Time Of Prostate Biopsy Research Articles

The treatment landscape of nonmetastatic castrate resistant prostate cancer: A contemporary perspective

ObjectivesThe incidence of nonmetastatic castrate resistant prostate cancer (nmCRPC) is not well defined in contemporary practice. The aim of this study is to describe the incidence and patterns of treatment of nmCRPC over the last 6 years at a single high-volume Australian health institution. Subjects and methodsAll men newly diagnosed with prostate cancer at Western Health, Melbourne from January 2016 to December 2021 were included in the study. Those diagnosed with nonmetastatic prostate cancer and treated with medical or surgical castration for biochemical failure post attempted curative therapy were retrospectively reviewed for signs of castration resistance using prostate specific antigen (PSA) and testosterone biochemical markers up until October 2022. ResultsFrom January 2016 to December 2021, 822 patients were diagnosed with prostate cancer, 590 had localized disease, 373 underwent definitive locoregional therapy, and 31 went on to have biochemical recurrence and were commenced on androgen deprivation therapy. Twenty-five patients had undetectable PSA levels and were classified as having nonmetastatic castrate sensitive prostate cancer (nmCSPC), whilst the remaining 6 patients experienced a rising PSA and were thus classified as nmCRPC. The incidence rate of nmCRPC was 228 cases per 100,000 person-years.The median age at the time of prostate biopsy was 74 years (interquartile range [IQR] 64–79) in the nmCRPC group and 62 years (IQR 57–69) in the nmCSPC group. The median prebiopsy PSA (ng/ml) in the nmCRPC and nmCSPC groups were 27.5 (IQR 19.9–50.4), and 16.5 (IQR 9.0–26.0), respectively. The median duration from prostate cancer diagnosis to onset of nmCRPC was 24 months (IQR 17–29) and the median PSA doubling time was 3.4 months (IQR 2.2–5.7). ConclusionsThus, nmCRPC is an uncommon disease. Further population-based studies are required to better understand the incidence of nmCRPC.

Ratio of the expression levels of androgen receptor splice variant 7 to androgen receptor in castration refractory prostate cancer.

In clinical samples, the expression of androgen receptor (AR) and of AR splice variant 7 (AR-V7) is higher in castration-resistant prostate cancer (CRPC) compared with that in hormone-sensitive prostate cancer (PCa). However, there are only a few reports on the ratio of the expression levels of AR-V7 to AR (AR-V7/AR) in prostate tissue. The present study evaluated AR-V7/AR expression in various types of human prostate tissues and CRPC cells. Pretreatment prostate tissue samples from patients with benign prostatic hyperplasia (BPH; n=18), Gleason score 7 (n=17), and Gleason score 8–10 (n=26) were collected at the time of prostate biopsy, and tissue samples from CRPC patients (n=10) were collected at the time of transurethral resection of the prostate. Furthermore, androgen-independent LNCaP cells were established. The mRNA expression levels of AR and AR-V7, cell proliferation and prostate-specific antigen (PSA) production were evaluated by reverse transcription quantitative PCR, MTS assay and chemiluminescent enzyme immunoassay, respectively. There was a significant difference in AR-V7/AR expression ratios between the CRPC group and the BPH and pre-treatment PCa groups (CRPC, 7%; BPH and pre-treatment PCa, 1%). Subsequently, we compared the AR and AR-V7 expression levels in CRPC samples with those in the pretreatment prostate tissues from the same patients. The results demonstrated that the AR-V7/AR ratio increased from 3 to 9% after CRPC onset. Furthermore, in vitro experiment demonstrated that AR-V7 expression in LNCaP cells was increased after transforming into CRPC cells. The AR-V7/AR ratio also increased from 0.05 to 0.3%. In addition, small interfering (si)-RNA-mediated knockdown of AR inhibited the proliferation of and PSA production from androgen-independent LNCaP cells; however, AR-V7 knockdown had no effect. Conversely, siRNA-mediated knockdown of both AR and AR-V7 inhibited the proliferation of VCAP cells. In summary, the findings from the present study demonstrated that AR-V7 expression and AR-V7/AR ratio were increased after the onset of CRPC, which had a limited role in CRPC cell proliferation. Further investigation is required to clarify the roles of AR other splice variants and AR-V7 in CRPC.

