Prostate Biopsy Gleason Score Research Articles

Correlation of Transrectal Ultrasonography Guided Prostate Biopsy Gleason Score Results with Prostate Volume in Patients with Prostate Specific Antigen Level Between 2.5-10 ng/mL

Correlation of Transrectal Ultrasonography Guided Prostate Biopsy Gleason Score Results with Prostate Volume in Patients with Prostate Specific Antigen Level Between 2.5-10 ng/mL

POST-PROSTATEKTOMİ İNKONTİNANSTA İNTRİNSİK SFİNKTER DİSFONKSİYONU DIŞINDAKİ NEDENLER DE AKILDA BULUNDURULMALIDIR

Objective: This study aims to determine the causes of urinary incontinence and accompanying bladder pathologies in patients with persistent incontinence 12 months after radical prostatectomy.
 Methods: Thirty-four patients who underwent open radical retropubic prostatectomy (RRP) due to localized prostate cancer and incontinent after surgery between January 2015 and December 2020 and underwent urodynamic study (UDS) were retrospectively reviewed. All UDSs were performed according to the ICS protocol of good urodynamic practice and assessed by the same doctor. Patients were assessed by demographic and clinical parameters including age, body mass index (BMI), comorbidity, preoperative PSA level, prostate volume (PV), transrectal prostate biopsy Gleason score, clinical stage, pathological ISUP grade, pathological stage, lymph node positivity, international consultation on incontinence questionnaire-short form and subjective questionnaire for daily pad use.
 Results: Urodynamic studies showed that 29 patients (85.2%) had intrinsic sphincter deficiency (ISD). Nine (26.4%) of 29 patients with ISD had a secondary diagnosis of overactive bladder (OAB), impaired detrusor contractility (IDC) and OAB+IDC 9 (11.6%), 4 (11.6%), 1 (2.9%), respectively. Nineteen patients (55.8%) had a sole diagnosis of ISD, whereas 15 patients (44.1%) had another primary diagnosis or a secondary diagnosis other than ISD. 
 Conclusion: Although ISD is the most common cause of persistent urinary incontinence in patients after radical prostatectomy, it should be taken into account that overactive bladder and impaired detrusor contractility are also accompanied by a significant proportion of patients.

Early biomarkers of extracapsular extension of prostate cancer using MRI-derived semantic features

BackgroundTo construct a model based on magnetic resonance imaging (MRI) features and histological and clinical variables for the prediction of pathology-detected extracapsular extension (pECE) in patients with prostate cancer (PCa).MethodsWe performed a prospective 3 T MRI study comparing the clinical and MRI data on pECE obtained from patients treated using robotic-assisted radical prostatectomy (RARP) at our institution. The covariates under consideration were prostate-specific antigen (PSA) levels, the patient’s age, prostate volume, and MRI interpretative features for predicting pECE based on the Prostate Imaging–Reporting and Data System (PI-RADS) version 2.0 (v2), as well as tumor capsular contact length (TCCL), length of the index lesion, and prostate biopsy Gleason score (GS). Univariable and multivariable logistic regression models were applied to explore the statistical associations and construct the model. We also recruited an additional set of participants—which included 59 patients from external institutions—to validate the model.ResultsThe study participants included 185 patients who had undergone RARP at our institution, 26% of whom were pECE+ (i.e., pECE positive). Significant predictors of pECE+ were TCCL, capsular disruption, measurable ECE on MRI, and a GS of ≥7(4 + 3) on a prostate biopsy. The strongest predictor of pECE+ is measurable ECE on MRI, and in its absence, a combination of TCCL and prostate biopsy GS was significantly effective for detecting the patient’s risk of being pECE+. Our predictive model showed a satisfactory performance at distinguishing between patients with pECE+ and patients with pECE−, with an area under the ROC curve (AUC) of 0.90 (86.0–95.8%), high sensitivity (86%), and moderate specificity (70%).ConclusionsOur predictive model, based on consistent MRI features (i.e., measurable ECE and TCCL) and a prostate biopsy GS, has satisfactory performance and sufficiently high sensitivity for predicting pECE+. Hence, the model could be a valuable tool for surgeons planning preoperative nerve sparing, as it would reduce positive surgical margins.

