scholarly journals Prognostic factors in postoperative radiotherapy for prostate cancer – tertiary center experience

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Marcin Miszczyk ◽  
Wojciech Majewski ◽  
Konrad Stawiski ◽  
Konrad Rasławski ◽  
Paweł Rajwa ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prognostic Factors ◽  
Recursive Partitioning ◽  
Local Failure ◽  
Gleason Grade ◽  
Grade Group ◽  
Treatment Indication ◽  
Increased Risk ◽  
Psa Nadir ◽  
Cancer Irradiation

Abstract Background The aim of the study was to analyse the prognostic factors in postoperative prostate cancer irradiation and develop a nomogram for disease-free survival (DFS). Patients and methods This retrospective study included 236 consecutive prostate cancer patients who had radical prostatectomy followed by radiotherapy (RT) at a single tertiary institution between 2009 and 2014. The main outcome was DFS analysed through uni- and multivariable analysis, Kaplan-Meier curves, log-rank testing, recursive partitioning analysis, and nomogram development. Results The median follow up was 62.3 (interquartile range [IQR] 38.1–79) months. The independent clinical factors associated with increased risk of recurrence or progression in the multivariate analysis (MVA) were prostate-specific antigen (PSA) level before RT, pT3 characteristic, and local failure as salvage indication. The value of PSA nadir had a significant impact on the risk of biochemical failure. Biochemical control and DFS were significantly different depending on treatment indication (p < 0.0001). The recursive partitioning analysis highlighted the importance of the PSA level before RT, Gleason Grade Group, PSA nadir, and local failure as a treatment indication. Finally, the nomogram for DFS was developed and is available online at https://apps.konsta.com.pl/app/prostate-salvage-dfs/. Conclusions The Pre-RT PSA level, pT3 characteristic and local failure as salvage indication are pivotal prognostic factors associated with increased risk of recurrence or progression. The Gleason grade group of 4–5 and PSA nadir value allow for further risk stratification. The treatment outcomes in postoperative prostate cancer irradiation are significantly different depending on treatment indication. An online nomogram comprising of both pre-treatment and current data was developed allowing for visualization of changes in prognosis depending on clinical data.

Incidence of periprostatic white adipose tissue inflammation in men with prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 63-63 ◽  
Author(s):  
Ayca Gucalp ◽  
Neil M. Iyengar ◽  
Xi K. Zhou ◽  
Dilip D. Giri ◽  
Domenick J. Falcone ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Adipose Tissue ◽  
White Adipose Tissue ◽  
Host Factors ◽  
Gleason Grade ◽  
High Grade ◽  
Adipose Tissue Inflammation ◽  
Grade Group ◽  
Tissue Inflammation ◽  
Increased Risk

63 Background: Obesity, a common cause of chronic inflammation, is associated with an increased risk of high grade, lethal prostate cancer (PC) and poor outcomes. The existence or clinical importance of periprostatic white adipose tissue inflammation (WATi) in patients (pts) with PC has not been previously described. We examined the relationships among periprostatic WATi and 1) tumor clinicopathologic features, and 2) host factors including age, body mass index (BMI), and circulating metabolic factors. Methods: Periprostatic WAT was collected prospectively from men with PC undergoing radical prostatectomy. WATi was defined by the presence of dead/dying adipocytes surrounded by macrophages forming crown-like structures (CLS). Tumor characteristics and host factors were measured. Wilcoxon rank-sum, Chi-square, or Fisher’s exact tests were used to examine the relationship between WATi and tumor and host characteristics. Results: From 11/2011-8/2015, periprostatic WAT was obtained from 169 pts (median age 62 years, range: 39 -77). Fasting blood samples were collected from 154 pts. CLS were present in 84 (49.7%) of pts. Presence of CLS was associated with higher median BMI (P = 0.02); 40/65 (61.5%) obese pts, 36/83 (43.4 %) overweight pts, and 8/21 (38.1 %) normal weight pts had CLS. Pts with CLS were more likely to have high grade prostate cancer (Gleason grade group IV/V, P = 0.02), larger adipocytes (P = 0.004), and positive surgical margins at the time of surgery (P = 0.04). WATi correlated with higher circulating levels of insulin, triglycerides, and leptin/adiponectin ratio, and lower high density lipoprotein cholesterol, compared to pts without WATi (P’s < 0.05). Conclusions: Periprostatic WATi is common in men with PC. It is associated with high grade PC and alterations in systemic factors that contribute to PC development and progression. Periprostatic WATi may represent a therapeutic target for improving PC risk and outcomes.

