scholarly journals Clinical outcome comparison of Grade Group 1 and Grade Group 2 prostate cancer with and without cribriform architecture at the time of radical prostatectomy

2020 ◽  
Vol 76 (5) ◽  
pp. 755-762 ◽  
Author(s):  
Eva Hollemans ◽  
Esther I Verhoef ◽  
Chris H Bangma ◽  
John Rietbergen ◽  
Monique J Roobol ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Clinical Outcome ◽  
Grade Group ◽  
Outcome Comparison ◽  
Group 2 ◽  
Group 1

scholarly journals Patient-level detection of grade group ≥2 prostate cancer using quantitative diffusion MRI

2021 ◽  
Author(s):  
Allison Y Zhong ◽  
Leonardino A Digma ◽  
Troy Hussain ◽  
Christine H Feng ◽  
Christopher C Conlin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Characteristic Curve ◽  
Grade Group ◽  
Bootstrap Confidence Intervals ◽  
Patient Level ◽  
Apparent Diffusion ◽  
Spectrum Imaging ◽  
Group 2 ◽  
Clinically Significant ◽  
Group 1

Purpose: Multiparametric MRI (mpMRI) improves detection of clinically significant prostate cancer (csPCa), but the qualitative PI-RADS system and quantitative apparent diffusion coefficient (ADC) yield inconsistent results. An advanced Restrictrion Spectrum Imaging (RSI) model may yield a better quantitative marker for csPCa, the RSI restriction score (RSIrs). We evaluated RSIrs for patient-level detection of csPCa. Materials and Methods: Retrospective analysis of men who underwent mpMRI with RSI and prostate biopsy for suspected prostate cancer from 2017-2019. Maximum RSIrs within the prostate was assessed by area under the receiver operating characteristic curve (AUC) for discriminating csPCa (grade group ≥2) from benign or grade group 1 biopsies. Performance of RSIrs was compared to minimum ADC and PI-RADS v2-2.1via bootstrap confidence intervals and bootstrap difference (two-tailed α=0.05). We also tested whether the combination of PI-RADS and RSIrs (PI-RADS+RSIrs) was superior to PI-RADS, alone. Results: 151 patients met criteria for inclusion. AUC values for ADC, RSIrs, and PI-RADS were 0.50 [95% confidence interval: 0.41, 0.60], 0.76 [0.68, 0.84], and 0.78 [0.71, 0.85], respectively. RSIrs (p=0.0002) and PI-RADS (p<0.0001) were superior to ADC for patient-level detection of csPCa. The performance of RSIrs was comparable to that of PI-RADS (p=0.6). AUC for PI-RADS+RSIrs was 0.84 [0.77, 0.90], superior to PI-RADS or RSIrs, alone (p=0.008, p=0.009). Conclusions: RSIrs was superior to conventional ADC and comparable to (routine, clinical) PI-RADS for patient-level detection of csPCa. The combination of PI-RADS and RSIrs was superior to either alone. RSIrs is a promising quantitative marker worthy of prospective study in the setting of csPCa detection.

The impact of tertiary Gleason pattern 5 in the grade group system on recurrence following radical prostatectomy in patients with prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 44-44
Author(s):  
Masashi Kato ◽  
Toyonori Tsuzuki ◽  
Ryo Ishida ◽  
Tohru Kimura ◽  
Osamu Kamihira ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Grade Group ◽  
Group System ◽  
Gleason Pattern ◽  
Group 4 ◽  
Significant Difference ◽  
Psa Progression ◽  
Group 3 ◽  
Group 2

