Characterization of a “low‐risk” cohort of grade group 2 prostate cancer patients: Results from the Shared Equal Access Regional Cancer Hospital database

McGinley, Kathleen F.; Sun, Xizi; Howard, Lauren E.; Aronson, William J.; Terris, Martha K.; Kane, Christopher J.; Amling, Christopher L.; Cooperberg, Matthew R.; Freedland, Stephen J.

doi:10.1111/iju.13387

Cited by 4 publications

(8 citation statements)

References 37 publications

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“…Sauter et al 2 studied a large historical RP cohort (2005–2014) and demonstrated that there were different likelihoods of BCR in GG2 and GG3 disease correlating with GP4% 2 . However, it is the mere presence of GP4 that significantly increases the probability of adverse surgical outcomes and imparts a metastatic potential relative to pure Gleason pattern 3 (GG1) cancer 1,4,7,32 . For example, none of our GG1 TNs regardless of TV demonstrated SV invasion which is similar to our prior study performed on a cohort from a different institution 33 .…”

Section: Discussionsupporting

confidence: 78%

“…A recent publication on prostate biopsy specimens suggested that there are similar clinical outcomes for patients with GG2 disease characterized by limited TV and GP4% as for those with GG1 disease. 1 Another study showed that there was no significant difference in time to BCR for GG1 and GG2 cancer when GP4% was less than 6% in biopsy specimens. 3 | 869 likelihoods of BCR in GG2 and GG3 disease correlating with GP4%.…”

Section: Discussionmentioning

confidence: 99%

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Percentage of Gleason pattern 4 and tumor volume predict adverse pathological stage and margin status at radical prostatectomy in grade Group 2 and grade Group 3 prostate cancers

et al. 2021

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Background: Increasing percentages of Gleason pattern 4 (GP4%) in radical prostatectomy (RP) correlate with an increased likelihood of nonorgan-confined disease and earlier biochemical recurrence (BCR). However, there are no detailed RP studies assessing the impact of GP4% and corresponding tumor volume (TV) on extraprostatic extension (EPE), seminal vesicle (SV) invasion (SV+), and positive surgical margin (SM) status (SM+).Methods: In 1301 consecutive RPs, we analyzed each tumor nodule (TN) for TV, Grade Group (GG), presence of focal versus nonfocal EPE, SV+ , and SM+. Using GG1 (GP4% = 0) TNs as a reference, we recorded GP4% for all GG2 or GG3 TNs.We performed a multivariable analysis (MVA) using a mixed effects logistic regression that tested significant variables for risk of EPE, SV+, and SM+, as well as a multinomial logistic regression model that tested significant variables for risks of nonorgan-confined disease (pT2+, pT3a, and pT3b) versus organ-confined disease (pT2).Results: We identified 3231 discrete TNs ranging from 1 to 7 (median: 2.5) per RP.These included GG1 (n = 2115), GG2 (n = 818), GG3 (n = 274), and GG4 (n = 24) TNs.Increasing GP4% weakly paralleled increasing TV (tau = 0.07, p < .001). In MVA, increasing GP4% and TV predicted a greater likelihood of EPE (odds ratio [OR]: 1.03 and 4.41), SV+ (OR: 1.03 and 3.83), and SM+ (1.01, p = .01 and 2.83), all p < .001. Our multinomial logistic regression model demonstrated an association between GP4%The data were presented in part at the 108th Annual Meeting of the

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Percentage of Gleason pattern 4 and tumor volume predict adverse pathological stage and margin status at radical prostatectomy in grade Group 2 and grade Group 3 prostate cancers

et al. 2021

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“…As the percentage of Gleason pattern 4 is currently being reported in the diagnosis, a number of research studies have been carried out to establish a category of patients with a ‘favourable’ prognosis who would benefit from AS. So far, these studies have found that patients with ‘favourable’ Gleason 3 + 4 = 7 (GrG2) still have a higher risk of Gleason grade 4 + 3 = 7 (GrG), EPE, and seminal vesicle invasion at RP, and a higher risk of BCR, than low‐risk men undergoing RP . These studies were performed without consideration of the percentage of Gleason pattern 4 or the different subtypes of Gleason pattern 4, which might have clinical implications for the evaluation of candidates with potential insignificant cancer in the setting of a minor Gleason pattern 4 component …”

Section: Significant Prostate Cancer At Rpmentioning

confidence: 99%

“…So far, these studies have found that patients with 'favourable' Gleason 3 + 4 = 7 (GrG2) still have a higher risk of Gleason grade 4 + 3 = 7 (GrG), EPE, and seminal vesicle invasion at RP, and a higher risk of BCR, than low-risk men undergoing RP. 38,39 These studies were performed without consideration of the percentage of Gleason pattern 4 or the different subtypes of Gleason pattern 4, which might have clinical implications for the evaluation of candidates with potential insignificant cancer in the setting of a minor Gleason pattern 4 component. 40 Another important consideration in establishing the significance of prostate cancer at RP is the presence of a tertiary pattern.…”