A Natural Language Processing–Assisted Extraction System for Gleason Scores: Development and Usability Study

BackgroundNatural language processing (NLP) offers significantly faster variable extraction compared to traditional human extraction but cannot interpret complicated notes as well as humans can. Thus, we hypothesized that an “NLP-assisted” extraction system, which uses humans for complicated notes and NLP for uncomplicated notes, could produce faster extraction without compromising accuracy.ObjectiveThe aim of this study was to develop and pilot an NLP-assisted extraction system to leverage the strengths of both human and NLP extraction of prostate cancer Gleason scores.MethodsWe collected all available clinical and pathology notes for prostate cancer patients in an unselected academic biobank cohort. We developed an NLP system to extract prostate cancer Gleason scores from both clinical and pathology notes. Next, we designed and implemented the NLP-assisted extraction system algorithm to categorize notes into “uncomplicated” and “complicated” notes. Uncomplicated notes were assigned to NLP extraction and complicated notes were assigned to human extraction. We randomly reviewed 200 patients to assess the accuracy and speed of our NLP-assisted extraction system and compared it to NLP extraction alone and human extraction alone.ResultsOf the 2051 patients in our cohort, the NLP system extracted a prostate surgery Gleason score from 1147 (55.92%) patients and a prostate biopsy Gleason score from 1624 (79.18%) patients. Our NLP-assisted extraction system had an overall accuracy rate of 98.7%, which was similar to the accuracy of human extraction alone (97.5%; P=.17) and significantly higher than the accuracy of NLP extraction alone (95.3%; P<.001). Moreover, our NLP-assisted extraction system reduced the workload of human extractors by approximately 95%, resulting in an average extraction time of 12.7 seconds per patient (vs 256.1 seconds per patient for human extraction alone).ConclusionsWe demonstrated that an NLP-assisted extraction system was able to achieve much faster Gleason score extraction compared to traditional human extraction without sacrificing accuracy.

Non-cancer mortality in elderly prostate cancer patients treated with combination of radical prostatectomy and external beam radiation therapy.

To test for rates of other cause mortality (OCM) and cancer-specific mortality (CSM) in elderly prostate cancer (PCa) patients treated with the combination of radical prostatectomy (RP) and external beam radiation therapy (EBRT) versus RP alone, since elderly PCa patients may be over-treated. Within the Surveillance, Epidemiology and End Results database (2004-2016), cumulative incidence plots, after propensity score matching for cT-stage, cN-stage, prostate specific antigen, age and biopsy Gleason score, and multivariable competing risks regression models (socioeconomic status, pathological Gleason score) addressed OCM and CSM in patients (70-79, 70-74, and 75-79 years) treated with RP and EBRT versus RP alone. Of 18,126 eligible patients aged 70-79 years, 2520 (13.9%) underwent RP and EBRT versus 15,606 (86.1%) RP alone. After propensity score matching, 10-year OCM rates were respectively 27.9 versus 20.3% for RP and EBRT versus RP alone (p < .001), which resulted in a multivariable HR of 1.4 (p < .001). Moreover, 10-year CSM rates were respectively 13.4 versus 5.5% for RP and EBRT versus RP alone. In subgroup analyses separately addressing 70-74 year old and 75-79 years old PCa patients, 10-year OCM rates were 22.8 versus 16.2% and 39.5 versus 24.0% for respectively RP and EBRT versus RP alone patients (all p < .001). Elderly patients treated with RP and EBRT exhibited worrisome rates of OCM. These higher than expected OCM rates question the need for combination therapy (RP and EBRT) in elderly PCa patients and indicate the need for better patient selection, when combination therapy is contemplated.

A novel prognostic risk factor for patients undergoing radical prostatectomy: Triglyseride‐glucose index

Obesity and metabolic syndrome are growing health problems in western countries. Recently reported triglyseride-glucose (TyG) index is a reliable and accessible indicator of metabolic syndrome. TyG index could be used as a indicator of a prognostic risk factor for metabolic syndrome-related cancers. To investigate the prognostic role of TyG index on oncological outcomes in patients undergoing radical prostatectomy. Data from 200 men who underwent radical prostatectomy were used. TyG was calculated based on TyG index=Ln [TG (mg/dL) FPG (mg/dL)/2] formula. Patients were divided into two groups according to the 8.55 level as cut-off value for TyG index. Laboratory results, oncological outcomes and survivals were comparised statistically between groups. Mean ages of patients were 64.32±6.1years and median follow-up time was 61.6±35 (range 4-140) month. Biochemical recurrens was observed in 42 (21%) patients. Positive correlation between TyG index, body mass index, waist circumference, prostate biopsy gleason score, clinical T stage, positive surgical margin, pathological T stage and biochemical recurrence were observed. There was no statistical significance in terms of survival between groups. Association between TyG index and prostate cancer may facilitate to predict unfavorable prognostic factors of radical prostatectomy. Increased TyG index may use as a predictive marker of positive surgical margin status before radical prostatectomy, BCR, advanced cT and pT stages after radical prostatectomy or worse biopsy gleason score in clinical practice.

The Discrepancy between Needle Biopsy and Radical Prostatectomy Gleason Score in Patients with Prostate Cancer.