44 Background: The current ISUP/WHO grade group system classified the Gleason grade into five groups. Although presence of tertiary Gleason pattern 5 (tG5) reported to be related with unfavorable tumor characteristic, only a few data is available about influences on the grade group system of tG5 so far. In this study, we evaluated the effect of tG5 on recurrence following radical prostatectomy in patients with prostate cancer. Methods: We retrospectively evaluated 1,020 patients with prostate cancer who underwent radical prostatectomy without neoadjuvant therapy at the hospitals that the authors were affiliated with between 2005 and 2013. After excluding the patients with missing data or slides, 1000 patients were enrolled in this study. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014. Recurrence following radical prostatectomy was defined according to European Association of Urology guidelines. The endpoint was defined as an increase in PSA level. Results: Patient median age was 67 years (range 49–77 years). The median serum PSA was 6.9 ng/mL (range 0.4–82 ng/mL). The median follow-up period was 69 months (range 0.7–134 months). All the patients showed Group1:163 cases (16.3%), Group2: 436 (43.6%), Group 2 with tG5: 54 (5.4%), Group 3:121 (12.1%), Group 3 with tG5: 89 (8.9%), Group 4: 39 (3.9%), and Group 5: 98 (9.8%). PSA progression-free survival was significantly different among the five groups (Group1-5) (p = 0.0001). As concerning tG5, it showed significant difference between Group 2 and Group 2 with tG5 by using log rank test (p < 0.0001). Similarly, there was significant difference between Group 3 and Group 3 with tG5 (p = 0.001). On the other hand, there was no difference between Group 2 with tG5 and Group 3 (p = 0.916), and in the same way, no difference between Group 3 with tG5 and Group 4 (p = 0.854). Conclusions: The Presence of tG5 on the grade group system increase PSA progression following radical prostatectomy in patients with prostate cancer. Especially, Group 2 and 3 showed upgrade by presence of tG5. Integrating tG5 into the grade group system will improve the accuracy of patient outcome predictions.

A nationwide trend away from radical prostatectomy for Gleason grade group 1 prostate cancer

2021 ◽  
Author(s):  
Joseph B John ◽  
John Pascoe ◽  
Sarah Fowler ◽  
Thomas Walton ◽  
Mark Johnson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Grade ◽  
Grade Group ◽  
Group 1

scholarly journals Pathological correlation between needle biopsy and radical prostatectomy specimen in patients with localized prostate cancer

2012 ◽  
Vol 1 (3) ◽  
Author(s):  
Muhammad A. Bulbul ◽  
Yaser El-Hout ◽  
Maurice Haddad ◽  
Ayman Tawil ◽  
Ali Houjaij ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Needle Biopsy ◽  
Positive Margins ◽  
Final Pathology ◽  
Bilateral Disease ◽  
Unilateral Disease ◽  
Group 2 ◽  
Group 1

Objective: This study aims to evaluate the accuracy of transrectal ultrasound (TRUS) guided prostate biopsies in predicting pathological grading and tumour distributionin the final pathological specimen of patients who underwent radical prostatectomy for clinically localized prostate cancer. The study ultimately aimsto gain more understanding of the pathological behaviour of prostate cancerand the limitations of the currently available diagnostic and prognostic tools.Material and Methods: We reviewed the records of 100 patients with localizedcarcinoma of the prostate diagnosed by TRUS-guided prostate biopsyand treated with radical retropubic prostatectomy, comparing tumour lateralityand Gleason score in core biopsies with tumour distribution and Gleasonscore of the surgical specimen. We then correlated both results to diagnosticand prognostic variables such as prostate specific antigen (PSA) values and surgical margins.Results: All 44 patients with bilateral disease on needle biopsy had bilateral diseaseon final pathology, with 15 of these patients (34%) having positive margins.Of the 56 patients with unilateral disease on biopsy, 37 (66%) had bilateral disease on final pathology; however, only 4 of them (7%) had positive margins (p < 0.001). Median Gleason score on final pathology was upgraded to 7, compared with a median score of 6 on biopsies. Stratifying patients to 2 groups based on their PSA level (group 1: PSA < 10 ng/mL, 72 patients; group2: PSA > 10ng/mL, 28 patients), revealed that 57patients (79%) in group 1and 24 patients (85%) in group 2 had bilateral disease. In addition, 13 patients(18%) in group 1 and 6 patients (21%) in group 2 had positive margins.Conclusions: Sixty-six percent of patients with unilateral disease on needlebiopsy had bilateral disease on final pathology, but this does not increasetheir rate of having positive margins. Gleason score is upgraded from 6 to7. PSA did not seem to affect laterality of disease in patients selected forradical prostatectomy.

