scholarly journals Retracted: Histopathological Correlation Between Prostatic Adenocarcinoma in Transrectal Ultrasound Guided Biopsies and Radical Prostatectomy Specimens

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Mohammad Faisal ◽  
Hina Tariq
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
National Level ◽  
Transrectal Ultrasound ◽  
Gleason Grade ◽  
Local Data ◽  
Grade Group ◽  
Regional Lymph Nodes ◽  
Gleason Grading ◽  
Bilateral Involvement

Introduction: Differences in Gleason grade in transrectal ultrasonography (TRUS) biopsies and radical prostatectomy (RP) specimens are well documented in literature. Keeping in view the limitations of Gleason grading system, Epstein JI grade group system was introduced. Various other parameters also have a significant role in predicting the pathological stage, extraprostatic extension, status of surgical margins and metastatic disease in regional lymph nodes. RP is performed at limited centres in Pakistan. Till date, no comparison of the histopathological findings in 12-core TRUS and RP specimens had been performed at the national level. Our study is aimed at generating local data in this context. Materials and Methods: This was a crosssectional study and non-probability consecutive sampling was performed. It was conducted at Histopathology Department, Shifa International Hospital, Islamabad, from January 2008 to December 2014. Gleason scores of 20 RP specimens were compared to Gleason scores of TRUS biopsies of same patients. Concordance in Gleason score and grade groups with laterality, perineural invasion was also studied. Results: Out of 20 RP cases, 40% (n = 8) had a Gleason score of 6, 30% (n = 6) had score 7, 20% (n = 4) had score 8 and 15% (n = 3) had score 9. Compared to the TRUS biopsy, RP Gleason score was concordant in 11 cases (55%), higher in 7 cases (35%) and lower in 2 cases (10%). TRUS involvement was unilateral in 10 cases (50%) and bilateral in 10 cases (50%). However, bilateral involvement of RP specimen was seen in 14 cases (70%) and unilateral in 6 cases (30%). Thus, better tumour yield was observed in RP specimens i.e., bilateral involvement in RP specimens was found in additional 5 cases (25%). Perineural involvement was higher in RP specimen i.e., 12 cases (60%), compared to 5 cases (25%) in TRUS biopsies. Its concordance was significantly higher in those with Gleason score of equal to or more than 7 (83%) and low in score less than score 7 (17%). Conclusion: When comparing RP to initial TRUS biopsies, Gleason score was upgraded in 35% and downgraded in 10% of cases. Bilateral involvement in 25% of cases of RP specimens was underestimated as unilateral involvement in TRUS biopsies. Perineural involvement with high Gleason score was also seen. 

A new prostate cancer biopsy reporting system with prognostic potential.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16572-e16572
Author(s):  
Paras Hemant Shah ◽  
Carl A. Olsson ◽  
David J Paulucci ◽  
Matthew Elmasri ◽  
Manish Arvind Vira ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Operating Characteristic ◽  
Reporting System ◽  
Gleason Grade ◽  
Grade Group ◽  
Multiple Cores ◽  
Positive Core ◽  
Cancer Biopsy ◽  
Extraprostatic Extension

e16572 Background: Presently, prostate biopsy (PBx) results typically report the highest Gleason Grade Group in the PBx as the single metric used to gauge the clinical aggressiveness of tumor and dictate treatment. However, using that single parameter alone limits the clinician by lack of consideration of the entire PBx. Intuitively we presumed that a PBx showing multiple cores of cancer would represent more aggressive disease. Herein, we propose the Weighted Gleason Grade Group (WGGG), a novel scoring system that synthesizes histopathologic data and cancer volume into a single numeric value representing the entire PBx, allowing the urologist to more accurately predict adverse pathologic outcomes of radical prostatectomy (RP). Methods: We studied 246 men who underwent RP after standard multi-core PBx. The highest Gleason score of each PBx was converted to its final GGG. The WGGG was calculated by summing the Gleason score of each positive core and normalized for a 12 core total. RP pathology was studied to determine adverse pathological outcomes, specifically, extraprostatic extension (EPE), positive surgical margins (PSM), seminal vesical invasion (SVI), pathological up-grading and any adverse feature. We then studied the ability of conventional GGG versus WGGG to have ‘predicted’ the risk of these adverse features comparing their respective receiver operating characteristic (ROC) areas under the curve (AUC) for each, as well as any adverse feature. Results: The AUC for the WGGG vs. GGG was significantly higher for predicting EPE (AUC 0.782 vs. 0.697, respectively; z = -3.29; p = .0009), PSM (AUC 0.644 vs. 0.563, respectively; z = -3.00; p = .0027), SVI (AUC 0.829 vs. 0.713, respectively; z = -3.05; p = .0023) and pathologic up-grading (AUC 0.584 vs. 0.349, respectively; z = -3.13; p = .002). Finally, the AUC for any adverse feature was 0.637 for WGGG versus 0.556 for GGG; z = -3.29; p = .001. Conclusions: The WGGG, by providing a metric reflecting the entirety of the PBx, is more informative than conventional single GGG alone in ‘predicting’ adverse pathologic outcomes on radical prostatectomy specimens. We are now studying if % cancer/ PBx core will improve WGGG performance.

