Faculty Opinions recommendation of PSA failure following definitive treatment of prostate cancer having biopsy Gleason score 7 with tertiary grade 5.

PURPOSE: To present nomograms providing estimates of prostate-specific antigen (PSA) failure–free survival after radical prostatectomy (RP) or external-beam radiation therapy (RT) for men diagnosed during the PSA era with clinically localized disease. PATIENTS AND METHODS: A Cox regression multivariable analysis was used to determine the prognostic significance of the pretreatment PSA level, 1992 American Joint Committee on Cancer (AJCC) clinical stage, and biopsy Gleason score in predicting the time to posttherapy PSA failure in 1,654 men with T1c,2 prostate cancer managed with either RP or RT. RESULTS: Pretherapy PSA, AJCC clinical stage, and biopsy Gleason score were independent predictors (P < .0001) of time to posttherapy PSA failure in patients managed with either RP or RT. Two-year PSA failure rates derived from the Cox regression model and bootstrap estimates of the 95% confidence intervals are presented in the format of a nomogram stratified by the pretreatment PSA, AJCC clinical stage, biopsy Gleason score, and local treatment modality. CONCLUSION: Men at high risk (> 50%) for early (≤ 2 years) PSA failure could be identified on the basis of the type of local therapy received and the clinical information obtained as part of the routine work-up for localized prostate cancer. Selection of these men for trials evaluating adjuvant systemic and improved local therapies may be justified.

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Critical analysis of the ability of the endorectal coil magnetic resonance imaging scan to predict pathologic stage, margin status, and postoperative prostate-specific antigen failure in patients with clinically organ-confined prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1996.14.6.1770 ◽

1996 ◽

Vol 14 (6) ◽

pp. 1770-1777 ◽

Cited By ~ 65

Author(s):

A V D'Amico ◽

R Whittington ◽

S B Malkowicz ◽

D Schultz ◽

M Schnall ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Gleason Score ◽

Clinical Stage ◽

Multivariable Analysis ◽

Specific Antigen ◽

Resonance Imaging ◽

Endorectal Coil ◽

Psa Failure ◽

Biopsy Gleason Score

PURPOSE To determine whether there is a role for endorectal coil magnetic resonance imaging (erMRI) in the prediction of pathologic stage, margin status, and/or postoperative prostate-specific antigen (PSA) failure in patients with clinically organ-confined prostate cancer. PATIENTS AND METHODS Using erMRI, the radiologic-pathologic correlation of extracapsular extension (ECE) and seminal vesicle invasion (SVI) was evaluated in 445 surgically managed patients. Logistic regression multivariable analysis was applied to the clinical stage, PSA, biopsy Gleason grade, and erMRI findings to assess the outcomes of ECE, SVI, positive surgical margins (PSM), and postoperative PSA failure. RESULTS The accuracy of erMRI to predict for ECE and SVI numerically decreased with both increasing PSA and biopsy Gleason score because of the increasing false-negative scans in cases of microscopic transcapsular or seminal vesicle disease. Of patients who could not be categorized into low or high risk for postoperative PSA failure on the basis of clinical stage, preoperative PSA, and biopsy Gleason score, a negative or positive erMRI for ECE or SVI stratified these patients into groups with a 78% versus 21% (P < .0001) 3-year rate of actuarial freedom from PSA failure. In this subgroup, the overall accuracy of the erMRI was 70% +/- 6% and 94% +/- 2% for ECE and SVI, respectively. The most significant predictor on multivariable analysis of PSM was the erMRI finding of ECE (P = .0001). CONCLUSION This initial report suggests that a preoperative erMRI can identify clinically organ-confined prostate cancer patients at high risk for having ECE, SVI, and PSM that otherwise would be missed on the basis of the clinical stage, preoperative PSA, and biopsy Gleason score. Confirmatory studies are needed.

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Predictors of Prostate Cancer–Specific Mortality After Radical Prostatectomy or Radiation Therapy

Journal of Clinical Oncology ◽

10.1200/jco.2005.01.2906 ◽

2005 ◽

Vol 23 (28) ◽

pp. 6992-6998 ◽

Cited By ~ 145

Author(s):

Ping Zhou ◽

Ming-Hui Chen ◽

David McLeod ◽

Peter R. Carroll ◽

Judd W. Moul ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Radical Prostatectomy ◽

Gleason Score ◽

Specific Antigen ◽

Study Cohort ◽

Psa Failure ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Biopsy Gleason Score

