Limitations of Biopsy Gleason Grade: Implications for Counseling Patients With Biopsy Gleason Score 6 Prostate Cancer

Sved, Paul; Gómez, Pablo; Manoharan, M.; Kim, Sandy S.; Soloway, Mark S.

doi:10.1097/01.ju.0000132135.18093.d6

Cited by 78 publications

(51 citation statements)

References 20 publications

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“…Ishizaki et al studied 144 consecutive patients with localized or locally advanced PCa and observed that the pathological stage tended to be skewed to a lower stage (65.3% pT2 and 33.9% pT3 (25). The concordance of GS between the biopsy and RRP specimens in this study (55%) was similar to that found in two previous studies (22,26), in which the authors found concordance rates of 56% and 62%, respectively.…”

Section: Discussionsupporting

confidence: 79%

“…This finding could also be explained by the different variables associated with the biopsy, including the gauge of the biopsy needle, the amounts of normal tissue and cancer in the biopsy specimen, the sampling method and interobserver variations (22). The highest concordance between biopsy and Radical Prostatecomy analysis in Single Positive Core Patients occurs when the patient has a low-volume prostate and low PSA level.…”

Section: Discussionmentioning

confidence: 98%

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Can Single Positive Core Prostate Cancer at biopsy be Considered a Low-Risk Disease after Radical Prostatectomy?

et al. 2013

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Purpose: Single positive core in a prostate biopsy is usually associated with indolent prostate cancer (PCa) and is one of the active surveillance (AS) inclusion criteria. We investigated whether single positive core PCa at biopsy could define an archetype of low-risk disease. Materials and Methods: A total of 1320 consecutive patients were enrolled. Among them, 249 patients with single positive core PCa were followed up, and the clinical and pathological parameters influencing prognosis were analyzed. Results: Out of the 249 patients, 172 (69.0%) had pathological findings ≥ pT2c and 87 (34.9%) had an undergraded Gleason Score (GS) based on the biopsy. Positive surgical margins (PSMs), extraprostatic extension (EPE) and seminal vesicle invasion (SVI) were found in 20.8%, 10.0% and 6.0% of patients, respectively. In a comparative analysis, we found that the PSA level, prostate weight and number of cores at biopsy are essential to correctly predict an indolent PCa. A total of 125 patients (67.3%) with nonpalpable tumors became high-risk tumors (pT2c-T3). Analyzing only nonpalpable tumors with a GS of 6 at biopsy (156 patients), we noted that 106 (67.9% of cT1) progressed from cT1c to pT2c-pT3. Conclusions: Single core PCa have clinically significant disease in the Radical Prostatectomy specimens, with considerable rates of overgrading for the GS, pT2c-pT3, PSMs, EPE and SVI. The treatment plan must be evaluated individually for patients with single core PCa and must take into account other prognostic factors when determining whether a patient should be managed with AS. Can

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 98%

Can Single Positive Core Prostate Cancer at biopsy be Considered a Low-Risk Disease after Radical Prostatectomy?

et al. 2013

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“…Yet, if the cancer does metastasize, the disease becomes lethal, as there is currently no cure. At present, predictions of the course of the disease in an individual patient using current prognostic markers have substantial limitations [4][5][6][7]. Thus, while a broad spectrum of approaches, from "watchful waiting" and hormone deprivation therapy to surgical, radiation, and cryosurgical therapies, are available, it is not a simple task to assign an individual patient to the most appropriate treatment strategy.…”

Section: Prostate Cancer Diagnosis Prognosis and Treatmentmentioning

confidence: 99%

“…Clinical (digital rectal exam (DRE)), pathologic (histologic grade from biopsy, and number and percentage of positive biopsies) [8], and biochemical parameters in serum (PSA, PAP) [9][10][11][12] or in tissue (MIB-1, bcl-2, p53, CD34) [13][14][15][16][17] can aid in assessing the extent and aggressiveness of the disease. However, these are often inaccurate or inadequate, particularly when used alone in individual patients for both pre-and post-treatment assessments [4,5] [18].…”