Gleason score (GS), as well as other prognostic and diagnostic modalities, can predict the possibility of tumor growth and metastasis during the life of patients with prostate cancer. Based on the prostate biopsy GS, clinicians choose the most appropriate therapy for managing patients. The objective of this cross-sectional study was to determine the discrepancy between needle biopsy and radical prostatectomy GS and to identify its predictive factors among the Iranian population. A total of 1147 patients who underwent radical prostatectomy from 2009 to 2019 were initially enrolled in this study. After consideration of the inclusion and exclusion criteria, 439 patients were finally included. The demographic variables and clinical data including age, PSA level, prostate volume, PSA density, GS derived from ultrasonography-guided core needle biopsy specimen, and GS derived from radical prostatectomy specimen were collected from the medical records of patients with prostate adenocarcinoma and were reviewed by a urology resident. Statistical analysis was done by using the Social Sciences Software version 21. The average age of patients was 64.5 years (range 48-84 years), and the average preoperative PSA level was 14.8 ng/mL. On histopathological examination, no changes in GS were observed in 237 (53.9%) patients, whereas GS was upgraded in 144 (32.8%) patients and downgraded in 58 (13.2%) patients at radical prostatectomy. The number of patients who had extracapsular extension, seminal vesicle invasion and positive lymph nodes was significantly higher in the upgraded group compared with the non-upgraded group. Conclusion: In this study, there was a steady decrease in GS upgrading with the prostate size extending up to 49.7 g. There was also an association between downgrading and extending prostate size. Due to the greater risk of high-grade disease in men with small prostates, smaller prostate bulks are most probably upgraded after radical prostatectomy. A higher maximum percentage of involvement per core was an independent predictive factor of upgrading from biopsy grade 1 to grade ≥ 2. Our study showed that patients' age was not predictive of upgrading, which is consistent with other studies. Also, we demonstrated a non-significant relationship between PSA level and upgraded GS. Findings in this study did not demonstrate a significant relationship between PSA level and upgrading.

Correlation between Prostate Specific Antigen and Prostate Biopsy Gleason Score

Background: Prostate Specific Antigen (PSA) is a commonly used marker in prostate cancer management. Gleason grading is one of the most powerful predictors of prostatic biological behaviour. PSA, when combined with the Gleason score and clinical stage, improves the prediction of the pathological stage for prostate cancer. Objectives: To assess the degree of correlation between PSA level and Gleason score as well as determine the likelihood of aggressiveness of prostate cancer using Gleason score as a parameter. Methods: A cross-sectional prospective study was conducted among 234 consecutive consenting patients presenting to the Urology Out-Patient Clinic between April 2015 and March 2018. Serum PSA was done and patients with values above 4ng/ml and/or abnormal Digital Rectal Examination (DRE) were selected to have a prostate biopsy. The sample was histologically analysed with Gleason score recorded for those with prostate cancer. Gleason score was then correlated with PSA levels. Results: The mean age for prostate cancer patients was 71.3±8.7 years. The mean PSA for patients with prostate cancer was 52.3±37.5ng/ml (Confidence Interval = 46.1-58.6) with p&lt;0.001. About 18.2% of histologically confirmed prostate cancer cases had Gleason score 8-10 implying a high level of tumour aggressiveness. There is a positive correlation between PSA and Gleason score with R-value 0.590 indicating a good degree of correlation. Conclusion: There is a good degree of a positive correlation between PSA level and Gleason score, as well as a high level of aggressiveness of prostate cancer in Umuahia.

Robotic radical prostatectomy in 93 cases: Outcomes of the first ERUS robotic urology curriculum trained surgeon in Turkey.

