Percentage Of Positive Biopsies Research Articles

Biochemical outcomes and predictive factors by risk group after permanent iodine-125 seed implantation: Prospective cohort study in 2,316 patients

PurposeTo evaluate the biochemical freedom from failure (bFFF) by risk group and treatment modality and the predictive factors of bFFF by risk group in patients with prostate cancer undergoing permanent seed implantation (PI) with or without external beam radiation therapy (EBRT) in a nationwide prospective cohort study (Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 [I-125] Seed Implantation) in Japan during the first 2 years. Methods and MaterialsThe analyses included 2,316 participants in 42 institutions; bFFF was evaluated using the Phoenix definition and calculated using the Kaplan–Meier method, and the Cox proportional hazards model was used to identify the factors associated with bFFF. ResultsMedian followup period was 60.0 months. The 5-year bFFF rates in all patients, 1,028 low-risk patients, 1,114 intermediate-risk patients, and 133 high-risk patients were 93.6%, 94.9%, 92.7%, and 91.1%, respectively. The 5-year bFFF rates in the PI group and EBRT combination therapy group were 93.7% and 93.3%, respectively. In a multivariate analysis, younger age, higher Gleason score (GS), higher percent positive biopsies (%PB), and lower prostate V100 (p = 0.0012, 0.0030, 0.0026, and 0.0368) in all patients; younger age, higher pretreatment prostate-specific antigen, and lower prostate V100 (p = 0.0002, 0.0048, and 0.0012) in low-risk patients; higher GS, higher %PB, and no hormonal treatment (p = 0.0005, 0.0120, and 0.0022) in intermediate-risk patients; and higher GS and higher %PB (p = 0.0329 and 0.0120) in high-risk patients were significantly associated with bFFF. ConclusionsPI with or without EBRT resulted in excellent short-term biochemical outcomes in all risk groups, especially in high-risk patients. Age, pretreatment prostate-specific antigen, and prostate V100 in low-risk patients; GS, %PB, and hormonal treatment in intermediate-risk patients; and GS and %PB in high-risk patients were independently affected bFFF.

Standard versus extended pelvic lymphadenectomy in the patients with clinically localized prostate cancer

Background/Aim. Pelvic lymph node dissection (PLND) is the most accurate staging procedure in the diagnosis of lymph node involvement by prostate cancer. However, the therapeutic value of this procedure is still unclear. The objective of the study was to compare diagnostic and therapeutic values of extended and standard PLND as an adjunct of radical prostatectomy. Methods. The patients who underwent surgical treatment for clinically localized prostate cancer (n = 157) were enrolled in this open nonrandomized prospective study. In the standard PLND (sPLND) group 109 patients were enrolled while the extended PLND (ePLND) group involved 48 patients. Both groups were compared regarding age, prostate-specific antigen (PSA) level, a percentage of positive biopsies, preoperative and postoperative Gleason score, number of retrieved and positive lymph nodes, duration of surgery, blood loss, amount of lymphorrhea and biochemical recurrence-free survival. Results. The average number of retrieved lymph nodes was 17.27 and 24.46 in the sPLND and ePLND group, respectively (p = 0.001). The rate of positive lymph nodes was 9/109 (8.3%) and 8/48 (16.7%) in the sPLND and ePLND groups, respectively. Biochemical recurrence was noted in 38/109 (31.2%) and 7/48 (14.6%) patients in the sPLND and ePLND group, respectively (p = 0.003). Conclusion. Comparison of sPLND to ePLND led to the following conclusions: nodal yield was significantly higher in the ePLND group; the ePLND template was associated with a much higher rate of lymph node metastases; the biochemical recurrence-free survival rate was significantly more favorable in the ePLND group comparing to the sPLND group.

Impact of Percent Positive Biopsy Cores on Cancer-Specific Mortality for Patients with High-Risk Prostate Cancer

ABSTRACT Objective A high percent positive biopsy cores (PBC), typically dichotomized at ≥50% is prognostic of worse cancer-specific outcomes for patients with low- and intermediate-risk prostate cancer (CaP). The clinical significance of ≥50% PBC for patients with high-risk disease is poorly understood. We examined the association between ≥50% PBC, compared to Materials and methods We identified 7,569 men from the Surveillance, Epidemiology, and End Results program who were diagnosed with high-risk CaP (Gleason score of 8–10, prostate-specific antigen >20 ng/mL, or cT3-T4 stage) in 2010–2011 and had 6 to 24 cores sampled at biopsy. Multivariable Fine and Gray competing risks regression was utilized to examine the association between ≥50% PBC and PCSM. Results Median follow-up was 3.8 years. 56.2% of patients (4,253) had ≥50% PBC. On competing risks regression, ≥50% PBC was associated with a significantly higher risk of PCSM compared to Conclusion In this large cohort of patients with high-risk CaP, ≥50% PBC was independently associated with an approximately 2-fold increased risk of PCSM for patients with cT1–T2, but not cT3–T4, tumors. Percent PBC, which is a widely available clinical value, should be routinely used to risk stratify men with high-risk disease and identify patients whom may benefit from treatment intensification.

The Prognostic PDE4D7 Score in a Diagnostic Biopsy Prostate Cancer Patient Cohort with Longitudinal Biological Outcomes.

