factor. It is a widely used angiogenesis inhibitor in the treatment of renal cell cancer (RCC) and other solid tumors. Proteinuria is associated with significant morbidity and treatment interruptions. The overall risk for proteinuria is unclear. This study was conducted to determine the risk of developing proteinuria among RCC and non-RCC patients receiving bevacizumab. Methods: Databases from PUBMED and Web Science from January 1966 until July 2008 and abstracts presented at ASCO from January 2000 to July 2008 were searched to identify relevant studies. Studies included randomized controlled clinical trials in which standard anti-neoplastic therapy was administered with and without bevacizumab with available data for proteinuria. Summary incidence rate, relative risk (RR), and 95% confidence interval (CI) were calculated employing fixed or random effect models based upon the heterogeneity of included studies. Results: A total of 6,702 patients from 14 randomized controlled studies were included for analysis. The incidence of all-grade proteinuria in patients receiving bevacizumab was 19.3% (95% CI: 11.9–29.6%) with 2.3% (95% CI: 1.2–4.1%) being high-grade (grade 3 or 4). Patients treated with bevacizumab had an increased risk of developing high-grade proteinuria with RR of 6.3 (95% CI: 4.0–9.9) compared with controls. Risk may vary with dose of bevacizumab; significant difference may exist in patients receiving bevacizumab at 5 mg/kg/week (RR 9.1, 95% CI: 4.3–19.6, p < 0.001) and 2.5 mg/kg/week (RR = 5.1, 95%CI: 3.0–8.8, p < 0.001). The risk of high-grade proteinuria may also depend on tumor type; the incidence of high-grade proteinuria was 10.0% (95% CI: 4.3–22.4%) with a RR 48.7 (95% CI: 9.7–244.3) among 703 RCC patients compared with an incidence of 1.7% (95% CI: 0.09–3.2%) and RR of 5.2 (95% CI: 3.3–8.4) among 5,999 non-RCC patients. Conclusions: There is a significant risk for high-grade proteinuria in patients receiving bevacizumab. The risk may vary with bevacizumab dose and tumor type. RCC patients may have higher risk than non-RCC patients. Close monitoring and management are recommended for patients at high risk. No significant financial relationships to disclose.

Multiparametric prostate MRI and MRI/ultrasound fusion biopsy as tools to follow prostate cancer progression for men on active surveillance.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 63-63 ◽  
Author(s):  
Nabeel Shakir ◽  
Annerleim Walton-Diaz ◽  
Soroush Rais-Bahrami ◽  
Baris Turkbey ◽  
Jason Rothwax ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Cancer Progression ◽  
Predictive Value ◽  
Low Risk ◽  
Fusion Biopsy ◽  
Trus Biopsy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

63 Background: Active surveillance (AS) is an option for patients with low risk prostate cancer (PCa); however, determining disease progression is challenging. At the NCI, multiparametric MRI (MP-MRI) with our biopsy protocol (MR-US fusion-guided plus 12 core extended sextant biopsy) has been used to confirm eligibility for AS. We evaluated the utility of these modalities in monitoring patients on AS. Methods: Patients who underwent MP-MRI of the prostate with biopsy per our protocol between 2007-2012 were reviewed. We selected a subset who met Johns Hopkins criteria for AS (Gleason score≤6, PSA density≤0.15, tumor involvement of ≤2 cores, and ≤50% of any single core) by outside 12−core TRUS biopsy. Patients with Gleason score≤6 confirmed at first NCI biopsy session were followed with annual MP-MRI and biopsy. MRI progression was defined as an increase in MP-MRI suspicion level, lesion diameter, or number of lesions. Pathologic progression was defined as an increase to Gleason score≥7 in either 12-core or MR-fusion biopsy. We determined the association between MRI and pathologic progression. Results: 129 patients met JHU criteria for AS by outside biopsy. Mean age was 61.6 years and mean PSA 5.16ng/mL. 28/129 (21.7%) patients had Gleason score ≥7 at first NCI biopsy session.31 patients had at least two biopsy sessions (mean follow up 18 months, range 12-54 months) of which 9/31 (29%) increased in Gleason score, all to 3+4=7. Fusion biopsy detected more pathologic progression than did standard biopsy (Table). The positive predictive value of MP-MRI for pathologic progression was 50%, while the negative predictive value was 84%. The sensitivity and specificity of MP-MRI for increase in Gleason score was 67% and 73%, respectively. Conclusions: Stable findings on MP-MRI are associated with Gleason score stability in patients with low-risk PCa choosing AS. The majority of patients who had pathologic progression were detected on fusion biopsy, which may suggest that random biopsies are unnecessary in this population. Larger studies are needed to validate these findings. [Table: see text]

