scholarly journals Neuroendocrine differentiation in prostate cancer

2004 ◽  
Vol 61 (5) ◽  
pp. 513-518 ◽  
Author(s):  
Snezana Cerovic ◽  
Goran Brajuskovic ◽  
Vinka Maletic-Vukotic ◽  
Sava Micic
Keyword(s):  
Prostate Cancer ◽  
Clinical Stage ◽  
Prognostic Significance ◽  
Specific Antigen ◽  
Neuron Specific Enolase ◽  
Neuroendocrine Differentiation ◽  
Current Evidence ◽  
Gleason Grade ◽  
Preoperative Serum ◽  
Significant Expression

Background. In numerous recent studies attention has been focused to neuroendocrine differentiation (NED) in prostate cancer (PC). Focal NED is present in almost all PCs, but it is prominent in only 5-10% of the carcinomas. The prognostic significance of focal NED in PC is controversial, but current evidence suggests its influence on the onset and/or conversion of hormon resistant tumor phenotype. The aim of this study was to evaluate the relationship between NED status, based only on immunohistochemical use of neuroendocrine (NE) markers, with PC grade and stage, and preoperative serum levels of prostate-specific antigen (PSA). Methods. The study included the biopsy material of 73 untreated PC patients (pts.) obtained by transurethral resection (TUR) (37 pts.), and radical retropubic prostatectomy (RRP) (36 pts.). Two representative tissue samples (tipically the block containing the largest amount of neoplasm) were selected for immunohistochemical (IMM) staining. NE cells were identified using a panel of IMM markers: chromogranin A, neuron-specific enolase, and serotonin. The level of PC exocrine differentiation was detected by monoclonal antibodies against PSA. Results. Significant expression of NE cells was demonstrated in 26 (70.2%) pts. with PC after TUR. In this group, serum preoperative PSA values ranged from 0.1 to 9.6 ng/ml. The majority of pts. with NED had low differentiated PC with Gleason grade score (GGS) >7, and normal PSA values below 4 ng/ml (77%), in clinical stage D (54%). Statistically significant correlation (p<0.01) of positive NED with higher stage and grade and low PSA values was established. Among the pts. with localized PC in whom RRP was performed (n=36), significant expression of NE cells was found in 15 pts. (41.7%), 8 (53.3%) in pT2 stage, and 7 (46.7%) in pT3 stage. Significant correlation between NED with preoperative PSA values and stage of PC in pts. with RRP was not found. Conclusion. We demonstrated the significant NED in poorly differentiated PC in patients in the advanced stage of the disease. The expression of NED in organ-confined PC did not correlate with tumor stage, but it correlated with tumor grade (GGS?7).

scholarly journals Correlation of focal neuroendocrine differentiation in prostate cancer with the parameters of predictive value

2019 ◽  
Vol 76 (11) ◽  
pp. 1115-1126 ◽  
Author(s):  
Milica Mijovic ◽  
Aleksandar Corac ◽  
Sonja Smiljic ◽  
Sladjana Savic ◽  
Predrag Mandic ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Predictive Value ◽  
Tumor Volume ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Neuroendocrine Differentiation ◽  
Secretory Cells ◽  
Biopsy Material ◽  
Preoperative Serum