Purpose. To further validate the prognostic power of the biomarker PDE4D7, we investigated the correlation of PDE4D7 scores adjusted for presurgical clinical variables with longitudinal postsurgical biological outcomes. Methods. RNA was extracted from biopsy punches of resected tumors (550 patients; RP cohort) and diagnostic needle biopsies (168 patients; DB cohort). Cox regression and survival were applied to correlate PDE4D7 scores with patient outcomes. Logistic regression was used to combine the clinical CAPRA score with PDE4D7. Results. In univariate analysis, the PDE4D7 score was significantly associated with PSA recurrence after prostatectomy in both studied patient cohorts' analysis (HR 0.53; 95% CI 0.41-0.67; p<1.0E-04 and HR 0.47; 95% CI 0.33-0.65; p<1.0E-04, respectively). After adjustment for the presurgical clinical variables preoperative PSA, PSA density, biopsy Gleason, clinical stage, percentage tumor in the biopsy (data only available for RP cohort), and percentage of positive biopsies, the HR was 0.49 (95% CI 0.38-0.64; p<1.0E-04) and 0.43 (95% CI 0.29-0.63; p<1.0E-04), respectively. The addition of the PDE4D7 to the clinical CAPRA score increased the AUC by 5% over the CAPRA score alone (0.82 versus 0.77; p=0.004). This combination model stratified 14.6% patients of the DB cohort to no risk of biochemical relapse (NPV 100%) over a follow-up period of up to 15 years. Conclusions. The PDE4D7 score provides independent risk information for pretreatment risk stratification. Combining CAPRA with PDE4D7 scores significantly improved the clinical risk stratification before surgery.

Impact of Androgen Deprivation Therapy on Overall Mortality in Prostate Brachytherapy Patients With Low Pretreatment Testosterone Levels.

To evaluate whether the use of androgen deprivation therapy (ADT) in prostate brachytherapy patients impacts overall mortality (OM) in patients with lower pretreatment serum testosterone levels compared with those with normal or high baseline serum testosterone. From October 2001 to May 2014, 1916 patients underwent brachytherapy and had a pretreatment serum testosterone. Baseline serum testosterone values were collected prospectively before initiation of therapy. Median follow-up was 7.2 years. In total, 26% of the patients received ADT, primarily men with higher risk disease. OM and prostate cancer-specific mortality were examined to determine whether men with lower baseline serum testosterone were at increased risk of mortality when ADT was used, compared with men with baseline normal or higher testosterone. Prostate cancer-specific mortality and OM at 10 years was 0.8% and 22.0%. Age, tobacco use, diabetes, cardiovascular disease, and percent positive biopsies were the strongest predictors of OM. ADT use by itself was not associated with an increased risk of OM on multivariate analysis (P=0.695). However, ADT use in men with lower baseline testosterone was associated with a significantly higher risk of OM (P<0.01). ADT use in men with normal or higher baseline testosterone was not associated with an increased OM risk (P=0.924). Men with lower baseline testosterone may be at increased risk of premature death when ADT is utilized compared with men with baseline normal or higher testosterone. Further analysis of this potential risk factor is warranted to further identify subsets of men who may be at higher risk of long-term adverse sequelae from ADT.

PD20-06 THE IMPACT OF MULTIPARAMETRIC MRI ON PREDICTING PROGRESSION IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance III1 Apr 2018PD20-06 THE IMPACT OF MULTIPARAMETRIC MRI ON PREDICTING PROGRESSION IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER Zachary Kornberg, Antonio Carlos Westphalen, Janet E Cowan, June M Chan, Matthew R Cooperberg, Katsuto Shinohara, and Peter R Carroll Zachary KornbergZachary Kornberg More articles by this author , Antonio Carlos WestphalenAntonio Carlos Westphalen More articles by this author , Janet E CowanJanet E Cowan More articles by this author , June M ChanJune M Chan More articles by this author , Matthew R CooperbergMatthew R Cooperberg More articles by this author , Katsuto ShinoharaKatsuto Shinohara More articles by this author , and Peter R CarrollPeter R Carroll More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric MRI (mpMRI) and PI-RADS scoring are increasingly utilized to identify lesions suspicious for prostate cancer that may require intervention. We sought to determine whether PI-RADS score was associated with risk of disease progression in men on active surveillance (AS) who underwent re-biopsy and/or delayed radical prostatectomy (RP). METHODS UCSF participants were enrolled on AS with low/intermediate risk prostate cancer (stage cT1/T2, CAPRA ≤5), had <33% positive cores and a Gleason score (GS) of 3+3 or 3+4 at diagnostic or confirmatory biopsy within 1 year, and underwent MRI. Primary outcomes were upgrade and progression on re-biopsy. Upgrade was defined as an increase from GS 3+3 to ≥3+4 or from GS 3+4 to ≥4+3. Progression was defined as upgrade or increase to >33% biopsy cores. The secondary outcome was adverse pathology on RP, defined as GS ≥4+3, stage ≥pT3a, or pN1 in a sub-group of men who underwent delayed surgery. We performed Cox proportional hazards regression models to evaluate association between PI-RADS score with each outcome, adjusted for diagnostic age (years), PSA (ng/ml), PSA density (log), and percent positive biopsy cores. RESULTS Of 1,585 men enrolled on AS, we evaluated 453 men with GS 3+3 (88%) and 3+4 (12%) who underwent MRI. Among patients with GS 3+3, PI-RADS 5 vs. PI-RADS 1-2 was associated with an increased risk of biopsy upgrade (Hazard Ratio [HR]: 2.93; 95% confidence interval [CI], 1.61-5.32, p<0.01, 159 events) and biopsy progression (HR: 2.28; CI, 1.40-3.71; p<0.01, 217 events) on re-biopsy. PI-RADS 4 vs. PI-RADS 1-2 was borderline associated with biopsy upgrade (HR: 1.79; CI 1.01-3.19; p=0.05), and associated with increased risk of biopsy progression (HR: 1.71; CI 1.08-2.72; p=0.02). PI-RADS 3 vs. PI-RADS 1-2 was associated with increased risk of biopsy upgrade (HR: 2.12; CI 1.17-3.83; p=0.01) and progression (HR: 1.68; CI 1.04-2.74; p=0.04). In a subgroup of 114 men who underwent delayed RP, PI-RADS score was not associated with increased risk of adverse pathology on delayed RP in men with GS 3+3, nor was PI-RADS associated with biopsy upgrade, progression, or adverse pathology in men with GS 3+4. CONCLUSIONS In patients with GS 3+3, PI-RADS 5 is associated with biopsy upgrade and progression, and PI-RADS 1-2 with non-progression. mpMRI may be a viable adjunct in treatment decision making for men on AS. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e403-e404 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Zachary Kornberg More articles by this author Antonio Carlos Westphalen More articles by this author Janet E Cowan More articles by this author June M Chan More articles by this author Matthew R Cooperberg More articles by this author Katsuto Shinohara More articles by this author Peter R Carroll More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of percent positive biopsy cores on cancer-specific mortality for patients with high-risk prostate cancer.