Contemporary Trends in Magnetic Resonance Imaging at the Time of Prostate Biopsy: Results from a Large Private Insurance Database

BackgroundMagnetic resonance imaging (MRI) of the prostate (MRI-prostate) facilitates better detection of clinically significant prostate cancer (PCa). Yet, the national trends of MRI at the time of prostate biopsy and its ability to increase the detection of PCa in a biopsy-naïve population remain unknown. ObjectiveTo elucidate the contemporary trends of MRI and prostate biopsy, and whether it improved PCa diagnosis among privately insured patients. Design, setting, and participantsThis was a retrospective cohort study of a large private health insurance database in the USA—the OptumLabs Data Warehouse. We identified all men ≥40 yr of age who underwent index prostate biopsies from 2010 through 2016. InterventionMRI-prostate at the time of index biopsy. Outcome measurements and statistical analysisUtilization of the MRI at the time of biopsy and incident PCa diagnosis constituted the primary outcomes. We enumerated unadjusted and age-specific annual rates of MRI over time to elucidate trends using regression models (trend analysis). Bivariate and multivariable regression analyses identified patient characteristics associated with MRI-prostate, and the association between the use of MRI and PCa diagnosis. Results and limitationsOverall, 119 202 men underwent index prostate biopsies. Unadjusted annual rates of MRI at the time of biopsy significantly increased from 7 per 1000 biopsies in 2010 to 83 per 1000 biopsies in 2016 (p < 0.001 for trend). Age-specific rates increased across all age groups (40–49, 50–59, 60–65, 66–74, and 75+ yr; all p < 0.001). On multivariable analysis, black patients had a lower likelihood of MRI compared with white patients (odds ratio [OR]: 0.6; p < 0.01). MRI at the time of biopsy was not associated with a higher likelihood of incident PCa compared with traditional systematic biopsy (OR: 1.0; p = 0.7). The retrospective design and the inability to detect clinically significant PCa (Gleason 7+) constitute the limitations of this study. ConclusionsWhile the use of MRI at the time of biopsy rose markedly, it was not associated with a higher detection rate of PCa. Further research is needed to address effective dissemination of MRI and targeted biopsies, and racial disparities. Patient summaryFrom 2010 to 2016, our study found a significant rise in the utilization of magnetic resonance imaging of the prostate (MRI-prostate) at the time of index biopsy, although only a minority of patients undergo MRI-prostate. The use of MRI-prostate was not associated with a higher likelihood of diagnosing incident prostate cancer.

MP66-01 APICAL INVOLVEMENT IS ASSOCIATED WITH ADVERSE PATHOLOGICAL OUTCOMES IN MEN WITH LOW RISK PROSTATE CANCER ELIGIBLE FOR ACTIVE SURVEILLANCE

INTRODUCTION AND OBJECTIVES:To assess the association between the presence of apical lesion at time of prostate biopsy (PBx) and pathological outcomes after radical prostatectomy (RP) in men with f...

Clinical association of metabolic syndrome, C-reactive protein and testosterone levels with clinically significant prostate cancer.

Recently, the influence that metabolic syndrome (MetS), hormonal alterations and inflammation might have on prostate cancer (PCa) risk has been a subject of controversial debate. Herein, we aimed to investigate the association between MetS‐components, C‐reactive protein (CRP) and testosterone levels, and the risk of clinically significant PCa (Sig‐PCa) at the time of prostate biopsy. For that, men scheduled for transrectal ultrasound guided biopsy of the prostate were studied. Clinical, laboratory parameters and criteria for MetS characterization just before the biopsy were collected. A total of 524 patients were analysed, being 195 (37.2%) subsequently diagnosed with PCa and 240 (45.8%) meet the diagnostic criteria for MetS. Among patients with PCa, MetS‐diagnosis was present in 94 (48.2%). Remarkably, a higher risk of Sig‐PCa was associated to MetS, greater number of MetS‐components and higher CRP levels (odds‐ratio: 1.83, 1.30 and 2.00, respectively; P < 0.05). Moreover, higher circulating CRP levels were also associated with a more aggressive Gleason score in PCa patients. Altogether, our data reveal a clear association between the presence of MetS, a greater number of MetS‐components or CRP levels >2.5 mg/L with an increased Sig‐PCa diagnosis and/or with aggressive features, suggesting that MetS and/or CRP levels might influence PCa pathophysiology.

Topical rectal antiseptic at time of prostate biopsy: how a resident patient safety project has evolved into institutional practice.

To report outcomes 5years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol. A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring. Median age and PSA of men included in this study were 64years and 12ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring. What started as a resident quality safety project 5years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

Historical and contemporary perspectives on cribriform morphology in prostate cancer.

