718 a Nomogram Based on an Extended Biopsy Strategy Predicting Low-Volume/Low-Grade Prostate Cancer: A Tool in Selecting Active Surveillance Patients

Nakanishi, H; Wang, X.; Ochiai, Atsushi; Trpkov, Kiril; Yilmaz, Aslı; Donnelly, Jackie; Troncoso, P.; Davis, John; Babaian, R. J.

doi:10.1016/s1569-9056(07)60714-3

Cited by 22 publications

(38 citation statements)

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“…Using the risk-stratification schemes based only on PSA level, DRE findings, biopsy Gleason score and extent of cancer involvement appears insufficient to identify cancers with a low risk of progression. Therefore, other factors, such as PSA density and PSA velocity, would provide additional significance [6,8]. In our cohort, patients who had a high PSA density at diagnosis were more likely to have unfavourable disease on RP specimens.…”

Section: Discussionmentioning

confidence: 90%

“…Many AS criteria have been based on series of patients diagnosed with much less than 21-core biopsies, sometimes even sextant biopsies only. The number of positive cores, the tumour length (total or at any core) and the percent of cancer involvement at any core are predictive factors of tumour volume in RP specimens or biochemical failure after RP [8,[22][23]. The aim of our retrospective study was to compare the rate of misclassification associated with the use of 3 different biopsy criteria [13, [16][17].…”

Section: Discussionmentioning

confidence: 99%

“…Active surveillance entails a strategy by which selected men are managed expectantly with the intention to apply potentially curative treatment in case of progression signs [4]. Cancers that are amenable to AS usually are identified on favourable preoperative parameters and the risk is estimated by integrating Gleason score, pretreatment PSA, clinical stage, prostate volume and the extent of biopsy involvement with tumour [6][7][8][9][10]. Published AS series use different criteria largely based on centre experiences and preferences with no hard data.…”

Section: Introductionmentioning

confidence: 99%

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Pathological Findings and Prostate Specific Antigen Outcomes After Radical Prostatectomy in Men Eligible for Active Surveillance—Does the Risk of Misclassification Vary According to Biopsy Criteria?

et al. 2010

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Word count abstract: Word count text :2 ABSTRACT Purpose: To evaluate and compare the pathological findings and the PSA outcomes after radical prostatectomy (RP) in men eligible for AS, according to 3 different biopsy inclusion criteria. Materials and Methods:The study population included 177 men eligible for AS who fulfilled clinico-biological criteria (Gleason score ≤6, PSA<10, clinical stage T1c) and biopsy criteria as follows: (1) <3 positive cores and <3 mm of total tumour length; (2) and/or <3 positive cores with a cancer involvement <50% in any core; (3) and/or <33% of positive cores. PSA density cut-offs of 15 and 20 ng/ml/gr were also studied among these groups. Pathological findings on RP specimens and biochemical recurrence-free survival (RFS) were studied. Median follow-up was 34 months.Results: Cancers were graded Gleason 7 on RP specimens from 48.3% to 55.4% of cases. The rates of extracapsular extension (ECE) and vesicle seminal invasion (SVI) ranged from 11.2% to 17.5%, and from 1.1% to 1.8%, respectively, regardless of PSA density. The use of PSA density as AS criterion decreased for AS by 1.4-fold and by 2.3-fold the number of men eligible according to the cut-off used. The risk of unfavourable disease (defined as pT3-4 stage and/or a Gleason score≥8) remained between 15% to 19.2% when a PSA density cut-off of 15 ng/ml/gr was used. The risk of overall unfavourable disease was significantly higher in men with a cancer involvement ≥3 mm in initial biopsy compared with men who fulfilled these most stringent biopsy criteria (27.3%, vs 13.5%, respectively; p=0.023). The 3-year biochemical RFS was 91.5% and was not affected by the 3 different AS definitions. Conclusions:Even with the use of a 21-core biopsy protocol, the rate of unfavourable disease on RP specimens remains still elevated in men eligible for AS. Patients must be informed of this risk of misclassification which is about 20% in men who fulfil the less stringent biopsy criteria.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pathological Findings and Prostate Specific Antigen Outcomes After Radical Prostatectomy in Men Eligible for Active Surveillance—Does the Risk of Misclassification Vary According to Biopsy Criteria?

