scholarly journals Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer

2013 ◽  
Vol 7 (1-2) ◽  
pp. 93 ◽  
Author(s):  
Stavros Sfoungaristos ◽  
Petros Perimenis
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Secondary Analysis ◽  
Intraepithelial Neoplasia ◽  
Treatment Modalities ◽  
Psa Density ◽  
Group 2

Introduction: Preoperative Gleason score is crucial, in combination with other preoperative parameters, in selecting the appropriate treatment for patients with clinically localized prostate cancer. The aim of the present study is to determine the clinical and pathological variables that can predict differences in Gleason score between biopsy and radical prostatectomy.Methods: We retrospectively analyzed the medical records of 302 patients who had a radical prostatectomy between January 2005 and September 2010. The association between grade changes and preoperative Gleason score, age, prostate volume, prostate-specific antigen (PSA), PSA density, number of biopsy cores, presence of prostatitis and high-grade prostatic intraepithelial neoplasia was analyzed. We also conducted a secondary analysis of the factors that influence upgrading in patients with preoperative Gleason score ≤6 (group 1) and downgrading in patients with Gleason score ≤7 (group 2).Results: No difference in Gleason score was noted in 44.3% of patients, while a downgrade was noted in 13.7% and upgrade in 42.1%. About 2/3 of patients with a Gleason score of ≤6 upgraded after radical prostatectomy. PSA density (p = 0.008) and prostate volume (p = 0.032) were significantly correlated with upgrade. No significant predictors were found for patients with Gleason score ≤7 who downgraded postoperatively.Conclusion: Smaller prostate volume and higher values of PSA density are predictors for upgrade in patients with biopsy Gleason score ≤6 and this should be considered when deferred treatment modalities are planned.

scholarly journals The role of PSA density to predict a pathological tumour upgrade between needle biopsy and radical prostatectomy for low risk clinical prostate cancer in the modified Gleason system era

2013 ◽  
Vol 7 (11-12) ◽  
pp. 722 ◽  
Author(s):  
Stavros Sfoungaristos ◽  
Ioannis Katafigiotis ◽  
Petros Perimenis
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Strong Predictor ◽  
Specific Antigen ◽  
Low Risk ◽  
Surgical Margins ◽  
Positive Surgical Margins ◽  
Psa Density

Objectives: We evaluate the role of prostate-specific antigen (PSA) density to predict Gleason score upgrade between prostate biopsy material and radical prostatectomy specimen examination in patients with low-risk prostate cancer.Methods: Between January 2007 and November 2011, 133 low-risk patients underwent a radical prostatectomy. Using the modified Gleason criteria, tumour grade of the surgical specimens was examined and compared to the biopsy results.Results: A tumour upgrade was noticed in 57 (42.9%) patients. Organ-confined disease was found in 110 (82.7%) patients, while extracapsular disease and seminal vesicles invasion was found in 19 (14.3%) and 4 (3.0%) patients, respectively. Positive surgical margins were reported in 23 (17.3%) patients. A statistical significant correlation between the preoperative PSA density value and postoperative upgrade was found (p = 0.001) and this observation had a predictive value (p = 0.002); this is in contrast to the other studied parameters which failed to reach significance, including PSA, percentage of cancer in biopsy and number of biopsy cores. Tumour upgrade was also highly associated with extracapsularcancer extension (p = 0.017) and the presence of positive surgical margins (p = 0.017).Conclusions: PSA density represents a strong predictor for Gleason score upgrade after radical prostatectomy in patients with clinical low-risk disease. Since tumour upgrade increases the potential for postoperative pathological adverse findings and prognosis, PSA density should be considered when treating and consulting patients with low-risk prostate cancer.

scholarly journals PSA density is superior than PSA and Gleason score for adverse

2013 ◽  
Vol 6 (1) ◽  
pp. 46 ◽  
Author(s):  
Stavros Sfoungaristos ◽  
Petros Perimenis
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Predictive Ability ◽  
Cancer Prognosis ◽  
Psa Density ◽  
Pathologic Features ◽  
Significant Difference

