Difference In Biochemical Recurrence Rate Research Articles

Risk and predictors of adverse pathology after radical prostatectomy in patients diagnosed with IUSP 1–2 prostate cancer at MRI-targeted biopsy: a multicenter analysis

PurposeAlthough active surveillance (AS) is recommended for low- to favorable intermediate-risk prostate cancer (PCa), risk of upgrading at radical prostatectomy (RP) is not negligible. Available studies based on systematic transrectal ultrasound biopsy might not be applicable to contemporary cohorts diagnosed with MRI-targeted biopsy (TB). The aim of the present study is to explore rates and risk factors for adverse outcomes (AO) at RP in patients with ISUP ≤ 2 PCa detected at TB with concomitant systematic biopsy (SB).MethodsMulticenter, retrospective analysis of 475 consecutive patients with ISUP ≤ 2 PCa at MRI-TB + SB is treated with RP. AO were defined as ISUP upgrading, adverse pathology (upgrading to ISUP ≥ 3 and/or ≥ pT3 at RP, and/or pN1) (AP) or biochemical recurrence (BCR) in men with follow-up (n = 327).ResultsThe rate of ISUP upgrading, upgrading ≥ 3, and AP were 39%, 21%, and 43%. Compared to ISUP2, men with ISUP1 PCa had a higher rate of overall upgrading (27 vs. 67%, p < 0.001), but less upgrading to ≥ 3 (27 vs. 10%, p < 0.001). AP was more common when ISUP2 was detected with a combined MRI-TB + SB approach compared to considering TB (p = 0.02) or SB (p = 0.01) alone. PSA, PSA density, PI-RADS, ISUP at TB, overall biopsy ISUP and EAU classification were predictors of upgrading to ISUP ≥ 3 and AP. The 1 year BCR-free survival was 94% with no differences in BCR rates between subgroups.ConclusionUpgrading in ISUP ≤ 2 PCa remains prevalent even in men diagnosed in the MRI era. The use of MRI-TB with concomitant SB allows for the accurate identification of ISUP2 PCa and predicts the risk of AO at RP.

MP15-06 RISK OF ADVERSE RADICAL PROSTATECTOMY OUTCOMES IN PATIENTS DIAGNOSED WITH IUSP ≤2 PROSTATE CANCER ON MRI/TRUS FUSION BIOPSY

