Risk of Pathologic Upgrading or Locally Advanced Disease in Early Prostate Cancer Patients Based on Biopsy Gleason Score and PSA: A Population-Based Study of Modern Patients

Caster, Joseph M.; Falchook, Aaron D.; Hendrix, Laura H.; Chen, Ronald C.

doi:10.1016/j.ijrobp.2015.01.051

Cited by 56 publications

(65 citation statements)

References 27 publications

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“…When dealing with low and intermediate-low risk PCA, it is important for the urologist and the radiation oncologist to identify clinical predictors of tumor upgrading in order to identify the subset of patients who are likely to bear more aggressive disease which needs further clinical in- vestigations before delivering active treatments. In contemporary series including low and intermediate risk classes, it has been shown that independent predictors of tumor upgrading included non-white race, older age, higher PSA, higher proportion of positive cores, and tumor involvement greater than 50% in each core as well [11][12][13] . In a contemporary cohort of PCA presenting with low and intermediate risk with bGP ≤ 3 + 4, our study showed that PSA and TT were independent predictors of upgrading; moreover, TT levels allowed risk stratification of tumor upgrading.…”

Section: Discussionmentioning

confidence: 99%

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Association between Basal Total Testosterone Levels and Tumor Upgrading in Low and Intermediate Risk Prostate Cancer

Porcaro

Luyk²,

Corsi³

et al. 2017

Urol Int

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Purpose: The study aimed to evaluate associations of basal levels of total testosterone (TT) with tumor upgrading to high risk disease in low-intermediate risk prostate cancer (PCA). Materials and Methods: We retrospectively evaluated the records of 135 patients undergoing radical prostatectomy. Evaluated factors included age, body mass index, prostate specific antigen (PSA), TT, prostate volume, PSA density (PSAD), proportion of biopsy positive cores (P+), clinical tumor stage, and biopsy grading system (1 or 2). Factors associating with tumor upgrading were investigated by the multivariate logistic regression analysis. Results: Tumor upgrading rate to high risk disease was 8.9%. TT, PSA, and PSAD were associated with tumor upgrading. On multivariate analysis, independent factors predicting tumor upgrading were PSA (OR 1.324; p = 0.001) and TT (OR 1.005; p = 0.015). Basal TT was dichotomized up to the third quartile (TT > q3) vs. TT ≤ q3 (426.0 ng/dL). The assessed tumor upgrading risk model showed that TT dichotomized to third quartile (TT > q3 vs. TT ≤ q3) stratified the risk of tumor upgrading (OR 6.577; p = 0.010) along increasing levels of PSA (OR 1.3; p < 0.0001). Conclusions: Low and intermediate risk PCA patients show a not negligible risk of tumor upgrading to high risk disease. In this particular subset of patients, basal levels of TT stratify the risk of tumor upgrading.

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Section: Discussionmentioning

confidence: 99%

“…Indeed, in large contemporary series, tumor upgrading rates are high and range from 43 to 63.8% [11][12][13] . Moreover, patients undergoing RP after AS progression are also at increased risk of tumor upgrading in the surgical specimen [8][9][10] .…”

Section: Association Between Basal Total Testosterone Levels and Tumomentioning

confidence: 99%

Association between Basal Total Testosterone Levels and Tumor Upgrading in Low and Intermediate Risk Prostate Cancer

Porcaro

Luyk²,

Corsi³

et al. 2017

Urol Int

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“…However, low-risk PCA is a heterogeneous population and prostate biopsies can underestimate the true grade of the cancer when compared to prostatectomy specimens as it has been reported in past series referring to the preceding Gleason score system [13,16,17,18]. Recently, in large contemporary series referring to the modified Gleason score system, it has been shown that there is still a wide variation of tumor upgrading, which ranges between 43% [19] and 63.8% [20]. In our study, low-risk PCA, which included 38.8% of the operated cases, tumor upgrade was detected in 65.3% of the surgical specimens.…”

Section: Discussionmentioning

confidence: 99%

“…In contemporary series, it has been shown that independent predictors of tumor upgrading in low-risk PCA include non-white race [19], older age [19,20], higher PSA levels [19,20], higher proportion of positive cores and tumor involvement greater than 50% per each core as well [20]. In our study, we tried to identify prognostic factors associating with tumor upgrading to the pGP = 3 + 4 and to the pGP >3 + 4.…”