Introduction: Prostate-specific antigen (PSA) and its kinetics have changed prostate cancer screening and diagnosis. The aim of the present study was to evaluate their value in prostate cancer prognosis by determining the predictive potential of PSA density for adverse pathologic features after radical prostatectomy, in terms of positive surgical margins (PSM), extracapsular disease (ECD), seminal vesicle invasion (SVI) and/or lymph node invasion (LNI), and to compare their predictive ability with preoperative PSA and biopsy Gleason score.Methods: We retrospectively analysed 285 patients diagnosed with prostate cancer and underwent a retropubic radical prostatectomy for clinically localized disease. Data concerning preoperative PSA, biopsy Gleason score and PSA density were collected and analyzed. PSA density was calculated by dividing preoperative PSA and the pathological volume of the prostate.Results: There was a significant difference in PSA density valuesbetween patients with PSM, ECD, SVI and LNI. Areas under thecurve for PSA density were higher than those of PSA and Gleason score for all parameters of adverse pathology. In multivariate analyses, it was shown that PSA density and Gleason score were the only statistically significant predictors for PSM and ECD, PSA density and PSA for SVI and only PSA density for LNI.Conclusion: PSA density is an accurate predictor for adverse pathology prediction in patients undergoing radical prostatectomy. Theseresults demonstrate that this parameter is useful to determine the aggressiveness of prostate cancer and can be used as an adjunct in predicting outcomes after surgery.

scholarly journals Integrated predictive model for prostatic cancer using clinical, laboratory and ultrasound data

2016 ◽  
Vol 43 (6) ◽  
pp. 430-437
Author(s):  
GUSTAVO DAVID LUDWIG ◽  
HENRIQUE PERES ROCHA ◽  
LÚCIO JOSÉ BOTELHO ◽  
MAIARA BRUSCO FREITAS
Keyword(s):  
Prostate Cancer ◽  
Predictive Model ◽  
Prostate Biopsy ◽  
Clinical Laboratory ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Roc Curves ◽  
Rectal Examination ◽  
Psa Density

ABSTRACT Objective: to develop a predictive model to estimate the probability of prostate cancer prior to biopsy. Methods: from September 2009 to January 2014, 445 men underwent prostate biopsy in a radiology service. We excluded from the study patients with diseases that could compromise the data analysis, who had undergone prostatic resection or used 5-alpha-reductase inhibitors. Thus, we selected 412 patients. Variables included in the model were age, prostate specific antigen (PSA), digital rectal examination, prostate volume and abnormal sonographic findings. We constructed Receiver Operating Characteristic (ROC) curves and calculated the areas under the curve, as well as the model's Positive Predictive Value (PPV) . Results: of the 412 men, 155 (37.62%) had prostate cancer (PC). The mean age was 63.8 years and the median PSA was 7.22ng/ml. In addition, 21.6% and 20.6% of patients had abnormalities on digital rectal examination and image suggestive of cancer by ultrasound, respectively. The median prostate volume and PSA density were 45.15cm3 and 0.15ng/ml/cm3, respectively. Univariate and multivariate analyses showed that only five studied risk factors are predictors of PC in the study (p<0.05). The PSA density was excluded from the model (p=0.314). The area under the ROC curve for PC prediction was 0.86. The PPV was 48.08% for 95%sensitivity and 52.37% for 90% sensitivity. Conclusion: the results indicate that clinical, laboratory and ultrasound data, besides easily obtained, can better stratify the risk of patients undergoing prostate biopsy.

scholarly journals Subsequent prostate cancer detection in patients with prostatic intraepithelial neoplasia or atypical small acinar proliferation

2012 ◽  
Vol 1 (3) ◽  
Author(s):  
Moamen A. Amin ◽  
Suganthiny Jeyaganth ◽  
Nader Fahmy ◽  
Louis Bégin ◽  
Samuel Aronson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Specific Antigen ◽  
Intraepithelial Neoplasia ◽  
Prostatic Intraepithelial Neoplasia ◽  
Atypical Small Acinar Proliferation ◽  
Psa Density ◽  
Significant Difference ◽  
Initial Biopsy