This study presents the surgical, oncological, and functional outcomes of the first 93 robotic radical prostatectomy (RARP) procedures performed in Erzurum, Turkey. These procedures were performed by a single surgeon who had completed the European Association of Urology Robotic Urology Section (ERUS) RARP curriculum in an ERUS-certified training center in Ankara. The study present the results of 93 RARP procedures performed by a single surgeon. The surgeon performing the operations completed an ERUS training program structured for RARP by two robotic surgeons holding ERUS training certificates in an ERUS-approved academic robotic surgery training center in Ankara. The RARP cases performed by the surgeon after completion of the training between April 2016 and August 2018 were retrospectively evaluated. The mean patient age was 63.62±7.04 years, and the mean preoperative serum prostate-specific antigen level was 8.34±4.96 ng/mL. Preoperatively, 82 and 4 patients had prostate biopsy Gleason scores of 3+3 and 4+3, respectively. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 21, 13, and 59 cases, respectively. The mean prostate weight was 85.34±47.57 g. Posterior rhabdosphincter reconstruction was performed in 60 (64.5%) cases. Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 170.49±36.50 min, 100.70±34.08 cc, 6.84±2.28 days, and 7.40±3.11 days, respectively. During the perioperative period (0-30 days), five minor (prolonged drain output, n=3; rectocele, n=1; gout arthritis, n=1) and six major (inguinal hernia, n=1; incisional hernia, n=2; anastomotic urinary leakage, n=2; myocardial infarction, n=1) complications were identified. No complication was detected during postoperative days 31-90. Postoperative pathological stages included pT2a, pT2b, and pT2c disease in 77 (82.8%), 9 (9.7%), and 7 (7.5%) patients, respectively. The positive surgical margin (SM) rate was 10.7% (n=10), including patients with pT2a (n=6) and pT2c (n=2) diseases. Eleven (11.8%) patients underwent pelvic lymph node (LN) dissection. The mean LN yield was 16.45±4.29. The mean length of follow-up was 11.17±8.01 months. Biochemical recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), and the other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up (n=48, 51.6%) were fully continent (0 pads/day). Of the 40 (43%) patients with no preoperative erectile dysfunction (ED) and with at least three-month follow-up, 18 (45%) had no ED, with or without any additional medication including phosphodiesterase-5 (PDE5) inhibitors. RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative, pathological and oncological outcomes, and satisfactory functional results. The ERUS RARP curriculum provides effective and sufficient training.

Does Type 2 Diabetes Mellitus Have an Impact on Postoperative Early, Mid-Term and Late-Term Urinary Continence After Robot-Assisted Radical Prostatectomy?

We evaluated the effect of diabetes mellitus (DM) on urinary continence after robotic radical prostatectomy (RARP). Overall, 99 patients with DM and 213 patients without DM who underwent RARP with at least 2-year follow-up were included. The preoperative prostate biopsy Gleason scores and clinical stages of the groups were similar. The patients who were dry or used one safety pad per day were regarded as continent. Early (0-3 months), mid-term (4-12 months), and late-term (>12 months) continence rates were evaluated. In diabetic and nondiabetic groups, mean age was 63.3 ± 6.5 and 61.3 ± 6.8 years, respectively (p = 0.015). On the day of the removal of the urethral catheter, 61.6% (n = 61) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At third-month follow-up, 80.8% (n = 80) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At sixth-month follow-up, 89.9% (n = 89) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At first-year follow-up, 93.9% (n = 93) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.001). At 18th-month follow-up, 96.0% (n = 95) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.013). At second-year follow-up, 98.0% (n = 97) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.115). Multivariate analysis showed that age and body mass index had no impact on urinary continence (p > 0.05). Presence of diabetes (p = 0.008) and duration (≥5 years) of diabetes (p = 0.004) were independent factors that had a significant negative impact on urinary continence. Diabetes seems to be a significant disadvantage in gaining urinary continence compared with nondiabetic patients particularly in the first 18 months after RARP. Diabetic patients should be informed about possible late recovery of postoperative urinary continence compared with nondiabetic patients after RARP.

Prostate cancer upgrading or downgrading of biopsy Gleason scores at radical prostatectomy: prediction of "regression to the mean" using routine clinical features with correlating biochemical relapse rates.

Recommendations for managing clinically localized prostate cancer are structured around clinical risk criteria, with prostate biopsy (PB) Gleason score (GS) being the most important factor. Biopsy to radical prostatectomy (RP) specimen upgrading/downgrading is well described, and is often the rationale for costly imaging or genomic studies. We present simple, no-cost analyses of clinical parameters to predict which GS 6 and GS 8 patients will change to GS 7 at prostatectomy. From May 2006 to December 2012, 1590 patients underwent robot-assisted radical prostatectomy (RARP). After exclusions, we identified a GS 6 cohort of 374 patients and a GS 8 cohort of 91 patients. During this era, >1000 additional patients were enrolled in an active surveillance (AS) program. For GS 6, 265 (70.9%) of 374 patients were upgraded, and the cohort included 183 (48.9%) patients eligible for AS by the Prostate Cancer Research International Active Surveillance Study (PRIAS) standards, of which 57.9% were upgraded. PB features that predicted a >90% chance of upgrading included ≥7 cores positive, maximum foci length ≥8 mm in any core, and total tumor involvement ≥30%. For GS 8, downgrading occurred in 46 (50.5%), which was significantly higher for single core versus multiple cores (80.4% vs 19.6%, P = 0.011). Biochemical recurrence (BCR) occurred in 3.4% of GS 6 upgraded versus 0% nonupgraded, and in GS 8, 19.6% downgraded versus 42.2% nondowngraded. In counseling men with clinically localized prostate cancer, the odds of GS change should be presented, and certain men with high-volume GS 6 or low-volume GS 8 can be counseled with GS 7-based recommendations.