Section: Discussionmentioning

confidence: 99%

Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

Porcaro

Siracusano²,

Luyk³

et al. 2016

Urol Int

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Objective: To identify clinical factors associated with prostate cancer (PCA) upgrading to higher patterns of the surgical specimen in low-risk PCA. Materials and Methods: We evaluated the records of 438 patients. The multinomial logistic regression model was used. Results: Low-risk PCA included 170 cases (38.8%) and tumor upgrading was detected in 111 patients (65.3%) of whom 72 (42.4%) had pathological Gleason patterns (pGP) = 3 + 4 and 39 (22.9%) pGP >3 + 4. Prostate-specific antigen (PSA) and proportion of positive cores (P+) were independent predictors of tumor upgrading to higher patterns. The main difference between upgraded cancers related to PSA and to P+ >0.20. The population was stratified into risk classes by PSA ≤5 μg/l and P+ ≤0.20 (class A), PSA >5 μg/l and P+ ≤0.20 (class B), PSA ≤5 μg/l and P+ >0.20 (class C) and PSA >5 μg/l and P+ 0.20 (class D). Upgrading rates to pGP >3 + 4 were extremely low in class A (5.1%), extremely high in D (53.8%). Conclusions: Low-risk PCA is a heterogeneous population with significant rates of undetected high-grade disease. Significant clinical predictors of upgrading to higher patterns include PSA and P+, which identify a very high-risk class that needs repeat biopsies in order to reclassify tumor grade.

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“…[5]. The biopsy Gleason score has also been included in models predicting organ-confined disease [6] as well as lymph node involvement [7], and it is associated with outcome even in patients with advanced disease receiving systemic treatment [8,9].Preoperative staging underestimates pathologic stage and prostate biopsies underestimate the Gleason score compared with prostatectomy specimens in up to 66% of patients, depending on PSA levels, biopsy Gleason score and clinical stage [10]. Apart from these variables, which have been incorporated in a validated predictive model to predict Gleason upgrading [11], a number of biomolecular markers were associated with Gleason upgrading [12,13].…”

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confidence: 99%

Urotensin II Receptor on Preoperative Biopsy is Associated with Upstaging and Upgrading in Prostate Cancer

et al. 2015

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Aim: A higher Gleason score was associated with a lower tumor urotensin II receptor (UTII-R) expression in prostate cancer patients. Methods: A retrospective review of formalinfixed paraffin-embedded tumor tissue derived from those who had prostatectomy and matching biopsy specimens was conducted at six Institutions. UTII-R expression was evaluated on biopsy by immunohistochemistry. Results: A total of 58 subjects undergoing radical prostatectomy were included. At multivariate analysis, low UTII-R expression was a significant predictor of Gleason upgrading, with an odds ratio of 10.3 (95% CI: 1.55-68.4), and of pathology upstaging, with an odds ratio of 11.1 (95% CI: 1.23-100.48). Conclusions: UTII-R expression on biopsy was associated with Gleason upgrading and pathology upstaging in prostate cancer patients. KEYWORDS• Gleason score • prostate cancer • urotensin II receptor Prostate cancer is the most prevalent malignant tumor in men, with varying incidences among different geographical areas and populations because of a complex interplay of genetic and socioeconomic factors [1]. The highly heterogeneous prognosis of localized disease poses a great challenge for clinicians and investigators, since prognostic assessment is essential to assess the balance of benefits and harms of treatment [2][3][4][5]. While a subset of patients can be safely actively monitored avoiding sexual, urinary and bowel toxicity associated with local treatments [2], patients with aggressive disease require a multimodality approach that includes surgery [3] and/or radiation therapy plus adjuvant hormonal treatment [4]. The clinical stage, prostate-specific antigen (PSA) levels and the biopsy Gleason score have been incorporated in an extensively employed risk classification model originally 3092RESEaRch aRticlE Ferro, Buonerba, Terracciano et al. future science group developed by D'Amico et^al. [5]. The biopsy Gleason score has also been included in models predicting organ-confined disease [6] as well as lymph node involvement [7], and it is associated with outcome even in patients with advanced disease receiving systemic treatment [8,9].Preoperative staging underestimates pathologic stage and prostate biopsies underestimate the Gleason score compared with prostatectomy specimens in up to 66% of patients, depending on PSA levels, biopsy Gleason score and clinical stage [10]. Apart from these variables, which have been incorporated in a validated predictive model to predict Gleason upgrading [11], a number of biomolecular markers were associated with Gleason upgrading [12,13]. Upgrading and upstaging have important therapeutic implications, as biopsy Gleason score and clinical stage along with PSA levels are the mainstay of the treatment-decision algorithm for localized prostate cancer [2][3][4][5]. Notably, baseline radiographic clinical staging has serious limitations.Urotensin II (UTII) is a vasoconstrictive agent that binds to UTII receptor (UTII-R) and is able to stimulate human corticoadrenal carcinoma proliferation [14]. In thr...

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Risk of Pathologic Upgrading or Locally Advanced Disease in Early Prostate Cancer Patients Based on Biopsy Gleason Score and PSA: A Population-Based Study of Modern Patients

Cited by 56 publications

References 27 publications

Association between Basal Total Testosterone Levels and Tumor Upgrading in Low and Intermediate Risk Prostate Cancer

Association between Basal Total Testosterone Levels and Tumor Upgrading in Low and Intermediate Risk Prostate Cancer

Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

Urotensin II Receptor on Preoperative Biopsy is Associated with Upstaging and Upgrading in Prostate Cancer

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