Grading Of Prostatic Carcinoma Research Articles

A Review on Prediction and Prognosis of the Prostate Cancer and Gleason Grading of Prostatic Carcinoma Using Deep Transfer Learning Based Approaches

A Review on Prediction and Prognosis of the Prostate Cancer and Gleason Grading of Prostatic Carcinoma Using Deep Transfer Learning Based Approaches

Expression of ERG in Prostatic Acinar Adenocarcinoma Diagnosed on TRUS-guided Biopsy and its Association with WHO Grade Group- A Prospective Observational Study

Introduction: Prostate cancer is a common malignancy affecting men and the second leading cause of cancer related death in India. Numerous molecular biomarkers have been evaluated for their potential role in predicting disease progression, their response to therapy and survival. Erythroblast Transformation Specific (ETS) related Gene (ERG) is one of the newest addition in the existing list of biomarkers of prostate cancer. Aim: To analyse the expression of ERG in prostatic adenocarcinoma and to evaluate its association with World Health Organisation (WHO) grade group. Materials and Methods: This was a prospective observational study was conducted in the Department of Pathology in association with Department of Urology, IPGME&R, SSKM Hospital, Kolkata, West Bengal, India. The duration of the study was 1.5 years, from January 2019 to June 2020. A total of 267 cases of Transrectal Ultrasound (TRUS) guided tru-cut biopsy was included. Clinical data including preoperative Prostate Specific Antigen (PSA) level, Digital Rectal Examination (DRE) were obtained. Histopathological reports were prepared by two pathologists along with Gleason scoring and WHO grading as per 2014 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Formalin Fixed Paraffin Embedded (FFPE) sections of representative blocks of each tumour was selected for Immunohistochemistry (IHC) study. Only the cases which had more than 10% nuclear staining were considered as positive. Statistical analysis was performed with help of Epi Info (TM) 7.2.2.2 and Chi-square test was used to test the association of different study variables. Results: The mean age of the study participants was 65.55 years, and the age range was 45-93 years. Among the 80 malignant cases where, ERG immunostaining was assessed, 28 cases (35%) showed positive expression. Among these positive cases, 50% cases were weakly positive, 28.57% showed moderate positivity and 21.43% had strong positive expression. Highest positivity was observed in WHO grade group V (44.83%). The intensity of ERG expression was also higher in high grade group (13) than low grade group cancer patients. Conclusion: ERG expression in the prostate cancer can be a prognostic factor as the expression and intensity of expression both increases with higher grade group of cancer.

P024 - Prostate cancer diagnosis composite probability index (pPCacomp): A novel multi-parametric mathematical model for predicting detection and ISUP grading of prostatic carcinoma on TRUS biopsy

P024 - Prostate cancer diagnosis composite probability index (pPCacomp): A novel multi-parametric mathematical model for predicting detection and ISUP grading of prostatic carcinoma on TRUS biopsy

Cytological Grading of Prostate Carcinoma

Introduction: The Gleason grading system is one of the most powerful prognostic predictors of carcinoma prostate. In 2014, a newer grading system, the International Society of Urologic Pathology (ISUP) grading system was proposed. The present study is a retrospective study conducted to compare the cytological grading of prostate carcinoma with the newly proposed ISUP grading system for prostate carcinoma. Materials and Methods: The present study is a retrospective study that included 42 cases of carcinoma prostate. The clinical data of the cases, fine-needle aspiration cytology slides, and histological slides were retrieved and reviewed. The cases were regraded using the ISUP grading system for prostate carcinoma. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS). Data were statistically analyzed and Chi-square testing was used to compare the two grading systems. Results: A total of 42 cases were studied. The preoperative grade was assigned to the smears and 26.19% (11 cases) were categorized as grade 1, 40.47% (17 cases) as grade 2, and 33.3% (14 cases) as grade 3. Histological sections were also graded according to the ISUP/grade groups (GG) system and 26.19% (11 cases) were graded as GG 1, 33.3% (14 cases) as GG2, 19.04% (8 cases) as GG3, 16.67% (7 cases) as GG4, and 4.47% (2 cases) as GG5. Conclusion: In the present study, it was concluded that there is a direct concordance between the histologic grade as proposed in the ISUP grading system and the cytologic grade on FNA.

Eight Endorsements of the International Society of Urological Pathology from the 2019 Consensus Conference on Grading of Prostatic Carcinoma.