Prostate cancer treatment disparities during the COVID-19 pandemic, lessons from a multi-institutional collaborative.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6542-6542
Author(s):  
Adrien Bernstein ◽  
Ruchika Talwar ◽  
Elizabeth A. Handorf ◽  
Kaynaat Syed ◽  
Serge Ginzburg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Safety Net ◽  
Mitigation Strategies ◽  
Categorical Variables ◽  
Gleason Grade ◽  
Grade Group ◽  
Black Patients ◽  
The Impact ◽  
White Patients

6542 Background: Minority communities have been disproportionately affected by COVID-19, however the impact of the pandemic on prostate cancer (PCa) treatment is unknown. To that end, we sought to determine the racial impact on PCa surgery during the first wave of the COVID-19 pandemic. Methods: After receiving institutional review board approval, the Pennsylvania Urologic Regional Collaborative (PURC) database was queried to evaluate practice patterns for Black and White patients with untreated non-metastatic PCa during the initial lockdown of the COVID-19 pandemic (March-May 2020) compared to prior (March-May 2019). PURC is a prospective collaborative, which includes private practice and academic institutions within both urban and rural settings including regional safety-net hospitals. As data entry was likely impacted by the pandemic, we limited our search to only practices that had data entered through June 1, 2020 (5 practice sites). We compared patient and disease characteristics by race using Fisher’s exact and Pearson’s chi-square to compare categorical variables and Wilcoxon rank sum to evaluate continuous covariates. Patients were stratified by risk factors for severe COVID-19 infection as described by the CDC. We determined the covariate-adjusted impact of year and race on surgery, using logistic regression models with a race*year interaction term. Results: 647 men with untreated non-metastatic PCa were identified, 269 during the pandemic and 378 from the year prior. During the pandemic, Black men were significantly less likely to undergo prostatectomy compared to White patients (1.3% v 25.9%;p < 0.001), despite similar COVID-19 risk-factors, biopsy Gleason grade group, and comparable surgery rates prior (17.7% vs. 19.1%;p = 0.75). White men had lower pre-biopsy PSA (7.2 vs. 8.8 vs. p = 0.04) and were older (24.4% vs. 38.2% < 60yr;p = 0.09). The regression model demonstrated an 94% decline in odds of surgery(OR = 0.06 95%CI 0.007-0.43;p = 0.006) for Black patients and increase odds of surgery for White patients (OR = 1.41 95%CI 0.89-2.21;p = 0.142), after adjusting for covariates. Changes in surgical volume varied by site (33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery, caring for a greater proportion of Black patients. Conclusions: In a large multi-institutional regional collaborative, odds of PCa surgery declined only among Black patients during the initial wave of the COVID-19 pandemic. While localized prostate cancer does not require immediate treatment, the lessons from this study illuminate systemic inequities within healthcare, likely applicable across oncology. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the pandemic in order to develop balanced mitigation strategies as viral rates continue to fluctuate.

Transcriptomic Heterogeneity of Gleason Grade Group 5 Prostate Cancer

2020 ◽  
Vol 78 (3) ◽  
pp. 327-332 ◽  
Author(s):  
Amar U. Kishan ◽  
Tahmineh Romero ◽  
Mohammed Alshalalfa ◽  
Yang Liu ◽  
Phuoc T. Tran ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Grade ◽  
Grade Group ◽  
Group 5

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.

scholarly journals Assessment of prostate cancer prognostic Gleason grade group using zonal-specific features extracted from biparametric MRI using a KNN classifier

2019 ◽  
Vol 20 (2) ◽  
pp. 146-153 ◽  
Author(s):  
Carina Jensen ◽  
Jesper Carl ◽  
Lars Boesen ◽  
Niels Christian Langkilde ◽  
Lasse Riis Østergaard
Keyword(s):  
Prostate Cancer ◽  
Gleason Grade ◽  
Grade Group ◽  
Knn Classifier

Is PI-RADS 3/total lesion ratio associated with clinically-significant prostate cancer in patients with equivocal-risk lesions on multi-parametric MRI?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 149-149
Author(s):  
Kamyar Ghabili ◽  
Matthew Swallow ◽  
Alfredo Suarez-Sarmiento ◽  
Jamil Syed ◽  
Michael Leapman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Volume ◽  
Area Under The Curve ◽  
Lesion Volume ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Psa Density ◽  
Increased Risk ◽  
Positive Core ◽  
Clinically Significant