Targeted Prostate Biopsy Gleason Score Heterogeneity and Implications for Risk Stratification

To quantify Gleason score (GS) heterogeneity within multiparametric magnetic resonance imaging (MRI)-targeted prostate biopsies and to determine impact on National Comprehensive Cancer Network (NCCN) risk stratification. An Institutional Review Board-approved retrospective study was performed on men who underwent Artemis (MRI-transrectal-ultrasound fusion) targeted biopsy (TB) for suspected prostate cancer between 2012 and 2015. Intratarget heterogeneity was defined as a difference in GS between 2 cores within a single target in patients with ≥2 positive cores. Prostate specific antigen, maximum tumor diameter, apparent diffusion coefficient, MRI suspicion score, prostate volume, systematic biopsy (SB) GS, and T-stage were analyzed for correlation with heterogeneity. Changes in NCCN risk based on high versus low GS on TB, SB alone, and SB+TB were compared. Fifty-three patients underwent TB of 73 suspected lesions. Seventy percent (51/73) had ≥2 positive cores, thus meeting inclusion criteria for heterogeneity analysis. Fifty-five percent (28/51) of qualifying targets showed GS heterogeneity. None of the evaluated factors showed a significant relationship with heterogeneity. NCCN low-risk, intermediate-risk, and high-risk groups were 30%, 49%, and 21%, respectively, with SB alone. Adding low GS TB to SB resulted in 17%, 55%, 28% in each risk group, while using high GS+SB resulted in 4%, 54%, and 42%. Overall, the addition of TB resulted in higher NCCN risk groups in 38% of cases. Over half of multiparametric MRI-defined targets demonstrated GS heterogeneity. The addition of high GS from TB leads to risk inflation compared with using SB alone. Further research is needed on how to integrate these findings into current risk stratification models and clinical practice.