Eight Endorsements of the International Society of Urological Pathology from the 2019 Consensus Conference on Grading of Prostatic Carcinoma.

Clinical deployment of AI for prostate cancer diagnosis

Clinical deployment of AI for prostate cancer diagnosis

Correlation of Gleason Grading and Prognostic Immunohistochemistry Markers (Human Epidermal Growth Factor Receptor 2/neu and Androgen Receptor) in Prostatic Core Needle Biopsy: A Study in a Tertiary Care Center

Abstract Background: Worldwide prostate cancer is the most common cause of cancer and the second leading cause of cancer death among men. Transrectal ultrasound-guided core needle biopsies are the diagnostic modalities which help in proper categorization and grading of prostatic carcinoma, thus facilitating individualized treatment. These biopsies are the primary source for performance of additional diagnostic immunohistochemical testing for basal cell-associated markers to rule out the morphological mimicker and prognostic markers such as androgen receptor (AR) and human epidermal growth factor receptor 2 (HER2)/neu. Materials and Methods: A prospective, observational study was conducted in the department of pathology in collaboration with department of urosurgery of a tertiary care hospital. One hundred and nineteen patients diagnosed with prostatic nodules were included in this study. Values of serum prostate-specific antigen were recorded. Tissue for histopathological study was obtained in the form of core needle biopsy, and Gleason grade was calculated in all malignant cases. Immunohistochemistry for p63 and alpha-methylacyl-CoA racemase was performed as an additional test in premalignant cases. Prognostication of the prostate cancer cases was done using AR and HER2/neu. Results: A total of 119 cases aged between 20 and 90 years were included in this study. Malignant lesions reveal an increase in the percentage of AR staining in comparison to the benign glandular structure. The Gleason score with higher value (8–9) showed increased expression of HER2/neu receptor. Conclusion: Critical histopathological analysis of core needle biopsy along with immunohistochemical evaluation maximizes the diagnostic accuracy in prostate cancer cases and also helps in prognosis assessment.

Stratification of Ki 67 proliferation marker labelling index – Use in Gleason Score Grading of Prostatic Carcinoma

Stratification of Ki 67 proliferation marker labelling index – Use in Gleason Score Grading of Prostatic Carcinoma

Utilization of the Polarized Infrared Light for Prostate Cancer Visualization in Isolated Prostates

The current imaging methods for the prostate cancer diagnosis are complicated and partially invasive. Therefore, a key challenge for prostate cancer detection is to use a simple and non-invasive method. Imaging plays a crucial role in the non-invasive identification, localization and grading of prostate carcinoma. In this paper, we demonstrate the possibility using of polarized a near infrared (NIR) light for the in vitro prostate cancer detection and imaging. Because the intensity of NIR light passing through the cancerous outgrowth is lower than the intensity of NIR light passing through the noncancerous one, the cancerous formations are differentiated as the dark areas in the relatively white background. Specially developed software analyses and processes a distribution of intensities of the grayscale images, measures the ratios of their strength, and determines the rate of prostate malignancy. Obtained results may hold promise to make an important contribution to the diagnosis of prostate cancer in the early stage of its development.

Grading of prostatic adenocarcinoma: current state and prognostic implications.

BackgroundDespite significant changes in the clinical and histologic diagnosis of prostate cancer, the Gleason grading system remains one of the most powerful prognostic predictors in prostate cancer. The correct diagnosis and grading of prostate cancer is crucial for a patient’s prognosis and therapeutic options. However, this system has undergone significant revisions and continues to have deficiencies that can potentially impact patient care.Main BodyWe describe the current state of grading prostate cancer, focusing on the current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma. We also explore the limitations of the current Gleason grading system and present a validated alternative to the Gleason score. The new grading system initially described in 2013 in a study from Johns Hopkins Hospital and then validated in a multi-institutional study, includes five distinct Grade Groups based on the modified Gleason score groups. Grade Group 1 = Gleason score ≤6, Grade Group 2 = Gleason score 3 + 4 = 7, Grade Group 3 = Gleason score 4 + 3 = 7, Grade Group 4 = Gleason score 8, Grade Group 5 = Gleason scores 9 and 10.ConclusionAs this new grading system is simpler and more accurately reflects prostate cancer biology, it is recommended by the World Health Organization (WHO) to be used in conjunction with Gleason grading.