78 Background: A high percent positive biopsy cores (PBC), typically dichotomized at ≥50%, is prognostic of worse cancer-specific outcomes for patients with low- and intermediate-risk prostate cancer. The prognostic value of ≥50% PBC for patients with high-risk disease is poorly understood. We examined the association between ≥50% PBC and prostate cancer-specific mortality (PCSM) for patients with high-risk prostate cancer. Methods: We identified 7,569 men from the Surveillance, Epidemiology, and End Results program who were diagnosed with high-risk prostate cancer (Gleason 8-10, prostate-specific antigen &gt; 20 ng/mL, or cT3-T4 stage without evidence of nodal or metastatic disease) in 2010 or 2011 and had 6-24 cores sampled at biopsy. Multivariable Fine and Gray competing risks regression was utilized to examine the association between ≥50% PBC and PCSM, with adjustments for sociodemographic and clinicopathologic factors. Results: Median follow-up was 3.8 years (interquartile range 3.3-4.3 years). 56.2% of patients (4,253) had ≥50% PBC. The 4-year unadjusted cumulative incidences of PCSM were 2.0% (95% confidence interval [CI] 1.5-2.6%) and 5.6% (95% CI 4.9-6.4%) for patients with &lt; 50% and ≥50% PBC, respectively. On multivariable analysis, the presence of ≥50% PBC was associated with a significantly higher risk of PCSM (adjusted hazard ratio [AHR] 1.95, 95% CI 1.43-2.66, P&lt; 0.001). On subgroup analysis, ≥50% PBC was associated with a significantly higher risk of PCSM only for cT1-T2 disease (AHR 2.21, 95% CI 1.59-3.07, P&lt; 0.001) but not cT3-T4 disease (AHR 0.77, 95% CI 0.33-1.81, P= 0.547), with a significant interaction ( Pinteraction= 0.012). Conclusions: In this large, contemporary cohort of patients with high-risk prostate cancer, ≥50% PBC was independently associated with a two-fold increased risk of PCSM for patients with cT1-T2, but not cT3-T4, tumors. Percent PBC should be used to routinely risk stratify men with high-risk disease and identify patients who may benefit from intensification of therapy, such as adding docetaxel or abiraterone to radiotherapy with androgen deprivation therapy, to optimize cancer-specific outcomes.

Prostate Cancer Antigen 3 Score Does Not Predict for Adverse Pathologic Features at Radical Prostatectomy or for Progression-Free Survival in Intermediate- and High-Risk Prostate Cancer