Purpose We evaluated predictors of prostate cancer–specific mortality (PCSM) after prostate-specific antigen (PSA) failure after radical prostatectomy (RP) or radiation therapy (RT). Patients and Methods A total of 1,159 men with clinically localized prostate cancer treated with RP (n = 498) or RT (n = 661) developed PSA failure, and they formed the study cohort. Competing risk regression analyses were used to evaluate whether previously identified predictors of time to metastasis, including post-treatment PSA doubling time (PSA-DT), Gleason score, and interval to PSA failure, could also predict time to PCSM after PSA failure. The cumulative incidence method was used to estimate PCSM after PSA failure. Results A post-RP PSA-DT of less than 3 months (hazard ratio [HR], 54.9; 95% CI, 16.7 to 180), a post-RT PSA-DT of less than 3 months (HR, 12.8; 95% CI, 7.0 to 23.1), and a biopsy Gleason score of 8 to 10 (HR, 6.1; 95% CI, 3.4 to 10.7) for patients treated with RT were significantly associated with PCSM. Post-RP estimated rates of PCSM 5 years after PSA failure were 31% (95% CI, 17% to 45%) v 1% (95% CI, 0% to 2%) for patients with PSA-DT of less than 3 months v ≥ 3 months. Post-RT estimated rates of PCSM 5 years after PSA failure were 75% (95% CI, 59% to 92%) v 35% (95% CI, 24% to 47%) for patients with a biopsy Gleason score of ≥ 8 v ≤ 7, respectively, and PSA-DT of less than 3 months; these rates were 15% (95% CI, 0.8% to 28%) v 4% (95% CI, 1% to 6%), respectively, for patients with a PSA-DT ≥ 3 months. Conclusion Patients at high risk for PCSM after PSA failure can be identified based on post-RP PSA-DT or post-RT PSA-DT and biopsy Gleason score. These parameters may be useful in identifying patients for a randomized trial evaluating hormonal therapy with or without docetaxel.

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Predictive Factors for Positive Surgical Margins in Patients With Prostate Cancer After Radical Prostatectomy: A Systematic Review and Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2020.539592 ◽

2021 ◽

Vol 10 ◽

Author(s):

Lijin Zhang ◽

Hu Zhao ◽

Bin Wu ◽

Zhenlei Zha ◽

Jun Yuan ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Predictive Factors ◽

Meta Analysis ◽

Positive Lymph Node ◽

Pathological Stage ◽

Positive Surgical Margins ◽

Subgroup Analyses ◽

Biopsy Gleason Score ◽

Extraprostatic Extension

Background and ObjectivesPrevious studies have demonstrated that positive surgical margins (PSMs) were independent predictive factors for biochemical and oncologic outcomes in patients with prostate cancer (PCa). This study aimed to conduct a meta-analysis to identify the predictive factors for PSMs after radical prostatectomy (RP).MethodsWe selected eligible studies via the electronic databases, such as PubMed, Web of Science, and EMBASE, from inception to December 2020. The risk factors for PSMs following RP were identified. The pooled estimates of standardized mean differences (SMDs)/odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A fixed effect or random effect was used to pool the estimates. Subgroup analyses were performed to explore the reasons for heterogeneity.ResultsTwenty-seven studies including 50,014 patients with PCa were eligible for further analysis. The results showed that PSMs were significantly associated with preoperative prostate-specific antigen (PSA) (pooled SMD = 0.37; 95% CI: 0.31–0.43; P < 0.001), biopsy Gleason Score (<6/≥7) (pooled OR = 1.53; 95% CI:1.31–1.79; P < 0.001), pathological Gleason Score (<6/≥7) (pooled OR = 2.49; 95% CI: 2.19–2.83; P < 0.001), pathological stage (<T2/≥T3) (pooled OR = 3.90; 95% CI: 3.18–4.79; P < 0.001), positive lymph node (PLN) (pooled OR = 3.12; 95% CI: 2.28–4.27; P < 0.001), extraprostatic extension (EPE) (pooled OR = 4.44; 95% CI: 3.25–6.09; P < 0.001), and seminal vesicle invasion (SVI) (pooled OR = 4.19; 95% CI: 2,87–6.13; P < 0.001). However, we found that age (pooled SMD = 0.01; 95% CI: −0.07–0.10; P = 0.735), body mass index (BMI) (pooled SMD = 0.12; 95% CI: −0.05–0.30; P = 0.162), prostate volume (pooled SMD = −0.28; 95% CI: −0.62–0.05; P = 0.097), and nerve sparing (pooled OR = 0.90; 95% CI: 0.71–1.14; P = 0.388) had no effect on PSMs after RP. Besides, the findings in this study were found to be reliable by our sensitivity and subgroup analyses.ConclusionsPreoperative PSA, biopsy Gleason Score, pathological Gleason Score, pathological stage, positive lymph node, extraprostatic extension, and seminal vesicle invasion are independent predictors of PSMs after RP. These results may helpful for risk stratification and individualized therapy in PCa patients.