You have accessJournal of UrologyCME1 May 2022MP15-06 RISK OF ADVERSE RADICAL PROSTATECTOMY OUTCOMES IN PATIENTS DIAGNOSED WITH IUSP ≤2 PROSTATE CANCER ON MRI/TRUS FUSION BIOPSY Claudia Kesch, Vlad Pantea, Timo Soeterik, Alessandro Marquis, Giulia La Bombarda, Allesandro Morlacco, Francesco Barletta, Felix Preisser, Fabio Zattoni, Giancarlo Marra, Roderik C.N. van den Bergh, Jan Philipp Radtke, Boris Hadaschik, and Giorgio Gandaglia Claudia KeschClaudia Kesch More articles by this author , Vlad PanteaVlad Pantea More articles by this author , Timo SoeterikTimo Soeterik More articles by this author , Alessandro MarquisAlessandro Marquis More articles by this author , Giulia La BombardaGiulia La Bombarda More articles by this author , Allesandro MorlaccoAllesandro Morlacco More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Felix PreisserFelix Preisser More articles by this author , Fabio ZattoniFabio Zattoni More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Roderik C.N. van den BerghRoderik C.N. van den Bergh More articles by this author , Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Boris HadaschikBoris Hadaschik More articles by this author , and Giorgio GandagliaGiorgio Gandaglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002544.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To avoid overtreatment, active surveillance (AS) is recommended for prostate cancer (PC) patients with low- to favorable intermediate-risk features. However, previous studies based on 12-core transrectal ultrasound (TRUS) biopsy have demonstrated high upgrading rates (up to 70%) at radical prostatectomy (RP) in men potentially suitable for AS. We aim at exploring rate and risk factors for adverse pathologic outcomes in patients with multiparmetric magnetic resonance imaging (mpMRI)/TRUS fusion biopsy confirmed ISUP ≤2 PC. METHODS: Multicentre, retrospective analysis of 477 consecutive patients with ISUP ≤2 PC on mpMRI/TRUS fusion biopsy treated with RP. Adverse outcomes (AO) were defined as any ISUP upgrading, upgrading to ISUP ≥3, ≥pT3 at RP, any AO (=ISUP upgrading to ≥ 3 and/or ≥pT3 and/or N1) or biochemical recurrence (BCR) in men with available follow-up (n=327). Rates of AO were calculated for the overall cohort, biopsy ISUP 1 (n=149) and biopsy ISUP 2 (n=328) PC. Groups were compared using Qui-square test. Logistic regression was used to determine predictive factors. RESULTS: The overall rates of ISUP upgrading, ISUP upgrading to ≥ 3, ≥pT3 on RP and any AO were 39%, 21%, 32% and 43%, respectively. Compared to biopsy ISUP 2, men with biopsy ISUP 1 PC experienced more frequently ISUP upgrading (27% vs. 67%, p<0.001), but less ISUP upgrading to ≥ 3 (27% vs. 10%, p<0.001) and any AO (48% vs. 32%, p=0.001). No differences were recorded for ≥pT3 on RP (34% vs. 26%, p=0.052). PSA density, PIRADS score on mpMRI, number of positive targeted biopsy (TB) cores, ISUP of TB cores, overall number of biopsy cores and positive biopsy cores were all predictive factors for ISUP upgrading to ≥3, ≥pT3 at RP as well as for any AO. Neither PSA nor positive digital rectal examination significantly predicted AOs. Median time of follow-up was 12 months. The 1-year BCR-free survival was 94%. No significant differences in BCR rates were observed comparing men with biopsy ISUP 1 and biopsy ISUP 2 (5% vs. 7%, p=0.518). Positive TB cores, ISUP at RP, ISUP upgrading, ISUP upgrading to ≥3, ≥pT3 on RP and any AO were all predictive for BCR. CONCLUSIONS: In men with mpMRI/TRUS fusion biopsy confirmed ISUP ≤ 2 PC adverse outcomes at RP are still frequent. When counseling patients regarding AS, especially PSA density, ISUP, mpMRI findings and number of positive biopsy cores should be taken into account to identify the men at higher risk of AO. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e243 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claudia Kesch More articles by this author Vlad Pantea More articles by this author Timo Soeterik More articles by this author Alessandro Marquis More articles by this author Giulia La Bombarda More articles by this author Allesandro Morlacco More articles by this author Francesco Barletta More articles by this author Felix Preisser More articles by this author Fabio Zattoni More articles by this author Giancarlo Marra More articles by this author Roderik C.N. van den Bergh More articles by this author Jan Philipp Radtke More articles by this author Boris Hadaschik More articles by this author Giorgio Gandaglia More articles by this author Expand All Advertisement PDF DownloadLoading ...

External validation of the novel International Society of Urological Pathology (ISUP) Gleason grading groups in a large contemporary Canadian cohort.

We sought to test the discriminatory ability of the 2014 International Society of Urological Pathology (ISUP) Gleason grading groups (GGG) for predicting biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) in a large, contemporary, Canadian cohort. A total of 621 patients who underwent RARP in two major Canadian centres were identified in a prospectively maintained Canadian database between 2006 and 2016. Followup endpoint was BCR. Log-rank test, univariable, and multivariable Cox regression analyses were used. Mean followup was 27.9 months. All five ISUP GGG independently predicted BCR. Statistically significant differences in BCR rates were found between GGG 2 and GGG 3 strata (p&lt;0.001). No statistically significant differences in BCR rates were found between GGG 4 and GGG 5 strata (p=0.3). Relative to GGG 1, the GGG 2, GGG 3, GGG 4, and GGG 5 yielded a 1.10-, 3.44-, 4.18-, and 4.74-fold hazard ratio (HR) increment in BCR, respectively. This population-based Canadian cohort study confirms the added discriminatory property of the novel ISUP grading, specifically for GGG 2 and GGG 3 strata. No difference, however, was observed between GGG 4 and GGG 5, likely due to the lower number of patients in these groups. As such, after external validation, the 2014 ISUP GGG appears to retain clinical prognostic significance in a Canadian population.

Association of anesthesia technique for radical prostatectomy with biochemical recurrence: a retrospective cohort study.