Pre-operative urinary prostate cancer antigen 3 (PCA3) gene scores predict for adverse pathologic features (APF) at radical prostatectomy (RP) in men with low- and intermediate-risk prostate cancer (PCa). However, whether these predict for APF in men with higher-risk disease, or for progression-free survival (PFS) in general, is unknown. We retrospectively investigated whether PCA3 scores were predictive for APF or PFS in men with higher-risk PCa. One hundred nine men with cT1-T2 National Comprehensive Care Network (NCCN) intermediate- and high-risk PCa were treated with RP from 2010-2015. Logistic regression analysis was performed to evaluate the association of PCA3 score with selected APFs—seminal vesicle invasion [SVI], lymph node positivity (pLN+), upgrading to Gleason score (pGS) 8-10 or tertiary pattern 5, and upstaging to pT3 disease—after adjusting for age, initial PSA (iPSA), clinical T-stage, biopsy GS, percent positive biopsies (PPB), and MRI T-stage. Biochemical recurrence was defined as confirmatory PSA ≥ 0.2 ng/mL or initiation of salvage therapy. Among 78 men with ≥ 1 year follow-up, the association between PCA3 score and PFS was assessed using Cox regression analysis after adjusting for age, pre-operative risk group, maximal tumor diameter (MTD), pGS, extracapsular extension (ECE), SVI, and pLN+. Kaplan-Meier analysis was performed to estimate 3-year PFS. Median follow-up was 2.3 years. Forty-eight percent had intermediate-risk and 52% had high-risk PCa. At RP, 42% had ECE, 10% had SVI, and 10% had pLN+. Twenty-one percent experienced GS upgrading and 41% were upstaged to pT3. On multivariate analysis (MVA), multiple significant predictors for individual APFs were elucidated, including increasing bGS predicting for SVI (OR 6.80, p=0.040), increasing iPSA and PPB predicting for pLN+ (ORs 1.12 and 1.06; p<0.05 for both), and increasing bGS, iPSA, and PPB predicting for upstaging to pT3 (ORs of 3.64, 1.08, and 1.03; p<0.05 for all). Overall, 3-year PFS was 70%. No significant predictors for PFS were found on MVA, but NCCN risk group (hazard ratio [HR] 4.17), MTD (HR 1.83), ECE (HR 2.69), SVI (HR 3.04), pLN+ (HR 3.70), and pGS (HR 4.79) were all significant on univariate analysis (UVA, p<0.05 for all). PCA3 score was not associated with any APF or with PFS on UVA or MVA. Unlike in lower-risk cohorts, PCA3 score was not associated with any APF in this higher-risk cohort, despite enrichment for APFs. Similarly, despite a relatively high number of biochemical recurrences, PCA3 score was not associated with PFS. Notably, multiple known pre-operative predictors for APFs were significant on MVA, and multiple predictors were associated with PFS on UVA. These results suggest that PCA3 may not be a useful adjunct predictive marker in men with higher-risk PCa.

A Predictive Model for Postoperative Margin Status in Localized Prostate Cancer

Positive surgical margins are a risk factor for recurrence following radical prostatectomy for prostate cancer. Accordingly, positive margins are an indication for adjuvant radiation therapy. The ability to accurately predict the risk of post-operative margin status based on pre-operative clinical characteristics may direct therapeutic management for clinically localized prostate cancer and potentially help avoid treatment with combined surgery and radiation. Based on a large, modern cohort of patients who underwent definitive surgical management for clinically localized prostate cancer, we have designed a novel predictive algorithm for post-operative margin status which incorporates initial prostate-specific antigen (iPSA) level, percent positive biopsy cores (PPC), Gleason score (GS), clinical tumor staging, and post-operative margin status. Records from 1,023 patients treated for clinically localized prostate cancer with radical prostatectomy were analyzed for age, primary and total GS on biopsy, iPSA, PPC, and clinical T stage. A multivariate analysis was performed via logistic regression modelling to create a predictive algorithm. Mean patient age was 59.0 years old. Regarding D’Amico risk stratification, 35.2% were low-risk, 51.5% were intermediate-risk, and 13.2% were high-risk. Post-operatively, 256 patients had positive margins and 767 patients had negative margins. On multivariate analysis, age and primary Gleason score were not statistically significant predictors for positive margins. Total GS, iPSA, PPC, and clinical T stage were all found to be statistically significant predictors. For total GS, odds ratio (OR) was 1.401 (p-value 1.14 x10-4). For iPSA, OR was 1.044 (p-value 5.66x10-5). For PPC, OR was 1.014 (p-value 6.91x10-5). For clinical stage T2a, OR relative to stage T1 was 1.440 (p-value 5.35x10-2). For clinical stage >T2a, OR relative to stage T1 was 2.349 (p-value 3.64x10-2). The area under the curve (AUC) for this model, corrected by bootstrapping, was calculated to be 0.6935. The AUC for this model indicates acceptable predictive performance in terms of sensitivity and specificity for a large, modern cohort of patients. This model may therefore serve to aid in therapeutic decision-making for patients with clinically localized prostate cancer. It does remain to be externally validated. Future modelling will incorporate data from pre-operative magnetic resonance imaging.

Novel Clinical Tools to Guide Management of Prostate Cancer: Preoperative Predictive Models to Identify Patients at Risk for Needing Adjuvant Radiation (T3 or +margin) or Having Detectable Postoperative PSA