A new technique of reporting prostate biopsy to predict prostatectomy outcome.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e544-e544
Author(s):  
Carl A. Olsson ◽  
Paras Hemant Shah ◽  
Oksana Yaskiv ◽  
Deepak A. Kapoor
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Prostate Biopsy ◽  
Lymphovascular Invasion ◽  
Gleason Grade ◽  
Grade Group ◽  
Multiple Cores ◽  
Positive Core ◽  
A New Technique ◽  
Extraprostatic Extension

e544 Background: Presently, the highest Gleason Grade Group (GGG) is the metric used to gauge the clinical aggressiveness of tumor and dictate treatment. However, the urologist is limited by lack of consideration of the entire biopsy using that single parameter alone. Intuitively we presumed that the biopsy showing multiple cores of cancer would represent more aggressive disease. Herein, we propose the Weighted Gleason Grade Group (WGGG), a novel scoring system that synthesizes histopathologic data and cancer volume into a single numeric value representing the entire biopsy that provides the urologist with the ability to more accurately predict adverse pathologic outcomes of prostatectomy. Methods: We studied 212 men who underwent radical prostatectomy after standard multi-core prostate biopsy. The highest Gleason score of each biopsy was converted to its final GGG. The WGGG was calculated by summing the Gleason score of each positive core and normalized for a 12 core total. Radical prostatectomy pathology was studied to determine adverse pathological outcomes, specifically, extraprostatic extension (EPE), positive surgical margins (PSM), lymphovascular invasion (LVI), seminal vesical invasion (SVI) and pathological upgrading. Logistic regression analysis was used to compare the ability of conventional GGG versus WGGG to predict the risk of these adverse features. Results: The odds ratio (OR) for predicting EPE, SVI and LVI for increasing GGG versus WGGG (in 10-point incremental increases) were 1.16 (95% CI 1.1-1.2, p < 0.001) versus 1.81 (95% CI 1.42-2.32, p < 0.001), versus 2.05 (95% CI 1.45-2.90, p < 0.001) and versus 3.46 (95% CI 1.99-6.04, p < 0.001), respectively. WGGG, but not GGG was significantly associated with PSM 1.07 (95% CI 1.029-1.104, p = 0.004) and pathologic upgrading 1.621 (95% CI 1.461- 1.837, p = 0.002) of the prostatectomy specimen. Conclusions: The WGGG, by providing a measurable value reflecting the entirety of the prostate biopsy, is more informative than conventional single GGG alone in reliably predicting adverse pathologic outcomes on radical prostatectomy specimens.

MRI-guided fusion biopsy of the prostate resection bed among post-radical prostatectomy patients with rising PSA.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 208-208
Author(s):  
Cheyenne Williams ◽  
Nabila Khondakar ◽  
Michael Daneshvar ◽  
Luke P. O'Connor ◽  
Jillian Egan ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Gland ◽  
Lesion Size ◽  
Prostate Tissue ◽  
Gleason Grade ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Prostate Bed ◽  
Gland Tissue ◽  
Benign Prostate