The Gleason scoring system is widely used for the grading and prognostication of prostate cancer. A Gleason pattern 4 subtype known as cribriform morphology has now been recognized as an aggressive and often lethal pattern of prostate cancer. The vast majority of published and ongoing prostate cancer studies still do not acknowledge the prognostic differences between various Gleason pattern 4 morphologies. As a result, current treatment recommendations are likely to be imprecise and not tailored towards patients who are most likely to die from the disease. Use of active surveillance for patients with Gleason score 3 + 4 prostate cancer has been suggested. However, the success of such paradigms would require cribriform morphology to be reported at the time of prostate biopsy, as patients harbouring such a pattern are poor candidates for surveillance. To date, only a limited number of studies have described the molecular alterations that occur in the cribriform morphological pattern. Further refinement of prostate cancer grading paradigms to distinguish cribriform from noncribriform Gleason pattern 4 is essential.

The impact of prostate cancer diagnosis and treatment decision-making on health-related quality of life before treatment onset

ObjectiveThe objective of this study is to test if patients’ health-related quality of life (HRQoL) declines after prostate biopsy to detect Pca, and after subsequent treatment decision-making in case Pca is confirmed, and to test whether personality state and traits are associated with these potential changes in HRQoL.MethodsPatients who were scheduled for prostate biopsy to detect Pca (N = 377) filled out a baseline questionnaire about HRQoL (EORTC QLQ-C30 and PR25), “big five” personality traits (BFI-10), optimism (LOT-r), and self-efficacy (Decision Self-efficacy Scale) (t0). Patients with confirmed Pca (N = 126) filled out a follow-up questionnaire on HRQoL within 2 weeks after treatment was chosen but had not yet started (t1).ResultsHRQoL declined between t0 and t1, reflected in impaired role and cognitive functioning, and elevated fatigue, constipation, and prostate-specific symptoms. Sexual activity and functioning improved. Baseline HRQoL scores were unrelated to the selection of a particular treatment, but for patients who chose a curative treatment, post-decision HRQoL showed a greater decline compared to patients who chose active surveillance. Optimism was associated with HRQoL at baseline; decisional self-efficacy was positively associated with HRQoL at follow-up. No associations between HRQoL and the “big five” personality traits were found.ConclusionPatients who have undergone prostate biopsy and treatment decision-making for Pca experience a decline in HRQoL. Choosing treatment with a curative intent was associated with greater decline in HRQoL. Interventions aimed at optimism and decision self-efficacy could be helpful to reduce HRQoL impairment around the time of prostate biopsy and treatment decision-making.

Editorial Comment

Accurate risk calculators for predicting the presence of significant prostate cancer at the time of prostate biopsy. Avoiding overdiagnosis and overtreatment is especially important given the increased awareness of prostate biopsy complications and the preventative task force's recommendations on prostate-specific antigen (PSA) screening. 1 Moyer VA Force USPST Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012; 157: 120-134 Crossref PubMed Scopus (1637) Google Scholar

Racial and Ethnic Variation in Time to Prostate Biopsy After an Elevated Screening Level of Serum Prostate-specific Antigen

To examine the racial and ethnic variation in time to prostate biopsy after an elevated screening level of serum prostate-specific antigen (PSA). Male members of the Kaiser Permanente of Southern California health plan, 45 years of age or older, with no history of prostate cancer or a prostate biopsy, and at least 1 elevated screening level of serum PSA between January 1, 1998 and December 31, 2007 were retrospectively identified (n = 59,506). All participants were passively followed via electronic health records until their time of prostate biopsy, death, membership disenrollment, or study conclusion (December 31, 2014), whichever was the initial event. Proportional hazard regression analyses were used to estimate the association between time from an elevated screening level of serum PSA to prostate biopsy, adjusting for age, benign prostatic hyperplasia, prostatitis, type 2 diabetes mellitus, hypertension, and Charlson Comorbidity Index score. Median time until biopsy was 0.6 years (214 days), with approximately 41% of participants receiving a prostate biopsy within the study period. Results from the fully adjusted analysis indicated that the non-Hispanic Asian or Pacific Islanders (hazard ratio: 1.10, 95% confidence interval: [1.04, 1.15]) and the non-Hispanic blacks (hazard ratio: 1.04, 95% confidence interval: [1.00, 1.08]) had a slightly shorter time to prostate biopsy after an elevated screening level of serum PSA compared to the non-Hispanic whites. These data suggest that, within an integrated healthcare organization, minimal differences exist between racial and ethnic subgroups in their time to prostate biopsy after an elevated screening level of serum PSA.

Change in prostate biopsy outcomes and costs of care for prostate cancer in underserved population after changes in USPSTF guidelines.