scholarly journals Practice Patterns in Reporting Tertiary Grades at Radical Prostatectomy: Survey of a Large Group of Experienced Urologic Pathologists

2019 ◽  
Vol 144 (3) ◽  
pp. 356-360
Author(s):  
Samson W. Fine ◽  
Debra L. Meisels ◽  
Andrew J. Vickers ◽  
Hikmat Al-Ahmadie ◽  
Ying-Bei Chen ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Online Survey ◽  
Practice Patterns ◽  
Grade Group ◽  
Future Studies ◽  
Group Assignment ◽  
Group 2 ◽  
High Consistency ◽  
Minor Pattern ◽  
Group 1

Context.— In prostate cancer, “tertiary” higher-grade patterns (TPs) have been associated with biochemical recurrence after radical prostatectomy. Objective.— To determine variation regarding definition and application of TPs. Design.— Online survey regarding TPs in a range of grading scenarios circulated to 105 experienced urologic pathologists. Results.— Among 95 respondents, 40 of 95 (42%) defined TPs as “third most common pattern” and 55 (58%) as “minor pattern/less than 5% of tumor.” In a tumor with pattern 3 and less than 5% pattern 4, of the 95 respondents, 35 (37%) assigned 3 + 3 = 6 with TP4, while 56 (59%) assigned 3 + 4 = 7. In a tumor with pattern 4 and less than 5% pattern 5, of the 95 respondents, 51 (54%) assigned 4 + 4 = 8 with TP5, while 43 (45%) assigned 4 + 5 = 9. Six scenarios were presented in which the order of most common patterns was 3, 4, and 5 (Group 1) or 4, 3, and 5 (Group 2) with varying percentages. In both groups, when pattern 5 was less than 5%, we found that 98% and 93% of respondents would assign 3 + 4 = 7 or 4 + 3 = 7 with TP5. In scenarios with 15% or 25% pattern 5, most respondents (70% and 80%, respectively) would include pattern 5 as the secondary grade, that is, 3 + 5 = 8 (Group 1) or 4 + 5 = 9 (Group 2). For 85 of 95 (89%), a TP would not impact Grade Group assignment. Conclusions.— This survey highlights substantial variation in practice patterns regarding definition and application of “tertiary” grading in radical prostatectomy specimens. High consistency was observed in 3 + 4 = 7/4 + 3 = 7 scenarios with truly minor pattern 5. These findings should inform future studies assessing the standardization and predictive value of “tertiary” patterns.

scholarly journals Increased Body Mass Index Is a Risk Factor for Poor Clinical Outcomes after Radical Prostatectomy in Men with International Society of Urological Pathology Grade Group 1 Prostate Cancer Diagnosed with Systematic Biopsies

2021 ◽  
pp. 1-8
Author(s):  
Matteo Ferro ◽  
Daniela Terracciano ◽  
Gennaro Musi ◽  
Ottavio de Cobelli ◽  
Mihai Dorin Vartolomei ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Body Mass Index ◽  
Risk Factor ◽  
Radical Prostatectomy ◽  
Body Mass ◽  
International Society ◽  
Specific Antigen ◽  
Characteristic Analysis ◽  
Grade Group ◽  
Group 1

<b><i>Introduction:</i></b> The association between obesity and clinically significant prostate cancer (PCa) is still a matter of debate. In this study, we evaluated the effect of body mass index (BMI) on the prediction of pathological unfavorable disease (UD), positive surgical margins (PSMs), and biochemical recurrence (BCR) in patients with clinically localized (≤cT2c) International Society of Urological Pathology (ISUP) grade group 1 PCa at biopsy. <b><i>Methods:</i></b> 427 patients with ISUP grade group 1 PCa who have undergone radical prostatectomy and BMI evaluation were included. The outcome of interest was the presence of UD (defined as ISUP grade group ≥3 and pT ≥3a), PSM, and BCR. <b><i>Results:</i></b> Statistically significant differences resulted in comparing BMI with prostate-specific antigen (PSA) and serum testosterone levels (both <i>p</i> &#x3c; 0.0001). Patients with UD and PSM had higher BMI values (<i>p</i> &#x3c; 0.0001 and <i>p</i> = 0.006, respectively). BCR-free survival was significantly decreased in patients with higher BMI values (<i>p</i> &#x3c; 0.0001). BMI was an independent risk factor for BCR and PSM. Receiver-operating characteristic analysis testing PSA accuracy in different BMI groups, showed that PSA had a reduced predictive value (area under the curve [AUC] = 0.535; 95% confidence interval [CI] = 0.422–0.646), in obese men compared to overweight (AUC = 0.664; 95% CI = 0.598–0.725) and normal weight patients (AUC = 0.721; 95% CI = 0.660–0.777). <b><i>Conclusion:</i></b> Our findings show that increased BMI is a significant predictor of UD and PSM at RP in patients with preoperative low-to intermediate-risk diseases, suggesting that BMI evaluation may be useful in a clinical setting to identify patients with favorable preoperative disease characteristics harboring high-risk PCa.