208 Background: Following treatment of prostate cancer with radical prostatectomy (RP), biochemical recurrence (BCR) can be detected with elevated PSA. This may be attributed to either cancer recurrence or retained benign prostatic gland tissue. Options for detecting malignancy after RP currently entail diagnostic imaging and biopsy with transrectal ultrasound (TRUS). TRUS alone has limited accuracy in detecting recurrence in the prostate bed. MRI fusion-guided biopsy (Fbx) may be a more accurate method of detecting post-RP local recurrence. We hypothesize that Fbx for diagnosing benign versus malignant recurrence in the prostate bed is feasible and produces clinically meaningful results. Methods: Our institutional database was queried for patients who received RP and demonstrated BCR between February 2015 and July 2020. All patients with evidence of prostate bed recurrence on mpMRI were included in this analysis. Cancer detection via mpMRI-guided fusion biopsy using the UroNav platform was evaluated and patient variables including final Gleason Grade group (GG), margin involvement, PSA at BCR, and prostate bed lesion size were analyzed with univariate logistic regression. Results: 40 patients (median age = 68) with BCR underwent post-RP mpMRI. 25/40 (62.5%) patients had MRI-visible lesions, and among those, 17/25 (68%) patients underwent Fbx of the prostate bed. 15/17 (88.2%) Fbxs detected prostate tissue (either benign or cancer), 11/17 (64.7%) contained cancer, and 4/17 (23.5%) contained benign prostate glands. Median cores per biopsy was 4 (IQR 4-6). Among the 83 cores obtained, 57 (68.6%) cores contained prostate gland tissue and 26 (31.3%) contained fibromuscular tissue. Of those 57 with gland tissue, 33 (57.9%) cores contained cancer, and 24 (42.1%) contained benign prostate tissue. Among patients with benign biopsies, none had further evidence of metastasis at median follow-up of 13.5 months after Fbx and 182 months after RP. On final RP pathology, 4 patients had GG1 disease, 4 had GG2, 4 had GG3, 2 had GG4, and 3 had GG5. 6/17 (35%) patients had positive RP margins. Median prostate bed lesion size was 1.3 cm (IQR 0.9-1.5). Prostate bed lesion size (cm) was the only variable significantly associated with cancer on Fbx (OR = 2.20, 95% CI:1.29-3.76, p = 0.011). Conclusions: mpMRI-Fbx is a feasible method for reliably targeting prostate bed lesions. With this technique, we found improved accuracy for biopsy-proven recurrence in the prostate bed. This technique will help direct treatment planning of salvage therapies among patients with detectable PSA post-RP. [Table: see text]

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.

Incidence and severity of prostate cancer (PCa) in 792 hypogonadal men with and without long-term testosterone therapy (TTh): Results from a controlled registry study.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 167-167
Author(s):  
Ahmad Haider ◽  
Karim Sultan Haider
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Tumor Grade ◽  
Tumor Stage ◽  
Observation Time ◽  
Testosterone Undecanoate ◽  
Total Observation Time ◽  
Total Observation

167 Background: There is no evidence that TTh in hypogonadal men increases PCa incidence or severity. A US-Scandinavian group recently found that men receiving TTh had lower risk of aggressive PCa (Loeb S et al., J Clin Oncol 2017; 35:1430-6). Methods: 412 men with testosterone ≤350 ng/dL and symptoms received testosterone undecanoate 1000 mg every 3 months for up to 12 years. 380 hypogonadal men (57-74) opted against TTh. Median follow-up: 9 years. Total observation time covered approximately 6,400 patient-years. Prostate volume (PV) and PSA were measured and digital rectal examination/transrectal ultrasound performed before treatment/observation initiation and then every 3-6 months (T-group) or once or twice per year (CTRL). Biopsies were performed when indicated according to EAU guidelines. Results: In the T-group, 11 men (2.7%) were diagnosed with PCa. In CTRL, 34 (8.9%) were diagnosed with PCa. The incidence per 10,000 years was 33 in the T-group and 108 in CTRL. The mean baseline age of PCa patients was 65.2 years in the T-group and 64.3 in CTRL. All PCa diagnoses in the T-group were made within the first 18 months of treatment initiation. In CTRL, PCa was diagnosed at any time during the observation time. In the T-group, radical prostatectomy was performed in all men. All but 1 patient had a Gleason score (GS) ≤6, and all but 1 a predominant GS of 3. Tumor grade was G2 in all 11 (100%), tumor stage T2a in 7 (64%), T2b in 3 (27%), and T2c in 1 (9%) patient(s). In CTRL, radical prostatectomy was performed in all but 6 patients. GS was > 6 in all 34 patients. 7 men had a GS of 7, 17 a GS of 8, and 10 a GS of 9. 2 men had a predominant Gleason score of 3, 22 had 4, and 10 had 5. Tumor grade was G2 in 6 (17.6%) and G3 in 28 (82.4%) patients, tumor stage T2c in 1 (0.3%), T3a in 3 (8.8%), T3b in 13 (38.2%) and T3c in 17 (50%) patients. In CTRL, biochemical recurrence occurred in 8 (23.5%) patients. These patients received androgen deprivation therapy (ADT). 10 (29.4%) patients died of whom 5 were on ADT. In the T-group, there were no biochemical recurrences or deaths during the observation time. Conclusions: In hypogonadal men, TTh may decrease PCa incidence compared to CTRL. PCa was less severe in the T-group.

Sign in / Sign up

Export Citation Format

Share Document