PD42-12 ONCOLOGICAL OUTCOMES OF UNFAVORABLE INTERMEDIATE-RISK IS COMPARABLE TO HIGH-RISK LOCALIZED PROSTATE CANCER IN PATIENTS TREATED WITH RADICAL PROSTATECTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2018PD42-12 ONCOLOGICAL OUTCOMES OF UNFAVORABLE INTERMEDIATE-RISK IS COMPARABLE TO HIGH-RISK LOCALIZED PROSTATE CANCER IN PATIENTS TREATED WITH RADICAL PROSTATECTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION Youness Ahallal, Davy Benarroche, Luis Felipe Snel Zanettini, Alexandre Colau, Clement Charbonnier, Jean-Francois Cote, and Bertrand Guillonneau Youness AhallalYouness Ahallal More articles by this author , Davy BenarrocheDavy Benarroche More articles by this author , Luis Felipe Snel ZanettiniLuis Felipe Snel Zanettini More articles by this author , Alexandre ColauAlexandre Colau More articles by this author , Clement CharbonnierClement Charbonnier More articles by this author , Jean-Francois CoteJean-Francois Cote More articles by this author , and Bertrand GuillonneauBertrand Guillonneau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1965AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with intermediate-risk prostate cancer (IR-PCa) are heterogeneous with highly variable prognoses. We have characterized an unfavorable subgroup of IR-PCa patients and aimed to compare their oncologic outcomes with those of patients harboring high-risk prostate cancer (HR-PCa) METHODS Between 2011 and 2016, 138 consecutive patients harboring IR-PCa according to the AUA risk groups were treated with radical prostatectomy and extended pelvic lymph node dissection (RP-ePLND) when the risk of lymph node involvement was higher than 2% according to the MSKCC nomogram. Of those, 91 patients who presented 4 out of 12 biopsy positive cores or higher were considered as unfavorable subgroup. Data were prospectively collected and extracted from our institutional database. Whithin the same period, 110 patients with HR-PCa were treated with RP-ePLND in our institution. Disease recurrence was defined as a serum PSA level of 0.2 ng/mL or higher with a confirmatory rise. The primary endpoint was biochemical recurrence-free survival and the secondary endpoints were metastasis-free survival, death due to prostate cancer and overall mortality. Statistical significance was set for p values <0.05. RESULTS Preoperative characteristics for patients with unfavorable IR-PCa and HR-PCa were respectively: median (interquartile range [IQR]) age was 65 (61-71) and 66 (61-70); median PSA was 8.6 (5.9-11.2) and 14.0 (4.7-27.7) ng/mL; prostate biopsy Gleason Score was 3 in five (3.3%) and four (4%) patients, 7 in 88 (96.7%) and 25 (23%) patients. Gleason score was 8 in 50 (45%), 9 in 10 (11%) HR-PCa patients and one HR-PCa patient had a Gleason score of 10. In patients with unfavorable IR-PCa and HR-PCa, respectively, 81 (89%) and 99 (90%) were disease-free after 18 (7.4-33.6) and 17.2 (5.3-31.7) months median (IQR) follow-up. When adjusted for pre-operative PSA, there was no significant difference in disease recurrence (hazard ratio [HR] 0.98 for HR-PCa vs IR-PCa; p=0.49). One (1.15%) and four (4.08%) patients developed subsequent metastases (HR 0.97 for HR-PCa vs IR-PCa; p=0.13), none of the patients died from prostate cancer and one patient died in each group from other causes. CONCLUSIONS The subgroup of unfavorable IR-PCa and HR-PCa patients had comparable oncological prognosis when treated with RP-ePLND. These results should be taken into account when counseling patients with such unfavorable IR-PCa characteristics who should be considered harboring a high-risk disease. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e819 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Youness Ahallal More articles by this author Davy Benarroche More articles by this author Luis Felipe Snel Zanettini More articles by this author Alexandre Colau More articles by this author Clement Charbonnier More articles by this author Jean-Francois Cote More articles by this author Bertrand Guillonneau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP82-15 HYPOGONADISM IS ASSOCIATED WITH A REDUCED RISK OF HIGH GRADE PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2018MP82-15 HYPOGONADISM IS ASSOCIATED WITH A REDUCED RISK OF HIGH GRADE PROSTATE CANCER Cosimo De Nunzio, Francesco Esperto, Riccardo Lombardo, Mariangela Bellangino, Antonio Nacchia, Angela Sica, Fabiana Cancrini, and Andrea Tubaro Cosimo De NunzioCosimo De Nunzio More articles by this author , Francesco EspertoFrancesco Esperto More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Mariangela BellanginoMariangela Bellangino More articles by this author , Antonio NacchiaAntonio Nacchia More articles by this author , Angela SicaAngela Sica More articles by this author , Fabiana CancriniFabiana Cancrini More articles by this author , and Andrea TubaroAndrea Tubaro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2743AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aim of our study was to explore the risk of prostate cancer and poorly differentiated prostate cancer (PCa) in hypogonadal men undergoing prostate biopsies. METHODS From 2008 onwards, a consecutive series of men undergoing 12-core prostate biopsy at one center in Italy were enrolled into a prospective database. Indications for prostatic biopsy were PSA value = 4 ng/ml and/or a positive digital rectal examination (DRE). Blood samples were collected before biopsy and tested for: total PSA levels, SHBG, serum testosterone level. Hypogonadism was defined as serum Testosterone levels < 2.3 ng/ml.We evaluated the association between hypogonadism status and prostate cancer risk and biopsy Gleason score using logistic regression analyses. RESULTS Overall 1124 patients were enrolled. Median age was 68 years (IQR: 62/63), median BMI was 27 kg/m2 (IQR: 25/29); median PSA 6.2 ng/ml (IQR: 4.4/9.0); median testosterone level was 3.8 ng/ml (IQR: 3.0/4.8), median SHBG 40 mmol/l (IQR 30/53). Overall 460/1124 (40.9%) had cancer on biopsy and out of them 126/460 presented a high grade disease (Gleason score =4+3).185/1124 (16%) of patients were hypogonadal. Prostate cancer detection was 380/939 (40.5%) in eugonadal patients and 80/185 (43.2%) in hypogonadal men (p=0.267). High grade prostate cancer was observed in 111/380 (29.2%) in eugonadal men and 15/80 (19%) in hypogonadal men (p=0.002). On multivariate analysis age (OR: 1.046 95%CI: 1.030-1.063; p= 0.000) and PSA (OR: 1.068 95%CI: 1.046-1.091; p= 0.000) were the only independent parameters associated with prostate cancer diagnosis while no difference was observed regarding the hypogonadal state. On multivariate analysis age (OR: 1.044 95%CI: 1.017-1.072; p= 0.000) and PSA (OR: 1.030 95%CI: 1.015-1.045; p= 0.000) were associated with high grade prostate cancer diagnosis while the presence of hypogonadal state reduced the risk of high grade PCa by 60% (OR: 0.40, IC 0.25-0.84, p=0.012). CONCLUSIONS In our study about 16% of patients at risk of PCa were hypogonadal. Hypogonadism was associated with a reduced risk of high grade prostate cancer. Although further studies should evaluate the pathophysiology behind this association, we support that hormonal status should be evaluated in patients at risk of PCa. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1112 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Cosimo De Nunzio More articles by this author Francesco Esperto More articles by this author Riccardo Lombardo More articles by this author Mariangela Bellangino More articles by this author Antonio Nacchia More articles by this author Angela Sica More articles by this author Fabiana Cancrini More articles by this author Andrea Tubaro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Repeat multiparametric MRI in prostate cancer patients on active surveillance.