Background/Aim. Neuroendocrine (NE) cells are one of the epithelial populations in the prostate. It is well-known that the focal neuroendocrine differentiation (FNED) in prostate cancer (PC) is an aggressive subtype that most commonly evolves from preexisting PC which does not respond to hormone therapy (androgen independed PC). The incidence and clinical importance of FNED in PC is not clearly understood because of conflicting results in the studies, and evaluation of FNED is not routinely performed in clinical practice. The aim of the present study is to determine the importance of FNED presence in the examined prostate changes with special reference to the relationship of FNED degree in PC with some parameters of predictive value [Gleason score, preoperative serum total prostata specific antigen (PSA) value, tumor volume and tumor stage]. Methods. The study included the biopsy material from 100 untreated consecutive prostate pathological changes: 70 PC, 20 prostatic intraepithelial neoplasia (PIN) and 10 benign prostatic hyperplasia (BPH). The patients with PIN and BPH were the control groups. A block containing part of the main bulk of pathological change was chosen as representative based on hematoxylin-eosin appearance, and a section of this block was immunohistochemically stained for the tissue PSA (to mark prostatic secretory cells) and chromogranin A, serotonin and synaptophysin (to mark NE cells). Results. We found a very pronounced degree of FNED differentiation in 16 (22.9%) PC. Ten (62.5%) of them had Gleason score ? 7, the average serum PSA level was 32.62 ? 30.80 ng/mL, average tumor volume was 43.18 ? 31.45 mL and 6 (37.5%) of this PC were detected in D clinical stage with distant hematogenous metastases. The FNED is negatively correlated with the serum PSA level, Gleason score and clinical stage positively correlated with the tumor volume, but without statistically significant differences. Conclusion. The FNED has no significant role in the prognosis of PC.

Prostate cancer

2017 ◽  
Author(s):  
Matthew Cooperberg ◽  
Peter Carroll
Keyword(s):  
Prostate Cancer ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Mortality Rates ◽  
Low Risk ◽  
Gleason Grade ◽  
Aggressive Treatment ◽  
Careful Monitoring ◽  
Biopsy Tissue

Management of prostate cancer remains controversial, in large part because of its wide heterogeneity in terms of aggressiveness and prognosis. Early detection efforts based on prostate specific antigen (PSA) and aggressive treatment of high-risk cancers have yielded major improvements in mortality rates, but overtreatment of low-risk cancers—those unlikely to cause symptoms or threaten life if they were never detected—is associated with high rates of avoidable toxicity and cost. Prostate cancer can be effectively risk-stratified based on tools (e.g. nomograms, CAPRA score) integrating the PSA level, Gleason grade, clinical stage, and extent of biopsy tissue involvement. Most men with low-risk tumours are eligible for active surveillance, a programme of careful monitoring based on PSA and follow-up biopsies. Men with higher-risk cancers are best served with radical prostatectomy or radiation therapy.

scholarly journals Preoperative Serum Prostate-specific Antigen (PSA) Below 10 μg/L Predicts Neither the Presence of Prostate Cancer Nor the Rate of Postoperative PSA Failure

2001 ◽  
Vol 47 (4) ◽  
pp. 631-634 ◽  
Author(s):  
Thomas A Stamey
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Serum Marker ◽  
Gleason Grade ◽  
Failure Rates ◽  
Preoperative Serum ◽  
Psa Failure ◽  
Relationship Of

Abstract Recent information on the relationship of serum prostate-specific antigen (PSA) to prostate cancer and new reports on death rates in men warrant a reassessment of how we diagnose and treat prostate cancer. We now know for the first time that the annual death rate from prostate cancer in men ≥65 years of age is only 226 per 100 000 men. At least 40 000 of 100 000 men over age 65 (40%) have invasive prostate cancer as judged by examination of prostates in 3- to 4-mm step-sections. Thus, only 1 of every 177 men 65 years of age or older (226 in 40 000) with invasive prostate cancer dies annually from his cancer. Serum PSA between 2 and 10 μg/L is used almost universally as an indication to biopsy the prostate. When 10–20 biopsies are commonly taken, it is not surprising that ∼40% of men are biopsy-positive for prostate cancer. Despite this reliance on serum PSA as an indication for biopsy, data at Stanford show no clinically useful relationship between preoperative serum PSA (in the range 2–10 mg/L) and the volume of Gleason grade 4/5 cancer or the volume of Gleason grades 3, 2, and 1 cancer, nor can we show any useful relationship of such preoperative PSA concentrations (2–10 μg/L) to biochemical PSA failure rates after radical prostatectomy. We urgently need a better serum marker for prostate cancer. Because PSA biochemical failure rates after radical prostatectomy are directly proportional to the amount of Gleason grade 4/5 cancer in the prostate, a serum marker of Gleason grade 4/5 carcinoma could be ideal.