149 Background: Prostate imaging reporting and data system (PI-RADS) category 3 (P3) provides an equivocal assessment of prostate cancer (PCa). We aimed to investigate imaging parameters including the ratio of P3-to-total regions of interest (ROI) that may assist in identifying P3 lesions harboring clinically-significant PCa (csPCa). Methods: We retrospectively queried our institutional MRI-ultrasound fusion biopsy database to identify patients without a prior diagnosis of PCa and with at least one P3 lesion on multi-parametric MRI (mpMRI) who underwent fusion biopsy during Feb 2015-Oct 2017. mpMRI findings were assessed, including prostate and P3 volumes, number of ROIs, and P3-to-total ROIs ratio (P3 lesion volume/total ROIs volumes). Logistic regression and area under the curve (AUC) were used to assess the ability of clinical and mpMRI characteristics to predict csPCa, defined as any grade group (GG)≥2 cancer or GG 1 cancer in > 2 cores or > 50% of any positive core from targeted biopsy of the P3 lesion. Results: Of 127 men with at least one P3 lesion, 29 (22.8%) had csPCa on the biopsy of P3 lesions. Patients with csPCa in P3 lesions had smaller prostate volumes (42.1mL vs 56mL, p = 0.003), lower P3/total ROIs ratios (0.46 vs 1.00, p < 0.001), and higher numbers of total ROIs (2 vs 1, p = 0.004). Compared with patients who had a P3/total ROIs ratio > 0.58, men with ratios < 0.58 were more likely to be diagnosed with csPCa in a P3 lesion (57.1% vs 9%, p < 0.001). Using a threshold of 0.58, P3/total ROIs ratio was 76.1% sensitive and 80.6% specific for csPCa in a P3 lesion. On multivariate analysis, smaller prostate volume (OR1.04, 95%CI 1.01-1.07, p = 0.01) and lower P3/total ROIs ratio (OR1.04, 95%CI 1.02-1.07, p = 0.003) were associated with an increased risk of csPCa in P3 lesions. P3/total ROIs ratio (AUC 0.73) and prostate volume (AUC 0.70) were superior to PSA density (AUC 0.65) for the prediction of csPCa in P3 lesions. Conclusions: Our data indicated that prostate volume and P3/total ROIs ratio outperformed PSA density in and were associated with detecting csPCa in P3 lesions. P3/total ROIs ratio could be used to avoid 80.6% of unnecessary biopsies of a P3 lesion in men with multiple ROIs.

Impact of initial treatment selection on clinical outcomes after biochemical failure in radiorecurrent high-risk prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 208-208
Author(s):  
Rebecca Levin-Epstein ◽  
Tahmineh Romero ◽  
Jessica Karen Wong ◽  
Kiri Cook ◽  
Robert Timothy Dess ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Initial Treatment ◽  
External Beam Radiotherapy ◽  
Oncologic Outcomes ◽  
Gleason Grade ◽  
Grade Group ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Median Interval

208 Background: Treatment of high risk prostate cancer (HRPCa) with external beam radiotherapy (EBRT) plus brachytherapy (BT) boost (EBRT+BT) has been prospectively associated with lower rates of BCR, albeit potentially with increased toxicity, and retrospectively linked to decreased distant metastasis (DM) and PCa-specific mortality (PCSM) compared to EBRT alone. However, it is unclear whether patients who develop BCR following either approach have similar downstream oncologic outcomes. Methods: We identified 706 out of 3820 men with HRPCa treated at 13 institutions from 1998-2015 with EBRT (n=468/2134) or EBRT+BT (n=238/1686) who developed BCR. We compared rates of DM, PCSM, and all-cause mortality (ACM) after BCR between treatment groups using Fine-Gray competing risk regression. Models were adjusted for age, Gleason grade group, initial PSA (iPSA), clinical T stage, time-dependent use of systemic salvage, and interval to BCR using inverse probability of treatment weighting. Results: Median follow-up was 9.9 years from RT and 4.8 years from BCR. Groups were similar in age, iPSA, presence of ≥2 HR features, and median interval to BCR (3.3 years). Most men received neoadjuvant/concurrent androgen deprivation therapy (ADT), 92.5% and 91.0% for EBRT and EBRT+BT, respectively, though for a longer duration with EBRT (median 14.7 vs. 9.0 months, p=0.0012). Local and systemic salvage rates were 2.3% and 36.3% after EBRT, and 2.6% and 43.6% after EBRT+BT, respectively. Initial EBRT+BT was associated with significantly lower rates of DM after BCR (HR 0.48, 95% CI 0.36-0.64, p<0.001). Rates of PCSM and ACM did not significantly differ (HR 0.93, 95% CI 0.67-1.30, p=0.93, and HR 0.8, 95% CI 0.6-1.1, p=0.11, respectively). Conclusions: In this large retrospective series of radiorecurrent HRPCa, initial treatment with EBRT+BT was associated with significantly lower rates of DM after BCR compared with EBRT, despite shorter ADT use and a similar median interval to BCR. Local salvage was widely underutilized in both groups. In the absence of salvage for local failure after EBRT, upfront treatment intensification with BT may reduce DM, though not PCSM or ACM, even after development of BCR.

PD62-09 EVALUATING THE OUTCOMES OF ACTIVE SURVEILLANCE IN GLEASON GRADE GROUP 2 PROSTATE CANCER

2020 ◽  
Vol 203 ◽  
pp. e1289
Author(s):  
Adrian J. Waisman Malaret* ◽  
Kehao Zhu ◽  
Yingye Zheng ◽  
Lisa Newcomb ◽  
Peter Chang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Grade ◽  
Grade Group ◽  
Group 2
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