Several valuable models use preoperative data to predict organ- confined disease at the time of radical prostatectomy. However, there are no similar tools to predict which patients will qualify for adjuvant radiation therapy (ART), or have a detectable postoperative prostate specific antigen (PSA). We developed logistic regression models to predict risk for extracapsular extension (ECE) and seminal vesicle invasion (SVI) and compared them to others (Roach, CAPRA, Memorial Sloan Kettering, and Partin models). We then created two novel formulas to predict risk for ART (either T3 or +margin) or detectable postoperative PSA. We conducted a retrospective multi-institutional review of patients with clinically localized prostate adenocarcinoma who had radical prostatectomy from 2001-2015 (N=1,676) at Kaiser Permanente in Southern California. Patients treated with preoperative leuprolide or missing data were excluded. Three multivariate models were developed to predict ECE, SVI, and either ECE or SVI. A fourth model was developed to predict ECE/SVI/+margin. A fifth model was developed to predict detectable postoperative PSA (≥0.1). The area under the receiver curve (AUC) was calculated and corrected using bootstrap resampling with 2000 samples. Statistical analysis was performed with R version 3.3.1. Statistically significant factors on multivariate analysis included percent positive biopsy cores, biopsy Gleason score, PSA, and clinical T-stage. Age and year of surgery were not statistically significant. The ECE, SVI, and ECE/SVI models (AUC 0.69-0.81) performed favorably compared to other tools (AUC 0.72-0.79) [Table 1]. Our T3/+margin model performs at corrected AUC 0.75. Our detectable postoperative PSA model performs at corrected AUC 0.81 [Table 1]. We developed three models predicting risk of extraprostatic disease, which compared favorably over other widely used models. We created two novel clinical formulas to predict preoperatively whether patients may require ART or have a detectable postoperative PSA. These tools may help guide the selection of surgery or radiation upfront, and could potentially reduce dual modality treatment. While our novel clinical prediction models performed well in our data set, no known tools exist for comparison, and external validation is needed.Abstract 2630; Table 1RoachCAPRAMSKPartinKaiserECE (25% risk) AUC0.740.740.760.720.69 Sen/Spec1.00/00.63/0.701.00/00.87/0.460.37/0.91 PPV/NPV0.22/ NA0.39/0.860.22/0.830.31/0.920.54/0.84SVI (25% risk) AUC0.760.780.790.760.81 Sen/Spec0.47/0.850.22/0.960.28/0.960.03/0.990.39/0.94 PPV/NPV0.27/0.930.39/0.910.47/0.920.40/0.900.42/0.93ECE/SVI (40% risk) AUC---0.760.79 Sen/Spec---0.64/0.720.52/0.86 PPV/NPV---0.48/0.830.61/0.82ECE, SVI, or +margin (20% risk) AUC----0.75 Sen/Spec----0.91/0.35 PPV/NPV----0.44/0.87Detectable 1st Postop PSA (20% risk) AUC----0.81 Sen/Spec----0.36/0.95 PPV/NPV----0.34/0.96 Open table in a new tab

Plasma levels of intact and cleaved urokinase plasminogen activator receptor (uPAR) in men with clinically localised prostate cancer

AimsLymph node metastasis (N1) is an adverse prognostic factor for men with clinically localised prostate cancer (PCa), but the prediction of N1 disease remains difficult. Urokinase plasminogen activator receptor (uPAR)...

PD40-10 EFFECTS OF THE 2012 USPSTF PSA SCREENING RECOMMENDATIONS ON PROSTATE BIOPSY PRACTICES IN AN INNER CITY HOSPITAL WITH A HIGH RISK PATIENT POPULATION

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2017PD40-10 EFFECTS OF THE 2012 USPSTF PSA SCREENING RECOMMENDATIONS ON PROSTATE BIOPSY PRACTICES IN AN INNER CITY HOSPITAL WITH A HIGH RISK PATIENT POPULATION Johnathan A. Khusid, Igor Inoyatov, Adan Beccera, Llewellyn Hyacinthe, Brian K. McNeil, and Andrew G. Winer Johnathan A. KhusidJohnathan A. Khusid More articles by this author , Igor InoyatovIgor Inoyatov More articles by this author , Adan BecceraAdan Beccera More articles by this author , Llewellyn HyacintheLlewellyn Hyacinthe More articles by this author , Brian K. McNeilBrian K. McNeil More articles by this author , and Andrew G. WinerAndrew G. Winer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1750AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the 2012 US Preventative Services Task Force (USPSTF) recommendation against prostate specific antigen (PSA) screening, it was acknowledged that African American men represented a disproportionately small minority of the population analyzed. We sought to describe the prostate biopsy practice patterns before and after the recommendation in an inner city hospital that serves a high risk patient population of predominantly Afro Caribbean descent. METHODS A retrospective chart review of patients who underwent prostate biopsy from 10/27/2008 to 12/15/2015 was performed. Patients were grouped into those who underwent biopsy prior to, and after the new USPSTF guidelines (5/22/2012). Patient and clinical characteristics were compared between the two time periods. Bivariate analyses included two sample t tests, chi square tests, and the Mann Whitney U tests. RESULTS Our analysis revealed no significant differences in the age, percent of positive biopsies, or type of physician initiating screening. There was a significant difference in median PSA (p= 0.05) and a trend toward significance in the difference in racial distribution between the two groups (p=0.06). Among those with positive biopsies, patients biopsied after the recommendation had significantly greater core positivity, and a borderline significantly higher incidence of clinically significant disease defined by D Amico criteria (p=0.24) CONCLUSIONS In a high risk patient population, we found that men biopsied after the USPSTF recommendation were more likely to have a higher PSA level, more likely to be African American, had greater core positivity, and a higher incidence of clinically significant disease. These results suggest that high risk patients in an inner city setting are also being negatively affected by the implementation of the task force recommendations. Further research is required to determine whether the practice pattern change occurred at the level of PSA screening or rather at patient selection for prostate biopsy. Such research will allow clinicians to provide more granular counseling with regards to PSA screening and prostate biopsies for high risk patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e753-e754 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Johnathan A. Khusid More articles by this author Igor Inoyatov More articles by this author Adan Beccera More articles by this author Llewellyn Hyacinthe More articles by this author Brian K. McNeil More articles by this author Andrew G. Winer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate cancer-specific death in brachytherapy treated high-risk patients stratified by pre-treatment PSA.