Infrared light enables visualization of the prostate carcinoma after radical prostatectomy

Abstract Background: Imaging plays a crucial role in the identification, localization and grading of prostate carcinoma. However current imaging methods for the prostate cancer diagnosis are complicated and partially

Interobserver Reproducibility of Gleason Histological Grading of Prostatic carcinoma in a Teaching Hospital Setting in Sri Lanka

Journal of Diagnostic Pathology is a peer reviewed journal published biannually by the College of Pathologists of Sri Lanka. The journal publishes manuscripts dealing with all aspects of pathology. The aim of the journal is to update knowledge and encourage original research in the field of pathology.

Interobserver reproducibility of Gleason histological grading of prostatic carcinoma: a study done in a teaching hospital setting in Colombo, Sri Lanka

Introduction : Gleason grading is one of the most important prognostic factors in prostatic carcinoma. Objective: To assess the interobserver reproducibility of Gleason grading of prostatic cancer among three pathologists in the local setting. Method: Fifty haematoxylin and eosin stained slides of previously diagnosed prostatic adenocarcinoma were retrieved and graded by using Gleason grading by three pathologists. These were re-graded by the same three pathologists after a time interval of 4 weeks after studying literature highlighting more descriptive criteria on the above grading system. The interobserver reproducibility was analysed using generalised kappa values. Results: The generalised kappa value for interobserver variation among the three pathologists in the first instance was 0.306 indicating a fair level of agreement and 0.488 in the second instance, indicating a moderate level of agreement. The lowest level of interobserver agreement was observed in the Gleason score 2-4 and 7 categories. Conclusion: The results emphasises the importance of continuous education of pathologists with regard to the Gleason grading system to reduce the inter observer variation in the grading of prostatic adenocarcnoma DOI: http://dx.doi.org/10.4038/jdp.v9i1.7641 Journal of Diagnostic Pathology 2014; 9(1): 18-23

Objective grading of prostate carcinoma based on fractal dimensions: Gleason 3 + 4= 7a ≠ Gleason 4 + 3 =7b

Significant intra- and interobserver variability ranging between 40 and 80% is observed in tumor grading of prostate carcinoma. By combining geometric and statistical methods, an objective system of grading can be designed. The distributions of cell nuclei in two-dimensional patterns of prostate cancer classified subjectively as Gleason score 3+3, 3+4, 4+3, 4+4, 4+5, 5+4, and 5+5 were analyzed with algorithms measuring the global fractal dimensions of the Rényi family and with the algorithm for the local connected fractal dimension (LCFD). The dimensions for global fractal capacity, information, and correlation (standard deviation) were 1.470 (045), 1.528 (046), and 1.582 (099) for homogenous Gleason grade 3 (n = 16), 1.642 (034), 1.678 (041), and 1.673 (084) for homogenous Gleason grade 4 (n=18), and 1.797 (042), 1.791 (026), and 1.854 (031) for homogenous Gleason grade 5 (n=12), respectively. The LCFD algorithm can be used to distinguish both qualitatively and quantitatively between mixed and heterogeneous patterns, such as Gleason score 3+4=7a (intermediate risk cancer) and Gleason score 4+3=7b (high-risk cancer). Sensitivity of the method is 89.3%, and specificity 84.3%. The method of fractal geometry enables both an objective and quantitative grading of prostate cancer.

Gleason grading of prostate cancer in needle core biopsies: a comparison of general and urologic pathologists

BACKGROUND AND OBJECTIVESThe Gleason grading of prostate carcinoma (PCa) in needle core biopsies is a major determinant used in management planning. The objective of this study was to evaluate the concordance between general pathologists Gleason grading and that of a urologic pathologist in our community.DESIGN AND SETTINGRetrospective review conducted at three tertiary care hospitals in Jeddah and Riyadh for all prostatic biopsies with carcinoma from January 2002 to January 2011.METHODSGleason scores assigned by the original pathologist were compared with that of the reviewing urologic pathologists. Biopsies were originally obtained and diagnosed at different referring hospitals and independent laboratories. The kappa test was used to evaluate agreement between the original and review scores.RESULTSFor 212 biopsies the exact concordance of the Gleason score assigned by the original pathologist and the reviewer was 38.7% (82/212). However, when grouped into the main four-score categories of 2–4, 5–6, 7, and 8 or greater, disagreement was noted in 88 (41.5%) biopsies; 87 were upgraded and 1 was downgraded on review. When grouped into two-score categories of low grade (≤6) and high grade (≥7), disagreement was noted in 32 (15%) of the biopsies.CONCLUSIONGleason grade score shows that there was only slight to fair agreement between outside and review scoring (kappa=0.43). When using only low versus high grade categorization, there was good agreement (kappa=0.69). Almost all of the cases with score disagreement were upgraded on review.