1548Background: This study investigates the impact of United States Preventive Services Task Force (USPSTF) guideline changes regarding prostate specific antigen (PSA) based screening for prostate cancer (PCa) on prostate biopsy outcomes and costs of care in a population of underserved men. Methods: Data were abstracted from male subjects ≥ 50years old who had a prostate biopsy and were part of the Inland Empire Health Plan. After reviewing data from 935 subjects, complete data were obtained from 580 subjects (430 subjects who had a biopsy after the guideline change and 130 who had biopsy before the guideline change). Direct medical cost of cancer care were obtained through claims data (Pharmacy, Professional and Institutional Claims) and were calculated for each member based on the services they had received. Results: Although PSA at time of prostate biopsy was not statistically different between the post and pre guideline subjects (Mean(SD), ng/ml: 6.3(6.2) vs 6.7(7.7), p = 0.73), the risk of being diag...

MP50-06 SIMVASTATIN INHIBITS THE PROLIFERATION, MIGRATION AND INVASION OF ANDROGEN INDEPENDENT HUMAN PROSTATE CANCER CELLS VIA UP-REGULATION OF ANNEXIN A10

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II1 Apr 2016MP50-06 SIMVASTATIN INHIBITS THE PROLIFERATION, MIGRATION AND INVASION OF ANDROGEN INDEPENDENT HUMAN PROSTATE CANCER CELLS VIA UP-REGULATION OF ANNEXIN A10 Yoshiyuki Miyazawa, Yoshitaka Sekine, Haruo Kato, Yosuke Furuya, Hidekazu Koike, and Kazuhiro Suzuki Yoshiyuki MiyazawaYoshiyuki Miyazawa More articles by this author , Yoshitaka SekineYoshitaka Sekine More articles by this author , Haruo KatoHaruo Kato More articles by this author , Yosuke FuruyaYosuke Furuya More articles by this author , Hidekazu KoikeHidekazu Koike More articles by this author , and Kazuhiro SuzukiKazuhiro Suzuki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.440AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, statins have been being studied for their proapoptic and antimetastatic effects. However, the exact mechanisms of their anticancer action are still unclear. By using microarray, we found that up-regulation of Annexin A10 (ANXA10) was observed in PC-3 after treatment of simvastatin. ANXA10 is reported to have antitumor effects. In this study, we evaluated the effects of simvastatin on ANXA10 signaling in androgen independent prostate cancer cells. METHODS PC-3, LNCaP-LA and DU145 human PC cell lines were usey. In Gunma university hospital, prostate tissues (BPH; n = 15, Gleason score 7; n = 15 and Gleason score 8 to 10; n = 15) were collected at the time of prostate biopsy. To evaluate the effect of simvastatin and/or ANXA10 on PC-3 cells, we used a nude mouse tumor xenograft model with administration of simvastatin 5mg/kg, 50mg/kg and saline (as control group) via intraperitoneal injections. RESULTS Simvastatin inhibited proliferation of PC-3, LNCaP-LA and DU145 cells. The expressions of ANXA10 were up-regulated by simvastatin in PC-3, LNCaP-LA and DU145. Transfection with ANXA10 inhibited PC-3 cell proliferation, migration and invasion. Knockdown of ANXA10 by siRNA increased proliferation of PC-3 cells. In a nude mouse xenograft model of PC-3 cells, simvastatin induced both reductions in tumor size and up-regulations of ANXA10 expression (Fig.1). In human prostate biopsy samples, ANXA10 mRNA expression was significantly lower in prostate cancer groups than BPH group (Fig.2). Next, we focused on S100 calcium binding protein A4 (S100A4), which is reported to be correlated with aggressiveness and worse prognosis for patients with different types of carcinoma. The expression of S100A4 was down-regulated by both simvastatin and overexpression of ANXA10. Moreover, knockdown of S100A4 by siRNA inhibited proliferation, migration and invasion of PC-3 cells. CONCLUSIONS Our results suggest statins inhibit proliferation, migration and invasion of androgen independent prostate cancer cells by up-regulation of ANXA10. In addition, S100A4 plays an important role in the effects. It seems that statins may be beneficial in preventative and/or therapeutic treatment of prostate cancer. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e674 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yoshiyuki Miyazawa More articles by this author Yoshitaka Sekine More articles by this author Haruo Kato More articles by this author Yosuke Furuya More articles by this author Hidekazu Koike More articles by this author Kazuhiro Suzuki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP53-14 VITAMIN D DEFICIENCY PREDICTS ADVERSE PATHOLOGY AT TIME OF RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2015MP53-14 VITAMIN D DEFICIENCY PREDICTS ADVERSE PATHOLOGY AT TIME OF RADICAL PROSTATECTOMY Diana K. Bowen, Gregory A. Jordan, Tyler J. Maiers, Rick A. Kittles, and Adam B. Murphy Diana K. BowenDiana K. Bowen More articles by this author , Gregory A. JordanGregory A. Jordan More articles by this author , Tyler J. MaiersTyler J. Maiers More articles by this author , Rick A. KittlesRick A. Kittles More articles by this author , and Adam B. MurphyAdam B. Murphy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1708AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently vitamin D has been associated with increased odds of prostate cancer (PCa) diagnosis in African American (AA) men and advanced PCa in European American (EA) and AA men. We examine the relationship between serum vitamin D levels in men who underwent radical prostatectomy (RP) and the presence of adverse pathology. METHODS Serum 25-hydroxyvitamin D (25-OH D) was obtained from 199 PCa patients at the time of prostate biopsy who underwent RP within 1 year in Chicago, Illinois. Adverse pathology at the time of RP was defined by the presence of dominant Gleason pattern 4, the presence of any pattern 5, and pathologic stage ≥ pT3a. Descriptive statistics were used to characterize important covariates including age, race, body mass index (BMI), alcohol & smoking use, income, PCa family history, marital status, education, 5 alpha-reductase inhibitor use, and season. Season was defined based on UV exposure data. Cut points for 25-OH D deficiency were based on sensitivity analysis. Binary logistic regression was used to evaluate the association of 25-OH D and adverse pathology. RESULTS Table 1 displays characteristics of the adverse vs. non-adverse pathology groups. On univariate analysis, adverse pathology was correlated with age (r=0.15; p=0.03), PSA (r=0.21;p=0.003), obesity (r=0.19; p=0.007) and a 25-OH D level less than 30ng/mL (r=0.16; p=0.03). Race, alcohol use, smoking status, income, level of education, PCa family history and season were not correlated with the presence of adverse pathology. On regression, age (OR 1.05; p=0.047), obesity (OR 2.39; p = 0.01), and 25-OH D < 30 ng/mL (OR 2.20; p=0.04) were associated with increased odds of adverse pathology. Smoking, season, and race were not statistically significant. CONCLUSIONS Serum vitamin D deficiency is associated with increased odds of adverse pathology on RP. The mechanisms underlying this association deserve further exploration. Table 1. Characteristics of men with and without adverse pathology at the time of radical prostatectomy. Continuous Variables Non-Adverse Pathology (N=128) N (SD) Adverse Pathology (N=71) N (SD) P-Value Age, years 60.6 (6.6) 62.7 (6.9) 0.03† BMI, kg/m2 27.0 (6.3) 28.2 (7.9) 0.24 PSA at diagnosis, ng/mL 5.7 (3.3) 35.8 (111.7) 0.03† 25-OH D, ng/mL 24.0 (10.3) 22.0 (9.3) 0.18 Income, US $ $49,200 ($26,700) $44,900 ($26,140) 0.27 Categorical Variables Non-Adverse Pathology N (%) Adverse Pathology N (%) P-Value Obesity (BMI > 30 kg/m2 25 (19.8%) 26 (37.7%) 0.007† Married, (yes/no) 94 (73.4%) 55 (77.5%) 0.53 1st degree PCa Family History 35 (28.0%) 17 (25.8%) 0.74 25-OH D < 30 ng/mL 88 (68.8%) 59 (83.1%) 0.03† 25-OH D < 20 ng/mL 41 (32.0%) 27 (38.0%) 0.39 Smoking History (ever/never) 63 (49.2%) 33 (46.5%) 0.71 Alcohol Use (ever/never) 119 (93.0%) 63 (88.7%) 0.31 Black Racial Status (yes/no) 90 (70.3%) 50 (70.4%) 0.99 5-alpha Reductase Inhibitor Use (yes/no) 7 (5.5%) 3 (4.2%) 0.7 High UV Season 64.0 (50.0%) 36 (50.7%) 0.92 † Denotes p< 0.05; High UV season was defined by the months of May through October based on reported average ultraviolet radiation exposure in Chicago, Illinois. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e641 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Diana K. Bowen More articles by this author Gregory A. Jordan More articles by this author Tyler J. Maiers More articles by this author Rick A. Kittles More articles by this author Adam B. Murphy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Needle biopsy size and pathological Gleason Score diagnosis: No evidence for a link