PurposeTo evaluate prostate-cancer specific mortality (PCSM) in a cohort of high-risk patients treated with a permanent prostate brachytherapy approach, stratified by pre-treatment PSA.Material and methods448 high-risk patients (NCCN criteria) underwent permanent prostate brachytherapy. High risk patients were stratified by pre-treatment PSA (≤ 10.0, 10.1-20, and > 20 ng/ml). Biochemical failure (BF), prostate cancer-specific mortality (PCSM), distant failure (DM), and overall mortality (OM) were assessed as a function of prognostic group. Multiple clinical, treatment, and dosimetric parameters were evaluated for impact on outcome.ResultsThe 10-year OM, BF, and PCSM for the entire cohort were 28.5%, 13.3%, and 4.9%, respectively. At 10 years, PCSM was 2.5%, 10.7%, and 4.5% in the PSA ≤ 10, 10.1-20, and > 20 ng/ml groups, respectively. No statistically significant differences in BF or overall survival (OS) were noted when stratified by pre-treatment PSA. DF was the most common in the 10.1-20 ng/ml cohort (8.6% at 10 years). In multivariate analysis, PCSM was most closely related to percent positive biopsies (p = 0.001) and tobacco (p = 0.042).ConclusionsHigh-risk prostate cancer treated with permanent prostate brachytherapy and supplemental external beam radiotherapy resulted in excellent long-term biochemical control and PCSM. Overall, PCSM was low in all cohorts but highest in the intermediate PSA group (10.1-20 ng/ml).

Current prostate cancer treatment: Not what but when?

In their paper, Taussky et al compare the rates of biochemical recurrence and salvage treatment between patients with low- and intermediate-risk prostate cancer treated with permanent seed prostate brachytherapy or radical prostatectomy from 2005–2011. The primary endpoint was biochemical recurrence or salvage therapy at 48 +/− 4 months after localized therapy. Younger patients, as well as those with higher-volume disease (higher initial prostate-specific antigen [PSA] and percentage of positive biopsies) were more likely to develop a biochemical recurrence. However, the central finding in this study was that there was no difference in the biochemical recurrence rate after radical prostatectomy or brachytherapy, which agrees with earlier publications. A recent systematic review by Wolff et al of limited, randomized data demonstrated no significant difference in biochemical progression-free survival in patients with low- to intermediate-risk prostate cancer treated with brachytherapy or radical prostatectomy.1 Patients treated with brachytherapy, however, reported better preservation of sexual function, but worse short-term (<5 years) urinary function.

Occult High-risk Disease in Clinically Low-risk Prostate Cancer with ≥50% Positive Biopsy Cores: Should National Guidelines Stop Calling Them Low Risk?

To identify contemporary, clinically low-risk patients with ≥50% cores positive and compare the risk of upgrading at prostatectomy with other low- or intermediate-risk patients. We studied 14,902 patients with prostate cancer in the Surveillance, Epidemiology, and End Results database in 2010-2011 treated with prostatectomy. Patients were categorized by National Comprehensive Cancer Network clinical risk groups, separating low-risk patients by percent positive biopsy cores (PBC). We measured incidence of pathologic high-risk disease, defined as pT3a-T4 or Gleason 8-10, and multivariable logistic regression was used to determine if patients with clinical low-risk disease and ≥50% PBC were similar to other low- or intermediate-risk patients. This analysis was repeated with favorable and unfavorable intermediate risk. At prostatectomy, 9.2% of clinically low-risk patients with <50% PBC, 18.6% of clinically low-risk patients with ≥50% PBC, and 27.6% of clinically intermediate-risk patients had occult, high-risk disease (P <.001). On multivariable logistic regression, low-risk patients with ≥50% PBC were more likely than low-risk patients with <50% PBC to have pathologic high-risk disease (adjusted odds ratio [AOR] 2.28, 95% confidence interval 1.90-2.73, P <.001), had similar risk to favorable intermediate patients overall (AOR 1.09, 0.91-1.31, P = .33), and had higher risk than favorable intermediate patients aged over 60 years (AOR 1.28, 1.00-1.64, P = .04). Low-risk patients with ≥50% PBC had a mean tumor size similar to unfavorable intermediate-risk patients (21.3 vs 21.0 mm, P = .82). Nearly 1 in 5 clinically low-risk prostate cancer patients with ≥50% PBC harbor occult pT3a-T4 or Gleason 8-10, suggesting that national guidelines should not classify low-risk patients with ≥50% cores positive as "low risk," and patients should be made aware of this excess risk if considering active surveillance.

Reassessment of the risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer treated using radical prostatectomy.