Introduction: To evaluate the predictors of prostate cancer in follow-up of patientsdiagnosed on initial biopsy with high-grade prostatic intraepithelial neoplasia(HGPIN) or atypical small acinar proliferation (ASAP).Methods: We studied 201 patients with HGPIN and 22 patients with ASAPon initial prostatic biopsy who had subsequent prostatic biopsies. The meantime of follow-up was 17.3 months (range 1–62). The mean number of biopsy sessions was 2.5 (range 2–6), and the median number of biopsy cores was10 (range 6–14).Results: On subsequent biopsies, the rate of prostate cancer was 21.9% (44/201)in HGPIN patients. Of these, 32/201 patients (15.9%), 9/66 patients (13.6%)and 3/18 patients (16.6%) were found to have cancer on the first, second and third follow-up biopsy sessions, respectively. In ASAP patients, the cancer detectionrate was 13/22 (59.1%), all of whom were found on the first follow-upbiopsy. There was a statistically significant difference between the cancer detectionrate in ASAP and HGPIN patients (p < 0.001). Multivariate analysis showedthat the independent predictors of cancer were the number of cores in theinitial biopsy, the number of cores (> 10) in the follow-up biopsy and a prostate specific antigen (PSA) density of ≥ 0.15 (odds ratio 0.77, 3.46 and 2.7,8 respectively;p < 0.04). Conversely, in ASAP patients none of these variables werefound to be associated with cancer diagnosis.Conclusion: ASAP is a strong predictive factor associated with cancer when comparedwith HGPIN. The factors predictive of cancer on follow-up biopsy ofHGPIN are number of cores on initial biopsy, more than 10 cores in rebiopsyand elevated PSA density. As the cancer detection rate on repeated biopsy of HGPIN patients is the same as that of patients without HGPIN, perhaps the standard of repeat biopsy in all patients with HGPIN should be revisited.

Oncological outcomes of surgery in very high risk pT3b prostate cancer

2011 ◽  
Vol 18 (3) ◽  
pp. 113-119
Author(s):  
Daimantas MILONAS ◽  
Giedrė SMAILYTĖ ◽  
Darius TRUMBECKAS ◽  
Mindaugas JIEVALTAS
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Cox Regression ◽  
Locally Advanced ◽  
Specific Antigen ◽  
Oncologic Outcomes ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Surgery Outcome

Background. The aim of the study was to present the oncologic outcomes and to determine the prognostic factors of overall (OS) and cancer-specific survival (CSS) as well as disease-progression-free survival (DPFS) after surgery for pT3b prostate cancer. Materials and methods. In 2002–2007, a pT3b stage after radical prostatectomy was detected in 56 patients. Patients were divided into groups according to the prostate-specific antigen (PSA) level (20 ng/ml), lymph nodes status (N0 vs. Nx vs. N1) and the Gleason score (6–7 vs. 8–10). The Kaplan–Meier analysis was used to calculate OS, CSS and DPFS. The Cox regression was used to identify the predictive factors of survival. Results. Five-year OS, CSS and DPFS rates were 75.1%, 79.6% and 79.3%, respectively. The survival was significantly different when comparing the Gleason 6–7 and 8–10 groups. The 5-year OS, CSS and DPFS were 91.2% vs. 48.6%, 97.1% vs. 51.1% and 93.8 vs. 51.1%, respectively. There was no difference in survival among the groups with a different PSA level. The OS and CSS but not DPFS were significantly different when comparing the N0 and N1 groups. The 5-year OS and CSS was 84.4% vs. 37.5% and 87.3% vs. 47.6%, respectively. The specimen Gleason score was a significant predictor of OS and CSS. The risk of death increased up to 4-fold when a Gleason score 8–10 was present at the final pathology. Conclusions. Radical prostatectomy may offer acceptable CSS, DPFS and OS rates in pT3b PCa. However, outcomes in patients with N1 and specimen Gleason ≥8 were significantly worse, suggesting the need of multimodality treatment in such cases. Keywords: prostate cancer, locally advanced, surgery, outcome

Advancing age and the risk of adverse pathology at radical prostatectomy in men with biopsy Gleason score 6 prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 289-289
Author(s):  
Daniel Kim ◽  
Ming-Hui Chen ◽  
Hartwig Huland ◽  
Markus Graefen ◽  
Derya Tilki ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Specific Antigen ◽  
Cancer Center ◽  
Study Cohort ◽  
Pathologic Features ◽  
Younger Men ◽  
Biopsy Gleason Score ◽  
The Impact