Biopsy Gleason score (GS), in combination with other clinical parameters, is important to take a therapeutic decision for patients with diagnosis of localized prostate cancer. However, preoperative GS is often upgraded after a radical prostatectomy. Increasing the amount of tissue in prostate biopsy may be a way to avoid this issue. We evaluate the influence of a larger biopsy needle size on the concordance between biopsy and pathological GS. We analyzed paired biopsies and prostatectomy specimens from 104 cases of men with clinically localized prostate cancer. At the time of prostate biopsy, the patients were prospectively randomized into two needle groups (16-Gauge [G] and 18G) using a 1:1 ratio. GS concordance was estimated performing kappa statistic testing, overall concordance rate and risk to under grade biopsy GS=6. A logistic regression analysis was performed to evaluate the patients' characteristics as possible risk factors. The overall concordance between prostate biopsy and pathological GS was 76.9% and 75.6% (p = 0.875) and the k values were 0.821 and 0.811 (p = 0.424), respectively, for 16G and 18G needle study groups. The risk to undergrade a biopsy GS=6 was 21.1% and 15.4% (p = 0.709) using a 16G and 18G needle, respectively. Age, prostate-specific antigen, prostate volume and needle calibre were not independently associated with a higher risk of GS discordance. Needle size does not affect the concordance between biopsy and pathological GS. Although GS is not the only way to determine treatment, it is still an unresolved urological issue.

Prostate volume as an independent predictor of prostate cancer in men with PSA of 10–50 ng ml−1

Prostate volume (PV) has been shown to be associated with prostate cancer (PCa) detection rates in men with a prostate-specific antigen (PSA) in the 'grey zone' (2.0-10.0 ng ml(-1)). However, the PSA 'grey zone' in Asian men should be higher because the incidence of PCa in Asian men is relatively low. Therefore, we evaluated the association between PV and PCa detection rates in men with PSAs measuring 10-50 ng ml(-1). Men who underwent a 13-core prostatic biopsy with PV documentation participated in the study. A multivariate stepwise regression was used to evaluate whether the PV at time of prostate biopsy could predict the risk of PCa. The rates of PCa among men in different PSA ranges, stratified by PV medians (<60 and ≥60 ml), were calculated. There were 261 men included in the final analysis. PV was the strongest predictor of PCa risk (odds ratio, 0.02; P<0.001) compared to other variables. The PCa rates in men with PVs measuring <60 and ≥60 ml in the 10-19.9 ng ml(-1) PSA group were 40.6% and 15.1%, respectively, while the rates for men with PSAs measuring 20-50 ng ml(-1) were 65.1% and 26.8%. PV is an independent predictor of PCa in men with PSA measuring 10-50 ng ml(-1). In clinical practice, particularly for those countries with lower incidences of PCa, PV should be considered when counselling patients with PSAs measuring 10-50 ng ml(-1) regarding their PCa risks.

Relationship between Chronic Inflammation at Prostate Biopsy and Transition Zone Prostate Volume Enlargement in a Prospectively UK Screened Population

Objective: The aim of this study was to evaluate the relationship between histological prostatic inflammation and prostate volume at the time of prostate biopsy. Patients and methods: From a prospective prostate cancer screening study, 137 men aged 50–65 years, underwent prostate biopsies negative for cancer, forming the study population. Biopsy criteria were prostate specific antigen (PSA) &gt;4 ng/ml ( n = 40), or between 1.1 and 4ng/ml with a percent free PSA (%fPSA) &lt;25% ( n = 97). Total gland (TG) and transition zone (TZ) volumes were measured prior to TRUS guided biopsy. Histological classification included chronic inflammation (CIlymphocyte predominant), active inflammation (AI-neutrophil predominant), and benign prostatic tissue (BPT-no inflammatory cells). A logistic regression analysis was performed using age, TPSA, %fPSA, histology, TZ and TG volume, TZ/TG ratio, PSA density, and transition zone PSA density as continuous variables. We also mailed validated self-administered symptom scores to men in the three histological subgroups (men without cancer) at a median of follow up of 6.5 years (range 5.9–7.1 years) after screening and biopsy. Results: Histological chronic inflammation ( n = 78, 57%) at biopsy was associated with a larger mean TG volume (30.8cc) than active inflammation ( n =7, 22.7cc) and benign prostatic tissue ( n = 52, 25.9cc). On bivariate analysis, chronic inflammation was associated with greater TZ volume ( p = 0.0015) and TZ/TG ratio ( p = 0.0008). On multivariate analysis, chronic inflammation was the only independent variable associated with a greater ratio of the TZ to TG volume (odds ratio 478, p = 0.005). IPPS symptoms scores were completed and returned by 88 men (66% compliance). In men with chronic inflammation (49), active inflammation (5), and benign tissue (30), the mean IPSS scores were 10.9, 7.2, and 8.7, respectively. These differences did not reach statistical significance p &gt; 0.05. Conclusions: In this younger screened population, chronic inflammation was associated with greater prostate gland volume secondary to transition zone volume enlargement. Further research is needed to establish a causally related link for this observation.