Pathologic upgrading on confirmatory biopsy in a racially diverse group of men on active surveillance for prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 142-142
Author(s):  
Allison H. Feibus ◽  
Nora M. Haney ◽  
John Boxberger ◽  
Justin Levy ◽  
Robert Scott Libby ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Repeat Biopsy ◽  
Diverse Group ◽  
Racially Diverse ◽  
Clinical Variables ◽  
Increased Risk ◽  
Initial Biopsy ◽  
Multiple Variables

142 Background: To evaluate the clinical variables associated with upgrading at confirmatory biopsy among a racially-diverse group of men with prostate cancer (PCa) who elect Active Surveillance (AS). Methods: Following IRB approval, of the more than 260 men from our multi-institutional prospective AS database we identified 140 that had undergone at least 1 confirmatory biopsy since their initial diagnosis. Patients whose diagnosis was made on TURP, had any Gleason 4 on their initial biopsy or whose initial and confirmatory biopsy were more than 2 years apart were excluded. The analysis cohort included 121 men who had Gleason Score ≤ 6, clinical stage ≤ T2a and PSA ≤ 20 ng/mL. Disease upgrading on confirmatory biopsy was Gleason score ≥ 7. Multiple variables were examined as univariate and MV predictors of upgrading. Results: We identified 121 men who fit inclusion criteria, 55 (45%) African Americans (AA) and 66 non-AA (55%) with a median follow-up of 22 months. The median age was 66, median number of biopsy cores taken at diagnostic biopsy was 12 and median time interval between diagnostic and confirmatory biopsy was 12 months. On confirmatory biopsy, no evidence of disease was noted for 51 (42%) men (26 AA, 25 non-AA), 48 (40%) men (18, AA, 30 non-AA) had findings consistent with their initial biopsy and 22 men (11 AA, 11 non-AA) experienced upgrading at repeat biopsy. Of the 22 (18%) men who were upgraded, 18 (8 AA, 10 non-AA) upgraded to a Gleason score of 7, 3 (2 AA, 1 non-AA) were upgraded to a Gleason score of 8 and 1 (AA) had a Gleason score of 9. In univariate analysis AA race was associated with a greater number of positive cores (p = 0.04) and greater total prostate volume (p = 0.03) at confirmatory biopsy. Multivariate analysis was performed and none of the clinical variables examined (race, age, BMI, PSA, volume, PSAD, number of positive cores, total number of cores, percentage of positive cores, time between biopsies) were associated with upgrading on repeat biopsy. Conclusions: Our findings suggest that race is not associated with an increased risk of upgrading at confirmatory biopsy. AA with low-risk PCa are reasonable candidates for inclusion in most AS protocols and should not be excluded based on race alone.

Prevalence and predictors of active surveillance management for black males diagnosed with low risk prostate cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18019-e18019
Author(s):  
Nicolette Taku ◽  
Vivek Narayan ◽  
Scarlett Bellamy ◽  
Neha Vapiwala
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Private Insurance ◽  
Univariate Analysis ◽  
Low Risk ◽  
Consensus Guidelines ◽  
Pathologic Features ◽  
Significant Difference ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