289 Background: We evaluated the impact of age > 65 years versus younger on the odds of finding adverse pathologic features (pT3/T4 and/or R1 and/or Gleason score 8, 9, 10) at radical prostatectomy (RP) among men with biopsy Gleason score 6 prostate cancer (PC). Methods: The study cohort comprised 3191 men with biopsy Gleason score 6 PC treated with a RP between February 28, 1992 and February 15, 2016 at the Martini-Klinik Prostate Cancer Center. Multivariable logistic regression was used to evaluate the impact of age > 65 years versus younger on the adjusted odds ratio (AOR) of finding adverse pathology at RP adjusting for pre-RP prostate specific antigen (PSA), clinical tumor category, year of diagnosis, percent positive biopsies (PPB), and PSA density (PSAd). Results: Men age > 65 years as compared to younger had significantly lower median PPB (16.67% vs 20.0%; p = 0.01) and PSAd (0.13 ng/mL vs 0.15 ng/mL; p < 0.0001). Yet, while both increasing PPB (AOR 1.018, 95% CI 1.013, 1.023; p- < 0.0001) and PSAd (AOR 4.28, 95% CI 1.66, 11.01; p = 0.003) were significantly associated with an increased odds of finding adverse pathology at RP, men age > 65 years versus younger had a higher odds of adverse pathology at RP (AOR 1.28, 95% CI 1.002, 1.62; p = 0.048). Conclusions: Despite a more favorable median PPB and PSAd, men with biopsy Gleason score 6 PC and who are age > 65 years compared to younger men are at higher risk for having adverse pathology at RP and may benefit from a multiparametric MRI and targeted biopsy before proceeding with active surveillance. If higher grade/stage disease is discovered and treatment indicated then this information could guide both the use and duration of supplemental androgen deprivation therapy in men considering radiation therapy.

Prognostic Value of Endocan in Prostate Cancer: Clinicopathologic Association between Serum Endocan Levels and Biochemical Recurrence after Radical Prostatectomy

2016 ◽  
Vol 103 (2) ◽  
pp. 204-208 ◽  
Author(s):  
Burak Arslan ◽  
Özkan Onuk ◽  
İsmet Hazar ◽  
Muammer Aydın ◽  
Nusret Can Çilesiz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Elevated Serum ◽  
Progression Free Survival ◽  
Control Group ◽  
Free Survival ◽  
Biochemical Progression

Purpose To assess the diagnostic capability of serum endocan level in association with clinicopathologic features and its impact on biochemical progression-free survival in patients with prostate cancer (PCa). Methods A total of 86 patients with localized prostate cancer were treated with open radical prostatectomy (RP). The control group included 80 patients who were referred to the urology outpatient clinic with normal rectal examination and prostate-specific antigen (PSA) levels. The patients’ characteristics, baseline PSA value, and serum endocan levels were recorded. The patients were followed up with the measurement of PSA concentration every 3 months during the first year, thereafter every 6 months until 5 years, then yearly after surgery. The primary endpoint of follow-up was the time of biochemical recurrence. Results The median serum endocan levels were 3.14 ng/mL in the RP group and 2.98 ng/mL in the control group (p = 0.122). A total of 86 patients who underwent RP for PCa were divided into 2 groups based on a cutoff serum endocan level of 1.8 ng/mL. The distribution of Gleason score and biochemical failure rate were significantly higher in patients with serum endocan ≥1.8 ng/mL (p = 0.031 and p = 0.047). The biochemical recurrence-free time for endocan ≥1.8 ng/mL and <1.8 ng/mL were 38 and 56 months, respectively (p = 0.041). Spearman correlation analysis showed a linear relationship between endocan expression and Gleason score (p = 0.025, p = 0.511). Multivariate analysis revealed that elevated serum endocan level (≥1.8 ng/mL) was a significant predictor of biochemical progression-free survival (hazard ratio 2.44; 95% confidence interval 1.78-3.23; p = 0.001). Conclusions The current study indicates that endocan has a close relationship with tumor recurrence in PCa.

scholarly journals Ar galima remiantis objektyviais ikioperaciniais veiksniais prognozuoti ankstyvą biocheminį atkrytį po radikalios prostatektomijos?

