Non‐organ confined stage and upgrading rates in exclusive PSA high‐risk prostate cancer patients

Hoeh, Benedikt; Flammia, Rocco Simone; Hohenhorst, Lukas; Sorce, Gabriele; Chierigo, Francesco; Tian, Zhe; Saad, Fred; Gallucci, Michele; Briganti, Alberto; Terrone, Carlo; Shariat, Shahrokh F.; Graefen, Markus; Tilki, Derya; Kluth, Luis A.; Mandel, Philipp; Becker, Andreas; Chun, Felix K.‐H.; Karakiewicz, Pierre I.

doi:10.1002/pros.24313

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…In prostate cancer, the discrepancy between the biopsy Gleason score and the radical prostatectomy (RP) Gleason score is a well-known phenomenon [1][2][3][4][5][6][7][8]. In particular, upgrading has been thoroughly studied in several single-and multi-institutional, as well as population-based databases [8][9][10][11][12]. Conversely, data that can be used to examine downgrading rates, particularly in biopsied high-risk prostate cancer patients, are limited due to the rarity of patients with Gleason scores ≥4 + 4 undergoing RP [13,14].…”

Section: Introductionmentioning

confidence: 99%

External Tertiary-Care-Hospital Validation of the Epidemiological SEER-Based Nomogram Predicting Downgrading in High-Risk Prostate Cancer Patients Treated with Radical Prostatectomy

et al. 2023

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We aimed to externally validate the SEER-based nomogram used to predict downgrading in biopsied high-risk prostate cancer patients treated with radical prostatectomy (RP) in a contemporary European tertiary-care-hospital cohort. We relied on an institutional tertiary-care database to identify biopsied high-risk prostate cancer patients in the National Comprehensive Cancer Network (NCCN) who underwent RP between January 2014 and December 2022. The model’s downgrading performance was evaluated using accuracy and calibration. The net benefit of the nomogram was tested with decision-curve analyses. Overall, 241 biopsied high-risk prostate cancer patients were identified. In total, 51% were downgraded at RP. Moreover, of the 99 patients with a biopsy Gleason pattern of 5, 43% were significantly downgraded to RP Gleason pattern ≤ 4 + 4. The nomogram predicted the downgrading with 72% accuracy. A high level of agreement between the predicted and observed downgrading rates was observed. In the prediction of significant downgrading from a biopsy Gleason pattern of 5 to a RP Gleason pattern ≤ 4 + 4, the accuracy was 71%. Deviations from the ideal predictions were noted for predicted probabilities between 30% and 50%, where the nomogram overestimated the observed rate of significant downgrading. This external validation of the SEER-based nomogram confirmed its ability to predict the downgrading of biopsy high-risk prostate cancer patients and its accurate use for patient counseling in high-volume RP centers.

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Section: Introductionmentioning

confidence: 99%

External Tertiary-Care-Hospital Validation of the Epidemiological SEER-Based Nomogram Predicting Downgrading in High-Risk Prostate Cancer Patients Treated with Radical Prostatectomy

et al. 2023

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“…Conversely, cT1–2 patients exhibited PSA > 20 ng/ml in 22% and biopsy GGG IV–V in 86% of cases. To further support the importance of other high‐risk features beyond clinical stage, Hoeh et al 23 reported an unexpected high rate of non‐organ confined disease (51%) in exclusive PSA high‐risk PCa patients. Consequently, lower rate of SVI in cT3a compared to cT2 patients might be due to the fact that these patients harbored less aggressive features (PSA and GGG) than cT2 counterparts when NCCN high‐risk only PCa patients are considered.…”

Section: Discussionmentioning

confidence: 99%

Contemporary seminal vesicle invasion rates in NCCN high‐risk prostate cancer patients

et al. 2022

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Background: Contemporary seminal vesicle invasion (SVI) rates in National CancerComprehensive Network (NCCN) high-risk prostate cancer (PCa) patients are not well known but essential for treatment planning. We examined SVI rates according to individual patient characteristics for purpose of treatment planning. Materials and Methods: Within Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), 4975 NCCN high-risk patients were identified. In the development cohort (SEER geographic region of residence: South, North-East, Mid-West, n = 2456), we fitted a multivariable logistic regression model predicting SVI. Its accuracy, calibration, and decision curve analyses (DCAs) were then tested versus previous models within the external validation cohort (SEER geographic region of residence: West, n = 2519).

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“…In Partin’s table, risk of recurrence is highest at PSA 6.1–10 and >10 [ 14 ]. This conflict testifies to the lack of uniformity in gauging the predictive ability of PSA vis-à-vis survivorship of PCa [ 22 ]. Toward resolving this ambivalence, there is a need to examine the relationship between PSA and survivorship of PCa.…”

Section: Introductionmentioning

confidence: 99%

Association between Pre-Operative Total Prostate-Specific Antigen and Survivorship of Prostate Cancer following Radical Prostatectomy: A Systematic Review

Okwor,

Meka

et al. 2023

Med Princ Pract

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Objective: This review aimed to systematically quantify the association between pre-operative total prostate specific antigen (tPSA) and survivorship of prostate cancer (PCa). Methods: Data sources for the review included MEDLINE, PubMed, Cochrane Library, CINAHL, Academic Search Complete, PsycINFO, and relevant reference lists. Databases were searched from inception to June, 2022. The study took place between May 2022 and March 2023. We included studies that applied a quantitative approach to examine the interaction between pre-operative PSA and survivorship of PCa. Pre-operative PSA constituted the independent variable, whereas survivorship of prostate cancer as measured by biochemical recurrence and mortality constitute the outcome variable. A risk of bias assessment was conducted with the aid of a mixed-method appraisal tool. We employed meta-analysis to quantify the association of pre-operative PSA with biochemical recurrence and mortality and computed I2 to assess the degree of heterogeneity. Results: We found a positive weak association between pre-operative PSA and biochemical recurrence (HR = 1.074; 95% CI = 1.042 - 1.106). With a median rise in PSA (≥ 2 ng/mL), the likelihood for biochemical recurrence increase by approximately 7.4%. There was statistically a significant association between PSA and mortality (HR = 1.222, CI 0.917 - 1.630). Conclusions: Biochemical recurrence associates with pre-operative PSA in an inconsistent manner. The sole use of pre-operative PSA in estimating post-prostatectomy biochemical recurrence should be discouraged. There is need for a multi-factorial model which employs a prudent combination of the most important and cost-effective biomarkers in predicting post-prostatectomy biochemical recurrence.

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Non‐organ confined stage and upgrading rates in exclusive PSA high‐risk prostate cancer patients

Cited by 4 publications

References 20 publications

External Tertiary-Care-Hospital Validation of the Epidemiological SEER-Based Nomogram Predicting Downgrading in High-Risk Prostate Cancer Patients Treated with Radical Prostatectomy

External Tertiary-Care-Hospital Validation of the Epidemiological SEER-Based Nomogram Predicting Downgrading in High-Risk Prostate Cancer Patients Treated with Radical Prostatectomy

Contemporary seminal vesicle invasion rates in NCCN high‐risk prostate cancer patients

Association between Pre-Operative Total Prostate-Specific Antigen and Survivorship of Prostate Cancer following Radical Prostatectomy: A Systematic Review

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