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Prostate-specific antigen failure despite pathologically organ-confined and margin-negative prostate cancer: the basis for an adjuvant therapy trial.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.4.1465 ◽

1997 ◽

Vol 15 (4) ◽

pp. 1465-1469 ◽

Cited By ~ 39

Author(s):

A V D'Amico ◽

R Whittington ◽

S B Malkowicz ◽

D Schultz ◽

J E Tomaszewski ◽

...

Keyword(s):

Prostate Cancer ◽

Adjuvant Therapy ◽

Cancer Patients ◽

Prostate Specific Antigen ◽

Gleason Score ◽

Multivariable Analysis ◽

Specific Antigen ◽

Radical Retropubic Prostatectomy ◽

Phase Iii ◽

Psa Failure

PURPOSE A multivariable analysis to evaluate the potential clinical and pathologic factors that predict for early biochemical failure in patients with pathologically organ-confined and margin-negative disease was performed to define patients who may benefit from adjuvant therapy. PATIENTS AND METHODS Three hundred forty-one prostate cancer patients treated with a radical retropubic prostatectomy between January 1989 and June 1995 and found to have pathologically organ-confined and margin-negative disease comprised the study population. A logistic regression multivariable analysis to evaluate the predictive value of the preoperative prostate-specific antigen (PSA) level, pathologic (prostatectomy) Gleason score, and pathologic stage on PSA failure occurring during the first postoperative year was performed. RESULTS Predictors of PSA failure during the first postoperative year in patients with pathologically organ-confined disease included pathologic Gleason score > or = 7 (P = .0007) and preoperative PSA level greater than 10 (P < .0001). Corresponding 3-year freedom-from-PSA-failure rates for these pathologic organ-confined patients with both, one, or neither of these factors were 60%, 75% to 84%, and 95%, respectively (P < .0001). CONCLUSION Prostate cancer patients with pathologically organ-confined and margin-negative disease and a preoperative PSA level greater than 10 ng/mL or a pathologic Gleason score > or = 7 have significant decrements in short-term PSA-failure-free survival. Therefore, these patients should be considered for adjuvant therapy in the setting of a phase III clinical trial.

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Impact of reporting rules of biopsy Gleason score for prostate cancer

Journal of Clinical Pathology ◽

10.1136/jcp.2008.060632 ◽

2008 ◽

Vol 62 (3) ◽

pp. 260-263 ◽

Cited By ~ 23

Author(s):

K Kuroiwa ◽

H Uchino ◽

A Yokomizo ◽

S Naito

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Biopsy Gleason Score

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Prediction of extraprostatic cancer by prostate specific antigen density, endorectal MRI, and biopsy Gleason score in clinically localized prostate cancer

The Prostate ◽

10.1002/pros.10239 ◽

2003 ◽

Vol 56 (1) ◽

pp. 23-29 ◽

Cited By ~ 30

Author(s):

Akio Horiguchi ◽

Jun Nakashima ◽

Yutaka Horiguchi ◽

Ken Nakagawa ◽

Mototsugu Oya ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Gleason Score ◽

Specific Antigen ◽

Localized Prostate Cancer ◽

Prostate Specific Antigen Density ◽

Endorectal Mri ◽

Biopsy Gleason Score

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Urinary dysfunction appears to be the primary determinant of castration versus observation for prostate cancer patients with PSA failure

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.14621 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 14621-14621

Author(s):

J. A. Zagory ◽

C. Chang ◽

S. Knight ◽

E. A. Lyons ◽

C. L. Bennett

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Watchful Waiting ◽

Specific Antigen ◽

Hormonal Treatment ◽

Initial Therapy ◽

Urinary Dysfunction ◽

Definitive Treatment ◽

Psa Failure ◽

Decision Satisfaction

14621 Background: After undergoing definitive treatment for a primary localized disease, prostate cancer patients may experience a rise in their prostate specific antigen (PSA) levels. Treating PSA failure with hormonal treatment has many health related quality of life (HRQOL) implications, including urinary, bowel, sexual, and male hormonal problems. Predictors of choice between hormonal treatment versus watchful waiting have not been investigated. Methods: Patients were approached after consecutive rises in PSA levels (n = 31). Patients completed HRQOL and decision satisfaction questionnaires, and a literacy assessment. Results: Patients were between 56 and 85 years old; 55% were African American. 71% of African Americans and 50% of whites had low functional literacy. 58% of patients chose hormonal therapy to treat their PSA rise; 81% of patients reported urinary problems. All patients reported decision satisfaction (see Table). Factors associated with castration versus watchful waiting were primarily related to poor urologic function, and were not specifically prostate cancer related (dysuria, nocturia, urination frequency). Conclusions: Primary treatment of urinary dysfunction, rather than castration, should be evaluated as initial therapy for prostate cancer patients with PSA failure. [Table: see text] No significant financial relationships to disclose.

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