Anesthesia technique has been associated with cancer outcomes after radical prostatectomy (RP). These studies are limited by variability in surgeon experience, bias in patient selection, and in some cases, sample size. We evaluated the impact of anesthesia technique for RP on biochemical recurrence (BCR) using a large cohort of patients operated on by a single experienced surgeon. We retrospectively reviewed data from a prospective institutional oncologic database on 929 patients treated with RP by a single surgeon from 1999-2008. Spinal anesthesia was used for patients from 2002-2006. We compared outcomes of these patients (n = 264) with outcomes of patients who underwent general anesthesia (n = 665) at Memorial Sloan-Kettering Cancer Center from 1999-2001 and 2006-2008. Cox proportional hazards regression was used to assess differences in BCR rates between the anesthesia groups adjusting for differences in postoperative factors related to anesthetic technique and tumour pathologic characteristics associated with BCR after RP. Median follow-up among patients free from BCR was 4.6 yr. On multivariable analysis, spinal anesthesia did not independently predict the rate of BCR (hazard ratio = 1.10; 95% confidence interval 0.7 to 1.74; P = 0.7). Independent predictors of BCR were preoperative prostate-specific antigen (PSA), pathologic Gleason grade, extracapsular extension, and seminal vesicle invasion. We did not find an association between anesthesia technique and disease recurrence in men with prostate cancer treated with RP. Anesthesia technique is unlikely to alter disease recurrence following RP independent of surgical and pathological factors.

Non metastatic cell protein 1 expression and clinical significance in prostate cancer

Objective To explore the role of non metastatic cell protein 1 (NME1) in diagnosing prostate cancer (PCa) and judging early metastasis of PCa.Methods The gene chip was used to screen NME1 in PCa and benign prostatic hyperplasia (BPH) tissues,the differential expression of NME1 prostein in PCa and adjacent tissues was analyzed by using fluorescence 2-D difference gel electrophoresis (2DDIGE) technology,and validated by using immunohistochemistry (IHC).The NME1 IHC score and clinicopathological parameters of PCa patients were analyzed.Results Relative to BPH tissues the expression of NME1 was down-regulated in PCa tissues by gene chip screening (P ＜ 0.01),and relative to adjacent tissues the same phenomenon was observed in PCa tissues by using 3D-DIGE technology (P ＜0.01).The expression of NME1 was negatively correlated with serum PSA levels (P ＜ 0.05),Gleason score (P ＜0.01) and TNM stage (P ＜ 0.05),positively correlated with metastasis (P ＜ 0.01),but not correlated with age (P ＞ 0.05).NME1-positive PCa patients had a lower overall survival rate (Log Rank =11.117,P ＜0.01),but there was no significant difference in biochemical recurrence rate between NMEl-negative and NMEl-positive PCa patients (Log Rank =0.247,P ＞ 0.05).Conclusion The low expression of NME1 is closely related with the malignancy of PCa,and the loss of NME1 may promote tumor cell growth.Serum PSA levels in combination with NME1 levels can be used to diagnose PCa early and judge the degree of the malignancy of PCa.The high expression of NME1 may promote PCa metastasis. Key words: Non metastatic cell protein 1 gene; Prostate carcinoma; Diagnosis

A case‐mix‐adjusted comparison of early oncological outcomes of open and robotic prostatectomy performed by experienced high volume surgeons

To compare early oncological outcomes of robot assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) performed by high volume surgeons in a contemporary cohort. We reviewed patients who underwent radical prostatectomy for prostate cancer by high volume surgeons performing RALP or ORP. Biochemical recurrence (BCR) was defined as PSA ≥ 0.1 ng/mL or PSA ≥ 0.05 ng/mL with receipt of additional therapy. A Cox regression model was used to evaluate the association between surgical approach and BCR using a predictive model (nomogram) based on preoperative stage, grade, volume of disease and PSA. To explore the impact of differences between surgeons, multivariable analyses were repeated using surgeon in place of approach. Of 1454 patients included, 961 (66%) underwent ORP and 493 (34%) RALP and there were no important differences in cancer characteristics by group. Overall, 68% of patients met National Comprehensive Cancer Network (NCCN) criteria for intermediate or high risk disease and 9% had lymph node involvement. Positive margin rates were 15% for both open and robotic groups. In a multivariate model adjusting for preoperative risk there was no significant difference in BCR rates for RALP compared with ORP (hazard ratio 0.88; 95% CI 0.56-1.39; P = 0.6). The interaction term between nomogram risk and procedure type was not statistically significant. Using NCCN risk group as the covariate in a Cox model gave similar results (hazard ratio 0.74; 95% CI 0.47-1.17; P = 0.2). The interaction term between NCCN risk and procedure type was also non-significant. Differences in BCR rates between techniques (4.1% vs 3.3% adjusted risk at 2 years) were smaller than those between surgeons (2.5% to 4.8% adjusted risk at 2 years). In this relatively high risk cohort of patients undergoing radical prostatectomy we found no evidence to suggest that ORP resulted in better early oncological outcomes then RALP. Oncological outcome after radical prostatectomy may be driven more by surgeon factors than surgical approach.