IntroductionThis study was conducted to describe the changes in repeat multiparametric MRI (mpMRI) occurring in prostate cancer (PCa) patients during active surveillance (AS), and to study possible associations between mpMRI-related parameters in predicting prostate biopsy (Bx) Gleason score (GS) upgrading >3+3 and protocol-based treatment change (TC).Materials and methodsThe study cohort consisted of 76 AS patients with GS 3+3 PCa and at least two consecutive mpMRIs of the prostate performed between 2006–2015. Patients were followed according to the Prostate Cancer Research International Active Surveillance (PRIAS) protocol and an additional mpMRI. The primary end points were GS upgrading (GU) (>3+3) in protocol-based Bxs and protocol-based TC.ResultsOut of 76 patients, 53 (69%) had progression (PIRADS upgrade, size increase or new lesion[s]), while 18 (24%) had radiologically stable disease, and 5 (7%) had regression (PIRADS or size decrease, disappearance of lesion[s]) in repeat mpMRIs during AS. PIRADS scores of 4–5 in the initial mpMRI were associated with GU (p = 0.008) and protocol-based TC (p = 0.009). Tumour progression on repeat mpMRIs was associated with TC (p = 0.045) but not with GU (p = 1.00). PIRADS scores of 4–5 predict GU (sensitivity 0.80 [95% confidence interval (CI); 0.51–0.95, specificity 0.62 [95% CI; 0.52–0.77]) with PPV and NPV values of 0.34 (95% CI; 0.21–0.55) and 0.93 (95% CI; 0.80–0.98), respectively.ConclusionmpMRI is a useful tool not only to select but also to monitor PCa patients on AS.

Corelation of body mass index with cancer detection on prostate biopsy and higher Gleason score

Objective To investigate the relationship between body mass index (BMI)and prostate cancer detection in prostate biopsy. Methods A total of 147 patients who underwent a prostate biopsy by transrectal ultrasound from January 2013 to December 2015 were reviewed retrospectively. All patients were divided into normal BMI group(BMI<25 kg/m2)and obese group(BMI≥25 kg/m2)by BMI index. The differences of age, prostate-specific antigen (PSA) level and BMI were analyzed between two groups. Results Compared with normal BMI group, the patients in obese group had later TNM and higher Gleason score(P<0.05). Logistic regression analysis showed that higher index BMI was risk factors for biopsy-positive patients(P<0.05). Conclusions Assessment of BMI can provide significant information for prostate cancer screening at clinical evaluation, which provide important evidence for the prevention, diagnosis and treatment of prostate cancer. Key words: Pr ostatic Neoplasms; Biopsy, Needle; Body Mass Index

The role of the serum testosterone levels as a predictor of prostate cancer in patients with atypical small acinar proliferation at the first prostate biopsy.

The current literature does not support the usefulness of clinical markers on predicting which patients with atypical small acinar proliferation (ASAP) are more likely to progress to prostate cancer (PCa). Androgens have long been considered to be the potential risk factors for PCa. However, the role of testosterone is controversial. The present study aims to analyze the relationship between serum testosterone (TS) levels and the diagnosis of PCa after a first prostate biopsy in patients affected by ASAP. This retrospective study included 143 patients diagnosed with ASAP in an initial transrectal ultrasound-guided prostate biopsy for suspicious PCa according to the European Association of Urology guidelines. Their TS levels, age, PSA, prostate volume, digital rectal examination, and prostate biopsy Gleason score (GS) were collected retrospectively for statistical analysis. All patients included in the study had a second biopsy and were suitable for further analysis. Re-biopsy was carried out 3–6 months after the first diagnosis of ASAP. Low and normal TS groups were composed of 29 (20.3%) and 114 (79.7%) patients, respectively. The diagnosis of the second biopsy was ASAP in 25.2% and PCa in 36.4% of patients. The comparison between patients with PCa and those with negative or an ASAP result in the second biopsy reported that men with cancer had significantly higher levels of TS (P < 0.001). However, there was no statistically significant association between GS postbiopsy and TS (P = 0.324). Our experience demonstrated that eugonadal patients may be a clinical risk factor for the diagnosis of PCa on re-biopsy after ASAP diagnosis than hypogonadal.