Section: Prostate Cancer Diagnosis Prognosis and Treatmentmentioning

confidence: 99%

The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 Tesla: The Beth Israel Deaconess Medical Center (BIDMC) approach

Bloch

Lenkinski

Rofsky

2008

CBM

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Management decisions for patients with prostate cancer present a dilemma for both patients and their clinicians because prostate cancers demonstrate a wide range in biologic activity, with the majority of cases not leading to a prostate cancer related death. Furthermore, the current treatment options have significant side effects, such as incontinence, rectal injury and impotence. Key elements for guiding appropriate treatment include: distinction of organ-confined disease from extracapsular extension (ECE); and determination of tumor volume and tumor grade, none of which have been satisfactorily accomplished in today's pre-treatment paradigm. Magnetic resonance imaging (MRI) has the capability to assess prostate tissue, both functionally and morphologically. MRI as a staging tool has not shown enough consistency or sufficient accuracy for widespread adoption in clinical practice; yet, recent technical developments in MRI have yielded improved results. At our institution we have combined the use of new endorectal 3 Tesla MRI technology, T2-weighted, and high spatial resolution dynamic-contrast enhanced (DCE) MRI to non-invasively assess the prostate with higher signal-to-noise ratio and spatial resolution than previously achieved. This approach allows assessment of prostate-tissue morphology and kinetics, thus providing a non-invasive tool for tumor detection and staging and, consequently, directing biopsy and treatment specifically to diseased areas for a pre-treatment evaluation that can assist in the rational selection of patients for appropriate prostate cancer therapy.

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“…Half of those diagnosed have a Gleason score of 6 or lower (6), which has very low metastatic potential, and the proper clinical treatment for these men is unclear. Indeed, upon removal of the prostate and subsequent histologic analysis, the Gleason score is often revised, and an upgrade upon surgery is associated with adverse prognosis (7)(8)(9). Hence, there is an unmet need for improved diagnostics and risk assessment.…”

Section: Introductionmentioning

confidence: 99%

Utility of Single-Cell Genomics in Diagnostic Evaluation of Prostate Cancer

et al. 2018

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A distinction between indolent and aggressive disease is a major challenge in diagnostics of prostate cancer. As genetic heterogeneity and complexity may influence clinical outcome, we have initiated studies on single tumor cell genomics. In this study, we demonstrate that sparse DNA sequencing of single-cell nuclei from prostate core biopsies is a rich source of quantitative parameters for evaluating neoplastic growth and aggressiveness. These include the presence of clonal populations, the phylogenetic structure of those populations, the degree of the complexity of copy-number changes in those populations, and measures of the proportion of cells with clonal copy-number signatures. The parameters all showed good correlation to the measure of prostatic malignancy, the Gleason score, derived from individual prostate biopsy tissue cores. Remarkably, a more accurate histopathologic measure of malignancy, the surgical Gleason score, agrees better with these genomic parameters of diagnostic biopsy than it does with the diagnostic Gleason score and related measures of diagnostic histopathology. This is highly relevant because primary treatment decisions are dependent upon the biopsy and not the surgical specimen. Thus, single-cell analysis has the potential to augment traditional core histopathology, improving both the objectivity and accuracy of risk assessment and inform treatment decisions.Significance: Genomic analysis of multiple individual cells harvested from prostate biopsies provides an indepth view of cell populations comprising a prostate neoplasm, yielding novel genomic measures with the potential to improve the accuracy of diagnosis and prognosis in prostate cancer. Cancer Res; 78(2); 348-58. Ó2017 AACR.

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Limitations of Biopsy Gleason Grade: Implications for Counseling Patients With Biopsy Gleason Score 6 Prostate Cancer

Cited by 78 publications

References 20 publications

Can Single Positive Core Prostate Cancer at biopsy be Considered a Low-Risk Disease after Radical Prostatectomy?

Can Single Positive Core Prostate Cancer at biopsy be Considered a Low-Risk Disease after Radical Prostatectomy?

The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 Tesla: The Beth Israel Deaconess Medical Center (BIDMC) approach

Utility of Single-Cell Genomics in Diagnostic Evaluation of Prostate Cancer

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