Significance of Neoadjuvant Hormonal Therapy in Radical Retropubic Prostatectomy: A Retrospective Single-Surgeon Study

PurposeThe purpose of this study was to evaluate whether neo-adjuvant hormonal therapy (NHT) prior to radical retropubic prostatectomy (RRP) for prostate cancer (PCa) is beneficial in terms of surgical outcomes and for preventing or delaying biochemical recurrence via single-surgeon case series study.Materials and MethodsFifty-three men underwent RRP by a single surgeon. The patients were divided into two groups according to whether or not NHT was performed prior to RRP. The study was analyzed retrospectively. We evaluated clinical parameters, surgical parameters, and biochemical recurrence rate. Group 1 (n=34) was treated with RRP only, while Group 2 (n=19) underwent RRP along with NHT.ResultsThere were no significant differences in clinical, operation-related and pathological factors between the two groups (p>0.05). There was also no significant difference in biochemical recurrence rate between the two groups at the last follow-up, although Group 2 tended to have a lower PCa recurrence rate than Group 1 and the initial prostate-specific antigen (PSA) level was significantly higher in Group 2 than Group 1 (p=0.0496).ConclusionThe present single-surgeon case series study revealed a trend toward a lower rate of PCa recurrence in NHT+RRP treated patients compared to those treated with RRP alone, but this did not reach statistical significance, despite the fact that NHT+RRP patients exhibited higher serum PSA levels preoperatively. Prospective studies with a longer duration of observation and a greater number of patients would be helpful in evaluating NHT more definitively.

Blood Storage Duration and Biochemical Recurrence of Cancer After Radical Prostatectomy

To test the hypothesis that perioperative transfusion of allogeneic and autologous red blood cells (RBCs) stored for a prolonged period speeds biochemical recurrence of prostate cancer after prostatectomy. We evaluated biochemical prostate cancer recurrence in men who had undergone radical prostatectomy and perioperative blood transfusions from July 6, 1998, through December 27, 2007. Those who received allogeneic blood transfusions were assigned to nonoverlapping "younger," "middle," and "older" RBC storage duration groups. Those who received autologous RBC transfusions were analyzed using the maximum storage duration as the primary exposure. We evaluated the association between RBC storage duration and biochemical recurrence using multivariable Cox proportional hazards regression. A total of 405 patients received allogeneic transfusions. At 5 years, the biochemical recurrence-free survival rate was 74%, 71%, and 76% for patients who received younger, middle, and older RBCs, respectively; our Cox model indicated no significant differences in biochemical recurrence rates between the groups (P=.82; Wald test). Among patients who received autologous transfusions (n=350), maximum RBC age was not significantly associated with biochemical cancer recurrence (P=.95). At 5 years, the biochemical recurrence-free survival rate was 85% and 81% for patients who received younger and older than 21-day-old RBCs, respectively. In patients undergoing radical prostatectomy who require RBC transfusion, recurrence risk does not appear to be independently associated with blood storage duration.

Changing Nature of High Risk Patients Undergoing Radical Prostatectomy

We examined the outcomes of radical prostatectomy alone in high risk patients with prostate cancer and evaluated changes in high risk prostate cancer outcomes with time. From 1988 to 2003, 251 men with high risk prostate cancer (prostate specific antigen more than 20 ng/ml and/or biopsy Gleason greater than 7) were identified in a cohort of 1,796 (14%) enrolled in the Shared Equal Access Regional Cancer Hospital Database. Temporal changes in clinicopathological characteristics and prostate specific antigen recurrence rates were examined stratified by 4, 4-year periods. With time significantly more men were considered at high risk due to a high biopsy Gleason score relative to prior years, when the most common reason for being considered at high risk was increased PSA (p <0.001). Only 3% of high risk men from 2000 to 2003 had increased prostate specific antigen and high biopsy Gleason score compared to 23% from 1988 to 1991. With time there were no differences in biochemical recurrence rates (p = 0.147). Men with a high biopsy Gleason score and increased prostate specific antigen had worse outcomes than men with only a high Gleason score or men with only high prostate specific antigen (p = 0.046 and 0.081, respectively). On multivariate analysis that only included preoperative clinical characteristics only prostate specific antigen was an independent predictor of prostate specific antigen failure following radical prostatectomy (p = 0.014). There was a trend, which did not attain statistical significance, for higher biopsy Gleason scores and higher clinical stage to be associated with higher failure rates (p = 0.060 and 0.081, respectively). Patients are designated as high risk by Gleason grade more commonly now than early in the prostate specific antigen era. Outcomes in high risk patients undergoing radical prostatectomy alone have not significantly improved with time. New treatment strategies, such as multimodality therapy, are needed to improve outcomes in high risk patients with prostate cancer.