Effect of delaying surgery on radical prostatectomy outcomes: a contemporary analysis

Study Type - Therapy (case series). Level of Evidence 4. What's known on the subject? and What does the study add? For patients electing surgical treatment, the question of the effect of surgical delay on clinical outcomes in prostate cancer is controversial. In this study we examined the effect of delay from diagnosis to surgery on outcomes in men with localized prostate cancer and found no association between time to surgery and risk of biochemical recurrence, even for patients with longer delays and high-risk disease. Men with localized prostate cancer can be reassured that reasonable delays in treatment will not influence disease outcomes. • To examine the effect of time from last positive biopsy to surgery on clinical outcomes in men with localized prostate cancer undergoing radical prostatectomy (RP). • We conducted a retrospective review of 2739 men who underwent RP between 1990 and 2009 at our institution. • Clinical and pathological features were compared between men undergoing RP ≤ 60, 61-90 and >90 days from the time of prostate biopsy. • A Cox proportional hazards model was used to analyse the association between clinical features and surgical delay with biochemical progression. Biochemical recurrence (BCR)-free rates were assessed using the Kaplan-Meier method. • Of the 1568 men meeting the inclusion criteria, 1098 (70%), 303 (19.3%) and 167 (10.7%) had a delay of ≤ 60, 61-90 and >90 days, respectively, between biopsy and RP. A delay of >60 days was not associated with adverse pathological findings at surgery. • The 5-year survival rate was similar among the three groups (78-85%, P= 0.11). • In a multivariate Cox model, men with higher PSA levels, clinical stages, Gleason sums, and those of African-American race were all at higher risk for developing BCR. • A delay to surgery of >60 days was not associated with worse biochemical outcomes in a univariate and multivariate model. • A delay of >60 days is not associated with adverse pathological outcomes in men with localized prostate cancer, nor does it correlate with worse BCR-free survival. • Patients can be assured that delaying treatment while considering therapeutic options will not adversely affect their outcomes.

African American men significantly underestimate their risk of having prostate cancer at the time of biopsy.

Guidelines for prostate cancer (PCa) screening recommend physicians to have an informational discussion with patients. At the time of biopsy, patients should be informed of their heightened PCa risk, particularly African Americans (AA) who have significantly higher diagnostic and mortality risk. We tested predictors of patients' estimation of their likelihood of having PCa at the time of biopsy. A convenience sample of AA (n = 207) and white (n = 271) biopsy patients was surveyed at the time of prostate biopsy. Participants gave likelihood estimations of having PCa and data on their socio-demographics, health, clinical status, and general and PCa-specific anxiety. Binary logistic regressions tested for predictors of the patients' estimations and biopsy results. Fifty-one percent of AA men answered that they had a '0%' likelihood of having PCa versus 19% of whites, whereas 57% of AA men had abnormal biopsies compared with 42% of whites. In logistic regressions, predictors of patient answers of 0% chance of PCa were AA ethnicity (OR = 4.50; p < 0.001), lower cancer-specific anxiety (OR = 0.93; p < 0.01), less education (OR = 2.38; p < 0.05), and less urinary disturbance (OR = 0.70; p < .05). In a second regression, AA patients trended towards higher positive biopsy rates (OR = 1.43; p = 0.17). At biopsy, AA more often estimated their likelihood of PCa as 0%, despite higher risks. Reasons for these low estimates and their potential contribution to poor treatment outcomes of AA patients require further investigation.

1204 HEIGHT AND THE RISK FOR AGGRESSIVE PROSTATE CANCER AT THE TIME OF BIOPSY–RESULTS FROM THE DUKE PROSTATE CENTER DATABASE