et al. 2010

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“…[38][39][40] In fact, these merely predict low-volume, low-grade, organ-confined tumors identified at time of radical prostatectomy, although they seem to be superior to the criteria defined by Epstein et al 41 (no pattern 4 disease, no extracapsular extension or lymph node invasion, and tumor volume Ͻ 0.5 cm 3 ) in predicting indolent or insignificant cancers. Indeed, although the 0.5 cm 3 threshold is frequently cited as an indicator of clinical insignificance, this has never been validated.…”

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confidence: 99%

Active Surveillance for Prostate Cancer: Progress and Promise

Cooperberg

Carroll

Klotz

2011

JCO

261

185

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‫ء‬Johns Hopkins studies do not use PSA-based definition of progression, but PSA outcomes for cohort have been reported in detail.44 †Progression based on PSA doubling time Ͻ 24 months/Ͻ 36 months. ‡Figures for University of Toronto do not include those who progressed but continued undergoing surveillance. §Repeat biopsy information reported for only subset (23%) of European Randomized Study of Screening for Prostate Cancer cohort. Cooperberg, Carroll, and Klotz 3672

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“…However, the pretreatment criteria predictive of small volume PCA were confirmed prospectively by Carter et al [9] and are an accepted instrument to predict the presence of such tumors. We did not chose more contemporary nomograms like from Nakanishi et al [23] or Steyerberg et al [24] to predict indolent or potentially insignificant PCA because data on tumor length in biopsy cores were lacking very frequently. However, so far no consensus has been reached which criteria should be applied to reliably predict clinically insignificant or indolent cancer.…”

Section: Discussionmentioning

confidence: 99%

Lowering the PSA Threshold for Prostate Biopsy from 4 to 2.5 ng/ml: Influence on Cancer Characteristics and Number of Men Needed to Biopt

Müntener¹,

Kunz²,

Eichler

et al. 2010

Urol Int

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Objective: In 1999 we lowered the prostate-specific antigen (PSA) threshold for prostate biopsy at our institution from 4 to 2.5 ng/ml. The aim of this study was to compare the differences in tumor characteristics of the detected prostate cancers (PCAs) and the detection rate for the two different PSA thresholds and to evaluate if lowering the threshold was justified by any of the detected differences. Patients and Methods: We retrospectively analyzed the records of all patients who underwent an 8-core prostate biopsy between January 1999 and December 2004 and had a PSA between 2.5 and 10 ng/ml. Patients with a PSA between 2.5 and 4 ng/ml (group 1, n = 214, mean age 62.0 years) were compared to patients whose PSA was between 4 and 10 ng/ml (group 2, n = 292, mean age 63.2 years). Patients who were older than 75 years or had a suspicious rectal examination were excluded from this study. Results: Overall, we detected 120 can-cers in 506 patients (cancer yield 23.7%). The cancer yield in group 1 was significantly lower than in group 2 (17 vs. 28%, p < 0.01). In group 1 significantly less Gleason score ≧7 (p = 0.04) and significantly more potentially insignificant cancers (p = 0.03) were identified. In 80 patients who subsequently underwent radical prostatectomy, final pathology revealed no significant differences between the two PSA groups with regard to high pT stages, Gleason score ≧7 PCA or positive surgical margins, respectively. The difference in the absolute risk of being diagnosed with high-grade PCA between a PSA threshold of 2.5 ng/ml and a PSA threshold of 4 ng/ml was 1%. Conclusion: Lowering the PSA threshold for prostate biopsy from 4 to 2.5 ng/ml results in a substantial increase in the number of men who undergo biopsy and may result in an increased detection of potentially insignificant cancers. If total PSA alone is used to determine the need for prostate biopsy, the disadvantages of this lower threshold probably outweigh its potential benefits.

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718 a Nomogram Based on an Extended Biopsy Strategy Predicting Low-Volume/Low-Grade Prostate Cancer: A Tool in Selecting Active Surveillance Patients

Cited by 22 publications

References 0 publications

Pathological Findings and Prostate Specific Antigen Outcomes After Radical Prostatectomy in Men Eligible for Active Surveillance—Does the Risk of Misclassification Vary According to Biopsy Criteria?

Pathological Findings and Prostate Specific Antigen Outcomes After Radical Prostatectomy in Men Eligible for Active Surveillance—Does the Risk of Misclassification Vary According to Biopsy Criteria?

Active Surveillance for Prostate Cancer: Progress and Promise

Lowering the PSA Threshold for Prostate Biopsy from 4 to 2.5 ng/ml: Influence on Cancer Characteristics and Number of Men Needed to Biopt

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