To assess the risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer patients treated using radical prostatectomy. We retrospectively reviewed the medical records of 1268 men with prostate cancer treated using radical prostatectomy without neoadjuvant therapy. The association between various risk factors and biochemical recurrence was then statistically evaluated. The Kaplan-Meier method, log-rank tests and Cox proportional hazards models were used for statistical analysis. In the intermediate-risk group, 96 patients (14.5%) experienced biochemical recurrence during a median follow up of 41 months. In the intermediate-risk group, preoperative prostate-specific antigen level, prostate volume and prostate-specific antigen density were significant preoperative risk factors for biochemical recurrence, whereas other factors including age, primary Gleason 4, clinical stage >T2 and percentage of positive biopsies were not. In multivariate analysis, higher preoperative prostate-specific antigen level and density, and a smaller prostate volume were independent risk factors for biochemical recurrence in the intermediate-risk group. Biochemical recurrence-free survival of patients in the intermediate-risk group with a higher prostate-specific antigen level and density (≥15 ng/mL, ≥0.6 ng/mL/cm(3), respectively), and lower prostate volume (≤10 mL) was comparable with that of high-risk group individuals (P = 0.632, 0.494 and 0.961, respectively). Preoperative prostate-specific antigen, prostate volume and prostate-specific antigen density are significant risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer patients treated using radical prostatectomy. Using these variables, a subset of the intermediate-risk patients can be identified as having equivalent outcomes to high-risk patients.

Is supplemental external beam radiation therapy necessary for patients with higher risk prostate cancer treated with 103Pd? Results of two prospective randomized trials.

To determine the necessity and/or dose of supplemental external beam radiotherapy (EBRT) in conjunction with palladium-103 ((103)Pd) brachytherapy for high-risk prostate cancer patients. Trial 44/20 randomized patients to 44Gy plus 90Gy (103)Pd vs. 20Gy with 115Gy (103)Pd, and the subsequent trial randomized patients to the 20Gy arm vs. 125Gy (103)Pd without EBRT (20/0 trial). Eligibility criteria included clinically organ-confined disease with Gleason scores 7-9 and/or a pretreatment prostate-specific antigen (PSA) 10-20ng/mL. The brachytherapy prescription dose was prescribed to the prostate gland with generous periprostatic margins. Biochemical failure (BF) was defined as a PSA >0.40ng/mL after nadir. Median Day 0 minimum dose covering 90% of the prostate volume (D90) was >121.0% of the prescription dose. Multiple parameters were evaluated for effect on outcomes. In 44/20 trial, 13-year BF, prostate cancer-specific mortality (PCSM), and overall mortality (OM) were 8.2%, 4.0%, and 42.8% vs. 8.0%, 1.0%. and 40.3% for the 44 and 20Gy arms. In 20/0 trial, 8-year BF, PCSM, and OM were 2.1%, 0%, and 14.4% vs. 3.6%, 0%, and 16.1% in the 20 vs. 0Gy arms. When stratified by either pretreatment PSA or by Gleason score, supplemental EBRT dose did not impact BF, PCSM, or OM. In multivariate analysis, BF was most closely related to percent positive biopsies and prostate volume. In both trials, patients with biochemically controlled disease had a median PSA of <0.02ng/mL. With high-quality brachytherapy dose distributions, supplemental EBRT did not influence BF or PCSM for patients with intermediate-risk disease. The number of patients with Gleason score 8-9 was too small to determine the role of supplemental EBRT in that cohort.

Correlation of clinical profile and specific histopathological features of temporal artery biopsies.

This study sought to correlate the clinical features of patients with giant cell arteritis (GCA) who present with ophthalmic symptoms and signs, with 2 specific histopathological findings-the presence of giant cells and arterial wall neoangiogenesis. The goal was to assess if these pathological features might be useful in guiding the approach to patient management. Medical charts were retrospectively reviewed from 58 patients who underwent a temporal artery biopsy at a single institution. Detailed information was collected about the clinical presentation and course, with an emphasis on visual function. Histopathological and immunohistochemical techniques were used to examine temporal artery biopsies for evidence of inflammation. Correlations were made between the clinical data and the presence of giant cells and neoangiogenesis. Twenty-one (34%) biopsies were positive for inflammation consistent with GCA. Although the percentage of positive biopsies with giant cells was high, neither the presence of giant cells nor neoangiogenesis was predictive of a patient's presenting visual symptoms, severity and bilaterality of vision loss, other ophthalmic manifestations of GCA, presence of headache or jaw claudication, or erythrocyte sedimentation rate. Giant cells were more common in patients with recent weight loss. Immunohistochemistry confirmed diagnoses but did not alter the clinical course or treatment plan. There was no correlation between the clinical, specifically visual, features of GCA and the presence or absence of giant cells or neoangiogenesis in temporal artery biopsy specimens. Although the presence of neoangiogenesis may be important in the pathogenesis of GCA, our study showed no correlation between this finding and the clinical course.

Does the addition of targeted prostate biopsies to standard systemic biopsies influence treatment management for radiation oncologists?