25-Year Disease-Free Survival Rate After Irradiation for Prostate Cancer Calculated with the Prostate Specific Antigen Definition of Recurrence Used for Radical Prostatectomy

We addressed whether there is durable control of prostate cancer, defined as a prostate specific antigen cutoff of less than 0.2 ng/ml, greater than 20 years after irradiation for this disease. We also evaluated late recurrence, defined as recurrence after 10-year followup. A total of 3,546 consecutive hormone naïve men were treated with a (125)I prostate implant (retropubic and later transperineal), followed by external beam irradiation, from 1984 to 2000. Recurrence was defined as a prostate specific antigen increase of greater than 0.20 ng/ml or a prostate specific antigen nadir of greater than 0.20 ng/ml. Median followup was 11 years (range 3 months to 26 years). In all men 10, 15, 20 and 25-year disease-free survival rates were 75%, 73%, 73% and 73%, respectively. Longest time to recurrence was at the 15.5-year followup. In 313 men with recurrence who were treated 16 to 25 years ago 5% of recurrences were late. In men implanted by the transperineal method since 1995 the 15-year disease-free survival rate was 79%. With this irradiation program cancer control, defined using the recurrence definition for radical prostatectomy, was durable with no further recurrence between 15.5 and 25 years of followup. This study also suggests that at least 15 years of followup are necessary to fully evaluate any prostate cancer treatment. Furthermore, if prostate specific antigen is less than 0.20 ng/ml 15 years after treatment, later recurrence should be unlikely.

Development and Internal Validation of a Prostate Health Index Based Nomogram for Predicting Prostate Cancer at Extended Biopsy

We developed and validated a Prostate Health Index (Beckman Coulter, Brea, California) based nomogram to predict prostate cancer at extended prostate biopsy. The study population consisted of 729 patients who were scheduled for prostate biopsy following suspicious digital rectal examination and/or increased prostate specific antigen. Total and free prostate specific antigen, percent free-to-total prostate specific antigen, [-2]proPSA and the prostate health index [([-2]proPSA/free prostate specific antigen) × √total prostate specific antigen)] were determined. Logistic regression models were fitted to test prostate cancer predictors. Predictive accuracy estimates of biopsy outcome predictions were quantified. Regression coefficients were used to create a decision making tool to predict prostate cancer. A calibration plot was used to evaluate the extent of overestimating or underestimating the observed prostate cancer rate. Decision curve analysis provided an estimate of the net benefit obtained using the prostate health index based nomogram. Overall 280 of 729 patients (38.4%) were diagnosed with prostate cancer at extended prostate biopsy. On accuracy analyses prostate health index emerged as the most informative predictor of prostate cancer (AUC 0.70) compared to established predictors, such as total prostate specific antigen (0.51) and percent free-to-total prostate specific antigen (0.62). Including the prostate health index in a multivariable logistic regression model based on patient age, prostate volume, digital rectal examination and biopsy history significantly increased predictive accuracy by 7% from 0.73 to 0.80 (p <0.001). Nomogram calibration was good. Decision curve analysis showed that using the prostate health index based nomogram resulted in the highest net benefit. The prostate health index based nomogram can assist clinicians in the decision to perform biopsy by providing an accurate estimation of an individual risk of prostate cancer.

The Potential Impact of Reproducibility of Gleason Grading in Men With Early Stage Prostate Cancer Managed by Active Surveillance: A Multi-Institutional Study