The fluciclovine (FACBC) PET/CT site-directed therapy of oligometastatic prostate cancer (Flu-BLAST-PC) trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS5099-TPS5099
Author(s):  
Risa Liang Wong ◽  
Sarah K Holt ◽  
Jing Zeng ◽  
Laura Graham ◽  
Rachel Kang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
The United States ◽  
Abiraterone Acetate ◽  
Ct Imaging ◽  
Definitive Treatment ◽  
Pet Ct ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

TPS5099 Background: Patients with biochemical recurrence (BCR) after local definitive therapy for prostate cancer (PC) represent the largest group of patients alive with PC in the United States. For patients with BCR after both radical prostatectomy and radiation, no further definitive treatment options currently exist as standard of care. FACBC PET/CT is a next-generation imaging modality approved in 2016 for suspected PC recurrence based on elevated PSA levels following prior treatment. FACBC PET/CT allows for earlier detection at lower PSA levels of oligometastatic PC in patients who would otherwise be considered as having micro-metastatic disease. FACBC PET/CT may provide potential targets for site-directed therapy; however, it is unknown whether this approach leads to improvement in clinically relevant outcomes. Methods: Flu-BLAST-PC (ClinicalTrials.gov Identifier: NCT0417543) is a prospective, interventional study enrolling men with PC and BCR who have previously undergone both radical prostatectomy and adjuvant or salvage radiation to the prostatic fossa, with PSA ≥0.5 to < 10 ng/mL, PSA doubling time > 3 to < 18 months, and no radiographically detectable metastases by conventional CT and bone scan imaging. Enrolled patients undergo FACBC PET/CT imaging, and those with no PC metastases detected (Group 1) undergo observation with repeat FACBC PET/CT performed at PSA thresholds of > 2 and > 5 ng/mL, with eligibility for the trial ending at PSA ≥10 ng/mL if FACBC PET/CT remains negative. Those with 1-3 PC regions (defined as radiation fields) detected on FACBC PET/CT (Group 2) undergo site-directed therapy with surgery (e.g. lymphadenectomy) and/or radiation, as well as six months of systemic treatment with androgen deprivation therapy (ADT) and abiraterone acetate with prednisone. Patients with ≥4 PC regions detected on FACBC PET/CT (Group 3) undergo six months of ADT and abiraterone acetate with prednisone without any site-directed therapy. Patients initially in Group 1 who subsequently have PC metastases detected on repeat FACBC PET/CT imaging per protocol join Group 2 or Group 3 based on the number of PC regions involved. Given the long anticipated survival of patients with PC and BCR, the primary endpoint of the study is undetectable PSA ( < 0.2 ng/mL) rate in Group 2 at two years beyond study treatment, with secondary endpoints including the same outcome measure for Group 3, undetectable PSA rate two years after testosterone recovery from ADT in Groups 2 and 3, time to re-initiation of ADT, overall survival, and safety and tolerability. Assuming a null hypothesis of 15% undetectable PSA rate for patients with BCR two years after completing ADT and alternative hypothesis of improvement to 40% in Group 2, planned enrollment is 65 patients in Group 2. This will provide 90% power at the two-sided significance level of 0.05. Five patients have enrolled to date. Clinical trial information: NCT0417543.

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