To study the management impact that magnetic resonance imaging (MRI)-guided targeted prostate biopsies could provide relative to using only non-targeted systematic biopsies in men with clinically localized prostate cancer (PCa). A consecutive series of untreated men undergoing Artemis (MRI-ultrasonography fusion) biopsies between March 2010 and June 2013 was evaluated in this retrospective, institutional review board-approved study. Fusion biopsy included MRI-targeted and systematic sampling at the same session. 3-Tesla multiparametric MRI was performed at a median of 2weeks before biopsy. Patients were included if ≥1 systematic core was found to harbour PCa. The impact of the information obtained from targeted vs systematic biopsies was studied with regard to the following: Gleason score (GS), National Comprehensive Cancer Network (NCCN) risk reclassification, cancer core length, percentage of core positive for tumour involvement, and percentage of positive biopsy cores. The study sample included 215 men (mean ± sd age 66 ± 8years). The median (range) prostate-specific antigen (PSA) was 6.0 (0.7-181)ng/mL. The mean number of total biopsy samples was 18 (12 systematic and six targeted samples). Of 215 men, 34 (16%) had a higher GS on targeted vs systematic biopsy. A total of 21/183 men (12%) were stratified into a higher NCCN risk group when incorporating targeted biopsy GS results and 18/101 men (18%) were upgraded to intermediate- or high-risk from the low-risk group. Among the 34 men whose cancer severity was upgraded, increases in cancer core length, percentage of tumour involvement and percentage of cores involved were all statistically significant (P< 0.01). Targeted prostate biopsy provided information about GS, NCCN risk and tumour volume beyond that obtained in systematic biopsies, specifically increasing the proportions of men in the intermediate- and high-risk groups. Such men may be recommended for additional treatments (pelvic nodal irradiation or hormonal therapy). The appropriateness of changing treatment because of targeted biopsy results is still unclear.

MP77-07 THE PREVALENCE OF PROSTATE BIOPSY GLEASON SCORE ≥ 7(3+4) EXCEEDS 40% IN YOUNG PUERTO RICAN MEN SCREENED FOR PROSTATE CANCER: A CASE FOR EARLY DETECTION BEFORE AGE 55 IN THIS POPULATION

You have accessJournal of UrologyProstate Cancer: Detection and Screening VI1 Apr 2015MP77-07 THE PREVALENCE OF PROSTATE BIOPSY GLEASON SCORE ≥ 7(3+4) EXCEEDS 40% IN YOUNG PUERTO RICAN MEN SCREENED FOR PROSTATE CANCER: A CASE FOR EARLY DETECTION BEFORE AGE 55 IN THIS POPULATION Patricia Maymi and Ricardo Sanchez-Ortiz Patricia MaymiPatricia Maymi More articles by this author and Ricardo Sanchez-OrtizRicardo Sanchez-Ortiz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.547AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While in US Census data only 8.0% of Puerto Ricans (PR) self−identified as “black or African American (AA)”, genomic admixture studies show that average West African ancestry gene values in PR range between 17 and 32%. These data, and the known association between aggressive prostate CaP cancer in AA men may help explain the higher observed CaP mortality in PR. Our goal was to evaluate the pathologic features of young PR men diagnosed through PSA screening to ascertain whether this population should be deemed high−risk and screened from age 40. METHODS Our CaP database was queried for men who diagnosed with asymptomatic CaP through PSA screening before age 55. Clinical variables were compared to men age 55 and older. All slides were reviewed by a pathologist trained at an NCCN−designated cancer center. Statistical analysis was performed with SPSS. RESULTS Of 606 patients, 183 men were identified age≤55 years (yrs.) (mean: 49.7 years, range 38 to 54). Mean serum PSA was 5.7 ng/ml, percent clinical stage T1c: 79.7%, and mean prostate size was 42.7 cc. Patients had undergone prostate biopsies with a mean number of 11.7 cores and a mean of 2.97 positive cores (range 1 to 14). On biopsy, 43.1% (79/183) of men had evidence of Gleason score ≥7(3+4). Patients younger than 55 (Y) were more likely to have a first−degree relative with CaP than older men (28% Y vs. 19.4%, p<0.01) but less likely to have smoked (22.8% Y vs. 33.3%, p< 0.02), have diabetes (9.4% Y vs. 19.6%, p <0.01), hypertension (34.8% Y vs. 58.7%, p< 0.01), a higher clinical stage (T1c 79.7% Y vs. 71.2%, p<0.03), or Gleason score ≥7 on biopsy (43.1% Y vs. 56.4%, p<0.02). There were no significant differences between young and older men with regards to serum PSA (5.7 ng/ml Y vs. 6.1 ng/ml), longest tumor length in any core per side (4.3 mm Y vs. 4.5 mm), total sum of tumor length per side (8.9 mm Y vs. 8.5 mm), percent positive cores (26.3% Y vs. 27.1%), or BMI (28.5 Y vs. 28.2). CONCLUSIONS In this series of Puerto Rican men found to have CaP through early detection, patients <55 yrs. exhibited a 43% risk of harboring Gleason score≥7(3+4) on biopsy. Furthermore, despite a lower prevalence of palpable disease than older patients, younger men exhibited no difference with regards to serum PSA, longest tumor length, total tumor sum in millimeters, and percent positive biopsies, traditional surrogates for tumor volume. These data support the concept that, similar to AA patients, discussions regarding early detection in Puerto Rican men should begin at age 40. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e995 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patricia Maymi More articles by this author Ricardo Sanchez-Ortiz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...