e18019 Background: Consensus guidelines recommend that active surveillance (AS) be considered in the management of men with low risk prostate cancer (LRPC). The evidence supporting this recommendation is largely derived from studies in which men of African descent were underrepresented; thus, the appropriate implementation of AS in this population remains controversial. The objective of our study was to evaluate the prevalence and clinical predictors of an AS approach in black men (BM) diagnosed with LRPC following the 2010 inclusion of AS in LRPC management consensus guidelines. Methods: BM (N = 15,242) and non-Hispanic white men (WM) (N = 86,655) diagnosed with LRPC (as defined by PSA ≤ 10 ng/ml, Gleason score ≤ 6, clinical stage T1 – T2a) between 2010 and 2013 were identified from the National Cancer Database. Logistic regression models were used to assess the likelihood of pursuing an AS strategy over time, as well as to examine associations between sociodemographic characteristics (SDCs) and the receipt of AS. Results: Overall, 9% of BM with LRPC were managed with AS. On univariate analysis, the likelihood of BM undergoing AS increased from 2010 and was statistically significant ( p < 0.001) for all subsequent years (2011: OR = 1.54, 95% CI 1.30-1.82; 2012: OR = 2.19, 95% CI 1.82-2.60; 2013: OR = 2.55, 95% CI 2.15-3.02). Uninsured BM were twice as likely as those with private insurance to pursue AS (OR 1.97, 95% CI 1.51-2.58, p < 0.001). BM seen at academic cancer programs were also more likely to be managed with AS, when compared to those seen at community cancer centers (OR 1.47, 95% CI 1.37-1.60, p < 0.001). BM were less likely than WM to receive AS (OR = 0.82, 95% CI 0.77 to 0.87, p < 0.001). On multivariate analysis adjusted for SDCs, there was no significant difference in AS utilization between the two ethnic groups. Conclusions: The utilization of AS for BM with LRPC appears to be increasing, may be influenced by SDCs, and may not differ from the AS utilization for WM with LRPC. Given the observed elevated rates of post-prostatectomy adverse pathologic features among BM, further evaluation of the determinants of AS utilization and scrutinous consideration of the appropriateness of AS in this population is warranted.

Evaluating the impact of African American ancestry among men with localized prostate cancer treated with radical prostatectomy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 41-41
Author(s):  
Daniel Canter ◽  
Julia E. Reid ◽  
Maria Latsis ◽  
Margaret Variano ◽  
Shams Halat ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Metastatic Disease ◽  
Proportional Hazards ◽  
Clinical Stage ◽  
Cox Proportional Hazards ◽  
Significant Difference ◽  
The Impact

41 Background: Prostate cancer (PC) is the most common male malignancy. Prior data has suggested that African American (AA) men present with more aggressive disease relative to men of other ancestries. Here, we examined the effects of ancestry on clinical and molecular measures of disease aggressiveness as well as pathologic outcomes in men treated with radical prostatectomy (RP) for localized PC. Methods: Data was collected from patients undergoing RP at the Ochsner Clinic from 2006 to 2011. Formalin−fixed paraffin embedded biopsy tissue was analyzed for the RNA expression of 31 cell cycle progression (CCP) genes and 15 housekeeping genes to obtain a CCP score (a validated molecular measure of PC aggressiveness). Cancer of the Prostate Risk Assessment (CAPRA) scores were also determined based on clinicopathologic features at the time of diagnosis. Clinical (Gleason score, tumor stage, CAPRA score) and molecular (CCP score) measures of disease aggressiveness were compared based on ancestry (AA versus non−AA). Cox proportional hazards models were used to test association of ancestry to biochemical recurrence (BCR) and progression to metastatic disease. Fisher’s exact and Wilcoxon rank sum tests were used to compare ancestries. Results: A total of 384 patients were treated with RP, including 133 (34.8%) AA men. At the time of diagnosis, the median age was 62 years (interquartile range (IQR) 56, 66) and PSA was 5.4 ng/mL (IQR 4.2, 7.6). When compared by ancestry, there were no significant differences in biopsy Gleason score (p = 0.26), clinical stage (p = 0.27), CAPRA score (p = 0.58), or CCP score (p = 0.87). In addition, there was no significant difference in the risk of BCR between ancestries (p = 0.55). Only non−AA men progressed to metastatic disease within the ten years of follow−up. Conclusions: Contrary to prior reports, these data appears to indicate that men of AA ancestry do not necessarily present with or develop a more biologically aggressive form of PC. Although these data represents only one institution’s experience, it contains a highly robust AA population compared to prior reports. Further research is required to account for the discrepancy in the previously published literature.

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