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 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.

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.

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.

Identifying Patients at Risk for Significant Versus Clinically Insignificant Postoperative Prostate-Specific Antigen Failure

2005 ◽  
Vol 23 (22) ◽  
pp. 4975-4979 ◽  
Author(s):  
Anthony V. D'Amico ◽  
Ming-Hui Chen ◽  
Kimberly A. Roehl ◽  
William J. Catalona
Keyword(s):  
Prostate Cancer ◽  
At Risk ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Study Cohort ◽  
Psa Failure ◽  
Psa Velocity

Purpose We evaluated whether men at risk for significant versus clinically insignificant prostate-specific antigen (PSA) failure after radical prostatectomy could be identified using information available at diagnosis. Patients and Methods A prospective prostate cancer screening study that enrolled, diagnosed, and treated 1,011 men with radical prostatectomy at Barnes-Jewish Hospital (St Louis, MO) from January 1, 1989, to June 1, 2002, for localized prostate cancer formed the study cohort. Preoperative predictors of a postoperative PSA doubling time (DT) of less than 3 months and more than 12 months or no PSA failure were identified using logistic regression. Results A preoperative PSA velocity more than 2.0 ng/mL/yr (P = .001) and biopsy Gleason score 7 (P = .006) or 8 to 10 (P = .003) were significantly associated with having a postoperative PSA DT less than 3 months. A PSA level less than 10 ng/mL (P = .005), a nonpalpable cancer (P = .001) with a Gleason score ≤ 6 (P = .0002), and a preoperative PSA increase that did not exceed 0.5 ng/mL/yr (P = .03) were significantly associated with a postoperative PSA DT of at least 12 months or no PSA failure. Most men with these preoperative characteristics and a postoperative PSA DT of 12 months or more had a persistent postoperative PSA level of at least 0.2 ng/mL that did not exceed 0.25 ng/mL after a median follow-up of 3.6 years. Conclusion A postoperative PSA DT less than 3 months is associated with a preoperative PSA velocity more than 2.0 ng/mL/yr and high-grade disease. Select men with a postoperative PSA DT more than 12 months may not require salvage radiation therapy.

Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low- or intermediate-risk disease.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 198-198
Author(s):  
N. D. Arvold ◽  
M. Chen ◽  
J. W. Moul ◽  
B. J. Moran ◽  
D. E. Dosoretz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Specific Antigen ◽  
Low Risk ◽  
Study Cohort ◽  
Intermediate Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference

198 Background: Radical prostatectomy (RP) and brachytherapy (BT) are widely utilized treatments for favorable-risk prostate cancer (PC). We estimated the risk of PC-specific mortality (PCSM) following RP or BT in men with low- or intermediate-risk PC using prospectively collected data. Methods: The study cohort comprised 5,760 men with low-risk PC (prostate-specific antigen [PSA] level ≤ 10 ng/mL, clinical category T1c or 2a, and Gleason score ≤ 6), and 3,079 men with intermediate-risk PC (PSA level 10-20 ng/mL, clinical T2b or T2c, or Gleason score 7). Competing risks multivariable regression was performed to assess risk of PCSM after RP or BT, adjusting for age, treatment year, cardiovascular comorbidity, and known PC prognostic factors. Results: There was no significant difference in the risk of PCSM among men with low-risk PC (11 vs. 6 deaths: adjusted hazard ratio [AHR], 1.62; 95% CI, 0.59–4.45; P = 0.35) who received BT compared to RP. However among men with intermediate-risk PC, despite significantly shorter median follow-up for men undergoing BT as compared to RP (4.1 vs. 7.2 years, P < 0.001), there was a trend toward an increased risk of PCSM (18 vs. 9 deaths: AHR, 2.30; 95% CI, 0.95–5.58; P = 0.07) for men treated with BT. Conclusions: The risk of PCSM among men with low-risk PC was not significantly different following RP or BT, however there may be a reduced risk of PCSM after RP as compared to BT in men with intermediate-risk PC. [Table: see text] No significant financial relationships to disclose.

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

Is systematic 10 core prostate needle biopsy enough for treatment determination of localized prostate cancer?

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 163-163
Author(s):  
Ryo Kishimoto ◽  
Ryuta Tanimoto ◽  
Kensuke Bekku ◽  
Yasuyuki Kobayashi ◽  
Shin Ebara ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Needle Biopsy ◽  
Chi Square ◽  
Prostate Needle Biopsy ◽  
Significant Difference ◽  
Chi Square Test

163 Background: To evaluate whether the systematic 10 cores prostate needle biopsy is enough for determination of NCCN risk classification (NRC), we analyzed migration of Gleason score (GS), cancer location, and NRC between pre and postoperative periods in a cohort of patients who underwent radical prostatectomy. Methods: A total of 197 patients were included in this study. These patients were divided into three groups along the number of biopsy cores: less than 10 (L), 10, and more than 10 (M). We compared between three groups about Gleason score, cancer location and NCCN risk classification change (CC) between prostate biopsy and radical prostatectomy specimen. Statistical analysis were performed with chi-square test, and multiple logistic regression with p<0.05, and Bonferroni correction with p<0.017 considered significant difference. Results: The rate of CC in L, 10, M was 55.1%, 43.0%, 26.5%, respectively. On chi-square test rates of CC were significantly different between three groups (P=0.035), but rates of Gleason score and cancer location were not. On univariate analysis, PSA (Odds rate (OR) 0.872 p<0.001), preoperative NRC (low vs. intermediate, and poor, OR 0.157 and 0.241, p<0.001), prostate volume (normal vs. mild or moderate, OR 1.989 p=0.025), the number of biopsy cores (L vs. M, OR 0.293 p=0.011), GS (6 vs. 8, OR 2.374 p=0.021) were correlated with CC. On multivariate analysis, the most important independent predictive factors for CC were preoperative NRC (low vs. intermediate, p<0.001, OR 0.198, 95% CI 0.09-0.45) and PSA (p=0.007, OR 0.903, 95%CI 0.83-0.98), but the number of biopsy cores was not associated CC significantly. Conclusions: Although multivariate analysis showed no significant difference, the more biopsy cores reduced the risk of CC. Systematic 10 core biopsy might be insufficient for accurate diagnosis and treatment decision of prostate cancer.

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