Impact of positive surgical margin on biochemical recurrence following radical prostatectomy in locally advanced prostate cancer

This study aimed to determine the effect of surgical margin positivity on biochemical recurrence (BCR) in patients with locally advanced prostate cancer (PCa) who underwent radical retropubic prostatectomy (RRP). The medical records of all patients with locally advanced PCa that underwent RRP were retrospectively reviewed. Patient demographics, digital rectal examination findings, prostate biopsy Gleason score, prostate volume, pre- and post-treatment prostate-specific antigen (PSA) levels, definitive pathology Gleason score, surgical margin status, seminal vesicle invasion, perineural invasion, absence or presence of BCR, and the time to BCR were analyzed. The study included 130 patients. The final pathologic examination showed that seven (5.4%) patients had T3a disease and 123 (94.6%) had T3b disease. In all, 93 (71.5%) patients had a positive surgical margin [SM(+)], whereas 37 (28.5%) patients had a negative surgical margin [SM(−)]. Among the seven patients with pT3a disease, four (57.1%) had SM(+), whereas 89 (72.4%) of the 123 patients with pT3b disease had SM(−). BCR occurred in 11.8% (11 of 93) of patients with SM(+) and in 45.9% (17 of 37) of those with SM(−) (p < 0.001). Multivariate logistic regression analysis showed that SM(+) was the only significant predictor of BCR following RRP (relative risk, 0.163; 95% confidence interval (0.062–0.433); p < 0.001). SM(+) in RRP specimens is not always indicative of BCR in patients with locally advanced PCa. RRP should be considered an effective treatment choice for selected patients with locally advanced PCa, despite the associated high SM(+) rate.

Outcomes of Active Surveillance after Initial Surveillance Prostate Biopsy

We analyzed the rates of disease reclassification at initial and subsequent surveillance prostate biopsy as well as the treatment outcomes of deferred therapy among men on active surveillance for prostate cancer. From a prospective database we identified 300 men on active surveillance who had undergone initial surveillance prostate biopsy, with or without confirmatory biopsy, within 1 year of diagnosis. Of these men 261 (87%) were classified as having NCCN very low or low risk disease at diagnosis. Disease reclassification on active surveillance was defined as the presence of 50% or more positive cores and/or surveillance prostate biopsy Gleason score upgrading. Patients with type I disease reclassification included those with any surveillance prostate biopsy Gleason score upgrading, while patients with type II reclassification had to have primary Gleason pattern 4-5 disease on surveillance prostate biopsy. Outcomes after initial surveillance prostate biopsy were evaluated using actuarial analyses. At the time of initial surveillance prostate biopsy 49 (16%) and 19 (6%) patients had type I and type II disease reclassification, respectively. Those who underwent confirmatory biopsy had significantly reduced rates of type I (9% vs 23%, p=0.001) and type II (3% vs 9%, p=0.01) reclassification at initial surveillance prostate biopsy. For the 251 patients without disease reclassification at initial surveillance prostate biopsy the 2-year rates of subsequent type I and II reclassification were 17% (95% CI 0-24) and 3% (95% CI 0.1-7), respectively. For the 93 patients who received deferred therapy the 5-year biochemical progression-free probability was 89% (95% CI 79-98), including 95%, 82% and 70% among those without, and those with type I and type II disease reclassification, respectively. Patients on active surveillance with stable disease at the time of initial surveillance prostate biopsy may be appropriate candidates for less intensive surveillance prostate biopsy schedules.

Apparent diffusion coefficient values are superior to transrectal ultrasound-guided prostate biopsy for the assessment of prostate cancer aggressiveness.

Background Few studies have focused on comparing the utility of diffusion-weighted imaging (DWI) and transrectal ultrasound (TRUS)-guided biopsy in predicting prostate cancer aggressiveness. Whether apparent diffusion coefficient (ADC) values can provide more information than TRUS-guided biopsy should be confirmed. Purpose To retrospectively assess the utility of ADC values in predicting prostate cancer aggressiveness, compared to the TRUS-guided prostate biopsy Gleason score (GS). Material and Methods The DW images of 54 patients with biopsy-proven prostate cancer were obtained using 1.5-T magnetic resonance (MR). The mean ADC values of cancerous areas and biopsy GS were correlated with prostatectomy GS and D'Amico clinical risk scores, respectively. Meanwhile, the utility of ADC values in identifying high-grade prostate cancer (with Gleason 4 and/or 5 components in prostatectomy) in patients with a biopsy GS ≤ 3 + 3 = 6 was also evaluated. Results A significant negative correlation was found between mean ADC values of cancerous areas and the prostatectomy GS ( P < 0.001) and D'Amico clinical risk scores ( P < 0.001). No significant correlation was found between biopsy GS and prostatectomy GS ( P = 0.140) and D'Amico clinical risk scores ( P = 0.342). Patients harboring Gleason 4 and/or 5 components in prostatectomy had significantly lower ADC values than those harboring no Gleason 4 and/or 5 components ( P = 0.004). Conclusion The ADC values of cancerous areas in the prostate are a better indicator than the biopsy GS in predicting prostate cancer aggressiveness. Moreover, the use of ADC values can help identify the presence of high-grade tumor in patients with a Gleason score ≤ 3 + 3 = 6 during biopsy.