We evaluated the reproducibility of Gleason grading as relevant to the clinical treatment of men on active surveillance. Three sets of digital images of prostatic adenocarcinoma in biopsies were reviewed and assigned Gleason scores by a total of 11 pathologists from 7 institutions. Interobserver and intra-observer reproducibility were assessed for assignment of the highest Gleason pattern (3 vs 4 or higher). We also identified 97 consecutive patients on active surveillance. Prostate biopsy glass slides from 82 of the patients were available for re-review and the frequency of carcinoma requiring the distinction of tangentially sectioned Gleason pattern 3 from 4 was determined. Interobserver reproducibility for classic Gleason patterns was substantial (Light's κ 0.76). Interobserver reproducibility for the histological distinction of tangentially sectioned Gleason pattern 3 from Gleason pattern 4 was only fair (Light's κ 0.27). Intra-observer reproducibility ranged from 65% to 100% (mean 81.5%). Of the 82 patients on active surveillance 61 had carcinoma and 15 (24.5%) had a set of biopsies with at least 1 focus in which the distinction between tangentially sectioned Gleason pattern 3 and poorly formed pattern 4 glands had to be considered. The reproducibility of grading classic Gleason patterns is high. However, variability in grading occurred when distinguishing between tangentially sectioned pattern 3 glands and the poorly formed gland subset of pattern 4. Developing universally accepted histological and/or molecular criteria to distinguish these patterns and subsequently characterizing their natural history would be useful when treating patients on active surveillance.

-2]Proenzyme Prostate Specific Antigen is More Accurate Than Total and Free Prostate Specific Antigen in Differentiating Prostate Cancer From Benign Disease in a Prospective Prostate Cancer Screening Study

Due to the limited specificity of prostate specific antigen for prostate cancer screening, there is an ongoing search for adjunctive biomarkers. Retrospective studies have suggested that an isoform of proenzyme prostate specific antigen called [-2]proenzyme prostate specific antigen may enhance the specificity of prostate specific antigen based screening. We examined the usefulness of this isoform in a prospective prostate cancer screening study. From a population of 2,034 men undergoing prostate cancer screening we examined the relationship between the measurement of the [-2]isoform of proenzyme prostate specific antigen (p2PSA) and prostate cancer detection. Specifically we compared the usefulness of total prostate specific antigen, the ratio of free-to-total prostate specific antigen, the ratio of p2PSA-to-free prostate specific antigen, and a formula combining prostate specific antigen, free prostate specific antigen and p2PSA (the Beckman Coulter prostate health index or phi) to predict prostate cancer in men from the study undergoing prostate biopsy with a prostate specific antigen of 2.5 to 10 ng/ml and nonsuspicious digital rectal examination. Despite similar total prostate specific antigen (p = 0.88), percent free prostate specific antigen (p = 0.02) and %p2PSA (p = 0.0006) distinguished between positive and negative biopsy results. On ROC analysis %p2PSA (AUC 0.76) outperformed prostate specific antigen (AUC 0.50) and percent free prostate specific antigen (AUC 0.68) for differentiating between prostate cancer and benign disease. Setting the sensitivity at 88.5%, p2PSA led to a substantial improvement in specificity as well as positive and negative predictive values. The Beckman Coulter prostate health index (AUC 0.77) had the best overall performance characteristics. This is the first prospective study to our knowledge to demonstrate that p2PSA provides improved discrimination between prostate cancer and benign disease in screened men with a prostate specific antigen of 2.5 to 10 ng/ml and a negative digital rectal examination.

Original and infiltrating patterns of prostatic carcinoma

In order to demonstrate the original and infiltrating patterns of prostatic carcinoma, the change of histological characteristics associated with increasing total cancer volume was investigated. Tissue specimens from 196 histopathological cases, obtained at the Kyushu Cancer Center, were reviewed in embedded whole-mount antegrade radical prostatectomy specimens with adenocarcinoma. Three groups (<0.5 cm(3), ≤0.5 cm(3) <1 cm(3) and ≥1 cm(3)) of total cancer volume were identified and a histological study on each group was conducted based on the 2005 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma. With a cancer volume of <0.5 cm(3), Gleason primary patterns 3 and 4 were observed in 64.4 and 26.7% of the tumors, respectively, while Gleason secondary patterns 3 and 4 were observed in 53.3 and 42.2%, respectively. The density of the acini was much higher in comparison with that of ambient normal acini. The percentage of acini, including cribriform carcinoma classified as Gleason pattern 3, increased significantly with the increase of cancer volume (p<0.01). The original pattern of the prostatic carcinoma was histologically composed of small acini of Gleason patterns 3 and 4 without forming a cribriform pattern. In addition, prostatic carcinoma infiltrated the surrounding stroma at a very early stage, thus infiltrating not only the stroma but also the preexisting ducts and acini, causing an increased cancer volume.