Postoperative Nomogram for Disease Recurrence After Radical Prostatectomy for Prostate Cancer

1999 ◽  
Vol 17 (5) ◽  
pp. 1499-1499 ◽  
Author(s):  
Michael W. Kattan ◽  
Thomas M. Wheeler ◽  
Peter T. Scardino
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Disease Recurrence ◽  
Gleason Grade ◽  
Antigen Level ◽  
Serum Prostate Specific Antigen

PURPOSE: Although models exist that place patients into discrete groups at various risks for disease recurrence after surgery for prostate cancer, we know of no published work that combines pathologic factors to predict an individual's probability of disease recurrence. Because clinical stage and biopsy Gleason grade only approximate pathologic stage and Gleason grade in the prostatectomy specimen, prediction of prognosis should be more accurate when postoperative information is added to preoperative variables. Therefore, we developed a postoperative nomogram that allows more accurate prediction of probability for disease recurrence for patients who have received radical prostatectomy as treatment for prostate cancer, compared with the preoperative nomogram we previously published. PATIENTS AND METHODS: By Cox proportional hazards regression analysis, we modeled the clinical and pathologic data and disease follow-up for 996 men with clinical stage T1a-T3c NXM0 prostate cancer who were treated with radical prostatectomy by a single surgeon at our institution. Prognostic variables included pretreatment serum prostate-specific antigen level, specimen Gleason sum, prostatic capsular invasion, surgical margin status, seminal vesicle invasion, and lymph node status. Treatment failure was recorded when there was either clinical evidence of disease recurrence, a rising serum prostate-specific antigen level (two measurements of 0.4 ng/mL or greater and rising), or initiation of adjuvant therapy. Validation was performed on this set of men and a separate sample of 322 men from five other surgeons' practices from our institution. RESULTS: Cancer recurrence was noted in 189 of the 996 men, and the recurrence-free group had a median follow-up period of 37 months (range, 1 to 168 months). The 7-year recurrence-free probability for the cohort was 73% (95% confidence interval, 68% to 76%). The predictions from the nomogram appeared to be accurate and discriminating, with a validation sample area under the receiver operating characteristic curve (ie, a comparison of the predicted probability with the actual outcome) of 0.89. CONCLUSION: A postoperative nomogram has been developed that can be used to predict the 7-year probability of disease recurrence among men treated with radical prostatectomy.

scholarly journals Correlation of serum prostate specific antigen with clinical, radiological and pathological variables in patients with prostate enlargement

2019 ◽  
Vol 6 (12) ◽  
pp. 4408
Author(s):  
Tinku Antony ◽  
Raghav Talwar ◽  
Tina Thomas ◽  
Vikram Trehan ◽  
Shrikant Manwantkar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Threshold Level ◽  
Gleason Grade ◽  
Chi Square ◽  
Abdominal Ultrasonography ◽  
Prostate Enlargement

Background: Prostate enlargement encompasses a spectrum of disorders ranging from benign to malignant. For diagnostic prostatic biopsies no clear prostate specific antigen (PSA) threshold level exists. The study correlates PSA with various clinical data (age of patient, international prostate severity score (IPSS), digital rectal examination (DRE) finding), radiological data (prostate volume) and pathological data (Gleason grade, prostate cancer stage) to aid decision making on treatment of prostate enlargement.Methods: 101 men aged more than 50 years with fresh LUTS and grade 1 or more prostate enlargement on DRE were enrolled. They were worked up with transabdominal ultrasonography, serum PSA and prostate biopsy (when indicated). A descriptive statistical analysis was done for correlation by applying Pearson’s Chi square test for significance.Results: Mean serum PSA value was found to increase with age and higher IPSS score. Mean serum PSA levels were found to rise with grade of prostatomegaly. No significant correlation was seen between serum PSA values and Gleason grade or clinical stage of prostate cancer.Conclusions: Serum PSA levels has a significant correlation with age. With increasing age there is increase in serum PSA levels. Serum PSA levels has a significant correlation with International prostate symptom severity scoring. Serum PSA levels has a significant correlation with prostate size measured by trans-abdominal ultrasonography. Serum PSA levels does not show significant correlation with Gleason score or clinical stage of prostate cancer.

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