2005 ◽  
Vol 3 (4) ◽  
pp. 0-0
Author(s):  
Daimantas Milonas ◽  
Dainius Burinskas ◽  
Stasys Auškalnis ◽  
Mindaugas Jievaltas
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Biochemical Failure ◽  
Surgical Margins ◽  
Antigen Concentration ◽  
The Mean

Daimantas Milonas, Dainius Burinskas, Stasys Auškalnis, Mindaugas JievaltasKauno medicinos universiteto Urologijos klinika,Eivenių g. 2, LT-50009 KaunasEl paštas: [email protected] Tikslas Nustatyti objektyvius veiksnius, kurie leistų prognozuoti ankstyvą biocheminį atkrytį po radikalios prostatektomijos. Ligoniai ir metodai Į tyrimą įtraukti 142 prostatos vėžiu sergantys ligoniai, kuriems buvo atliktos radikalios prostatektomijos. Ankstyvas biocheminis atkrytis konstatuotas, kai prostatos specifinio antigeno koncentracija, praėjus 3 mėn. po operacijos, buvo >0,2 ng/ml. Neoadjuvantinė terapija (hormonų ar spindulių) buvo pagrindinis atmetimo kriterijus. Vertinta prostatos specifinio antigeno koncentracija, vėžio diferenciacijos laipsnis iki ir po operacijos, vėžio stadija, prostatos chirurginio šalinimo išlaidos. Rezultatai Galutinei analizei panaudoti 94 ligonų duomenys. Vidutinis jų amžius buvo 66,6 metų, prostatos specifinis antigenas iki operacijos – 9,87 ng/ml, Gleason diferenciacijos laipsnis iki operacijos – 5,87, diferenciacijos laipsnis po operacijos – 6,38, teigiami rezekciniai kraštai rasti 36 (38%), ankstyvas biocheminis atkrytis – 13 (14%) pacientų. Atlikus logistinę regresijos analizę nustatyta, jog ankstyvą biocheminį atkrytį galima patikimai prognozuoti, kai Gleason pooperacinis vėžio diferenciacijos laipsnis didesnis nei 7 (p = 0,02, tikimybių santykis – 7,8) ir vėžio stadija T3b (p = 0,012, tikimybių santykis – 6,76). Išvados Remiantis ikioperaciniais objektyviais veiksniais negalima patikimai prognozuoti ankstyvo biocheminio atkryčio. Prostatos vėžio išplitimas į sėklines pūsleles (T3b stadija) ir Gleasono pooperacinis vėžio diferenciacijos laipsnis > 7 leidžia reikšmingai prognozuoti ankstyvą biocheminį atkryti, po radikalios prostatektomijos, tokiems ligoniams indikuojamas ankstyvas adjuvantinis gydymas, nelaukiant biocheminio atkryčio požymių. Reikšminiai žodžiai: prostatos vėžys, radikali prostatektomija, ankstyvas biocheminis atkrytis Can objective preoperative parameters predict early biochemical recurrence after radical prostatectomy? Daimantas Milonas, Dainius Burinskas, Stasys Auškalnis, Mindaugas JievaltasClinic of Urology, Kaunas University of Medicine,Eivenių str. 2, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Objective To estimate objective parameters which can be useful for predicting early biochemical recurrence after radical prostatectomy due to prostate cancer. Patients and methods The study embraced 142 patients that underwent radical retropubic prostatectomy. Early biochemical failure was defined as a prostate-specific antigen level 3 months after radical prostatectomy > 0.2 ng/ml. Neoadjuvant treatment (hormonal therapy or radiation) was the mane exclusion criteria. Preoperative antigen concentration, Gleason score at the biopsy, patients’ age, postoperative Gleason score, stage and surgical margins were investigated as possible predictors of early biochemical recurrence. Results Final analysis was done using data on 94 patients. The mean patients’ age was 66.6 years and mean preoperative prostate specific antigen concentration 9.87 (range 0.44–98.4) ng/ml. The mean Gleason score preoperatively was 5.87 (range 2–8) and postoperatively 6.38 (range 4–9). Positive surgical margins were in 36 (38%) and early biochemical failure was detected in 13 (14%) cases. Logistic regression analysis shows that postoperative Gleason score >7 (p = 0.02, OR-7.8) and stage pT3b (p = 0.012, OR-6.76) are powerful parameters for predicting early biochemical recurrence. Conclusions Preoperative parameters cannot predict early biochemical recurrence. Postoperative parameters such as Gleason score >7 and stage pT3b are useful in the prediction of early biochemical recurrence. In such patients early adjuvant treatment is advisable. Keywords: prostate cancer, radical prostatectomy, early biochemical recurrence

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