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20111204 HEIGHT AND THE RISK FOR AGGRESSIVE PROSTATE CANCER AT THE TIME OF BIOPSY–RESULTS FROM THE DUKE PROSTATE CENTER DATABASE Elizabeth E. Calloway, David I. Chu, Leah Gerber, Jean-Alfred Thomas, Cary N. Robertson, Thomas J. Polascik, Judd W. Moul, and Lionel L. Bañez Elizabeth E. CallowayElizabeth E. Calloway Durham, NC More articles by this author , David I. ChuDavid I. Chu Durham, NC More articles by this author , Leah GerberLeah Gerber Durham, NC More articles by this author , Jean-Alfred ThomasJean-Alfred Thomas Durham, NC More articles by this author , Cary N. RobertsonCary N. Robertson Durham, NC More articles by this author , Thomas J. PolascikThomas J. Polascik Durham, NC More articles by this author , Judd W. MoulJudd W. Moul Durham, NC More articles by this author , and Lionel L. BañezLionel L. Bañez Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adult height is closely related to childhood exposures to androgens, growth hormone (GH) and other molecules such as insulin-like growth factor-1 (IGF-1), bioactive substances which have been linked with prostate cancer (CaP) growth and development. Thus, height is being considered as a potential risk factor for CaP and advanced CaP, though previous studies have been inconclusive. Herein, we examine the relationship between height and risk for overall and aggressive CaP in a contemporary cohort of men undergoing prostate biopsy in a tertiary-care hospital. METHODS Demographic, anthropometric and clinical information on 1,180 men who underwent initial prostate biopsy from 2004 to 2009 were retrospectively abstracted from the Duke Prostate Center database. Risk for overall and aggressive (biopsy Gleason sum ≥8) CaP were evaluated using crude and multivariable-adjusted logistic regression models controlling for age, race, body mass index, year of biopsy, pre-biopsy PSA and digital rectal examination findings. Measured height was treated as a continuous variable in all analyses. RESULTS Mean height was 177.8 cm (±7.6) overall. A total of 520 men (44%) received a diagnosis of CaP. Among these men, 69 (13%) had Gleason sum ≥8 CaP. Height was not associated with risk for overall CaP in both crude (p=0.55) and adjusted (p=0.17) regression models. On univariate analysis, there was a trend for elevated risk for Gleason sum ≥8 CaP with increasing height which did not reach statistical significance (OR 1.025; p=0.114). However, after adjusting for potential demographic and clinical confounders, height was found to be significantly associated with increased risk for aggressive CaP on a continuum (OR 1.033; 95% CI 1.001–1.065; p=0.039). Specifically, for each additional centimeter difference in height, the log-odds for aggressive CaP increases by 3.3%. CONCLUSIONS In the current study, height was a significant risk factor for aggressive CaP at the time of prostate biopsy. Our findings support the investigation of pharmacologic agents directed at biological pathways, such as the GH-IGF axis, that are related to both increased adult height and development of high-grade tumors. Indeed, novel drugs targeting the GH-IGF axis, such as IGF-1 receptor inhibitors, are currently under investigation to treat non-small cell lung cancer but have not been studied in-depth to treat CaP. In addition, whether height can be used to risk stratify and identify patients who are more likely to respond to GH-IGF axis-directed therapies warrants further investigation. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e483 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth E. Calloway Durham, NC More articles by this author David I. Chu Durham, NC More articles by this author Leah Gerber Durham, NC More articles by this author Jean-Alfred Thomas Durham, NC More articles by this author Cary N. Robertson Durham, NC More articles by this author Thomas J. Polascik Durham, NC More articles by this author Judd W. Moul Durham, NC More articles by this author Lionel L. Bañez Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Prevalence, Correlates, and Impact of Logically Inconsistent Preferences in Utility Assessments for Joint Health States in Prostate Cancer

Variations in health state utilities can impact cost-effectiveness analyses. One potential source of error is when joint health state (JS) utilities are rated higher than the embedded single state (SS) utilities. Knowing when and in whom this occurs can improve cost-effectiveness analyses. Men (n = 323) were surveyed at the time of prostate biopsy. Time tradeoff SS and JS utilities for prevalent prostate cancer (PCa) health states were collected. JS utilities assessed included those most prevalent for PCa. "Inconsistency" was defined in the following 3 ways: (1) any size rank order violation; (2) total number of violations; and (3) differences greater than 1 standard deviation (SD). Regression analysis assessed independent patient characteristics associated with inconsistent responses. Aggregate JS utilities were consistent. At the individual level, 36% to 41% of responses violated rank order and 12% to 14% were larger than 1 SD. In all, 69% of respondents had at least 1 JS inconsistency, and 24% had >1 SD inconsistencies. Being married and feeling anxious were independently correlated with giving all types of inconsistent ratings, and lower education correlated with making >SD errors. SS utilities, and not JS utilities, were significantly lower for the inconsistent group. "Correcting" JS inconsistencies decreased aggregate utilities 1 to 9 units. Inconsistent JS utilities for PCa are prevalent in men at biopsy. Being married, more anxious, and having less education are correlated with inconsistencies. It is the SS utilities, rather than the JS utilities, that differ between consistent and inconsistent raters. Better understanding of the source of these inconsistencies is needed.