Section: T U M O U R G R a D E I N S I G N I F I C A N T C A N C E R mentioning

confidence: 99%

“…48,49 The first criteria for AS, which are known as the Epstein criteria, were adopted as the 'very-low-risk' criteria in the NCCN guidelines, and correspond to one or two cores with cancer Gleason score 3 + 3 = 6 (GrG1), no core with >50% of cancer, and a PSA density of <0.15 ng/ml per cm 3 . 4 This criterion was developed on the basis of a study that reviewed the clinical and pathological characteristics of men who underwent RP for T1c More EPE, 26 higher risk of BCR, 20 higher risk of undersampled high-grade tumours 29 Tumour grade GrG1 4 'Favourable' GrG2 37,38 Higher risk of GrG3, EPE, SV invasion, and BCR 37,38 EPE No EPE 4 Focal EPE or non-focal EPE [41][42][43][44][45] Higher risk of BCR and local recurrence 41 BCR, Biochemical recurrence; EPE, Extraprostatic extension; GrG1, Gleason 6 (Grade Group 1); GrG2, Gleason 3 + 4 = 7 (Grade Group 2); GrG3, Gleason 4 + 3 = 7 (Grade Group 3); SV, seminal vesicle.…”

Section: Significant Prostate Cancer At Needle Biopsymentioning

confidence: 99%

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Defining clinically significant prostate cancer on the basis of pathological findings

2018

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The definition of clinically significant prostate cancer is a dynamic process that was initiated many decades ago, when there was already evidence that a great proportion of patients with prostate cancer diagnosed at autopsy never had any clinical symptoms. Autopsy studies led to examinations of radical prostatectomy (RP) specimens and the establishment of the definition of significant cancer at RP: tumour volume of 0.5 cm3, Gleason grade 6 [Grade Group (GrG) 1], and organ‐confined disease. RP studies were then used to develop prediction models for significant cancer by the use of needle biopsies. The first such model was used to delineate the first active surveillance (AS) criteria, known as the ‘Epstein’ criteria, in which patients with a cancer Gleason score of 3 + 3 = 6 (GrG1) involving fewer than two cores, and <50% of any given core, and a prostate‐specific antigen density of <0.15 ng/ml per cm3 had a minimal risk of significant cancer at RP. These were adopted as components of the ‘very‐low‐risk category’ of the National Comprehensive Cancer Network guidelines, in which AS is supported as a management option. With the increase in the popularity of AS, much research has been carried out to better define significant/insignificant cancer, in order to be able to safely offer AS to a larger proportion of patients without the risk of undertreatment. Research has focused on allowing higher volume tumours, focal extraprostatic extension, and a limited amount of Gleason pattern 4, and the significance of different morphological patterns of Gleason 4. Other areas of research that will probably impact on the field but that are not covered in this review include the molecular classification of tumours and imaging techniques.

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Lower urinary tract symptoms in elderly men: Considerations for prostate cancer testing

Schmit,

Malshy,

Ochsner

et al. 2024

The Prostate

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PurposeBoth lower urinary tract symptoms (LUTS) and prostate cancer (PCa) are common in elderly men. While LUTS are generally due to a benign etiology, they may provoke an evaluation with prostate‐specific antigen (PSA), which can lead to a cascade of further testing and possible overdiagnosis in patients with competing risks. There is limited patient and provider understanding of the relationship between LUTS and PCa risk, and a lack of clarity in how to evaluate these men to balance appropriate diagnosis of aggressive PCa with avoidance of overdiagnosis.MethodsA literature review was performed using keywords to query the electronic database PubMed. All articles published before November 2023 were screened by title and abstract for articles relevant to our subject.ResultsEpidemiological studies suggest that LUTS and PCa are largely independent in elderly men. The best available tools to assess PCa risk include PSA permutations, novel biomarkers, and imaging, but there are limitations in older men based on lack of validation in the elderly and unclear applicability of traditional definitions of “clinically significant” disease. We present a three‐tiered approach to evaluating these patients.ConclusionElderly men commonly have LUTS as well as a high likelihood of indolent PCa. A systematic and shared decision‐making‐based approach can help to balance objectives of appropriate detection of phenotypically dangerous disease and avoidance of over‐testing and overdiagnosis.

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Characterization of a “low‐risk” cohort of grade group 2 prostate cancer patients: Results from the Shared Equal Access Regional Cancer Hospital database

Abstract: Among men with prostate-specific antigen ≤10 ng/mL and clinical stage T1c/T2a, those in grade group 2 with ≤2 total positive cores have similar rates of adverse pathology and biochemical recurrence as men with grade group 1.

Cited by 4 publications

References 37 publications

Percentage of Gleason pattern 4 and tumor volume predict adverse pathological stage and margin status at radical prostatectomy in grade Group 2 and grade Group 3 prostate cancers

Percentage of Gleason pattern 4 and tumor volume predict adverse pathological stage and margin status at radical prostatectomy in grade Group 2 and grade Group 3 prostate cancers

Defining clinically significant prostate cancer on the basis of pathological findings

Lower urinary tract symptoms in elderly men: Considerations for prostate cancer testing

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