Pathological Upgrading and Up Staging With Immediate Repeat Biopsy in Patients Eligible for Active Surveillance

Berglund, Ryan K.; Masterson, Timothy A.; Vora, Kinjal; Eggener, Scott E.; Eastham, James A.; Guillonneau, Bertrand

doi:10.1016/j.juro.2008.07.051

Cited by 248 publications

(152 citation statements)

References 24 publications

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“…However, Boorijan et al (27) published one of the few studies showing that discordance in the GS is associated with adverse pathological features, including advanced tumor stage, lymph node metastasis and positive surgical margins.…”

Section: Discussionmentioning

confidence: 99%

“…The discordance in the GS between biopsy and RRP specimens is widely recognized, but the prognostic importance of these discrepancies has not been definitively established. However, Boorijan et al (27) published one of the few studies showing that discordance in the GS is associated with adverse pathological features, including advanced tumor stage, lymph node metastasis and positive surgical margins. Chun et al concluded that the tumor weight is an independent prognostic indicator of biochemical recurrence (6).…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…Criteria for AS set forth from published series are shown in Table 1 [7][8][9][10][11][12][13][14][15]. First described in 1994, and then updated in 2004, the Epstein criteria integrate biopsy criteria with clinical data to identify potentially low-risk tumors and are among the most commonly used methods to identify lowrisk disease [16,17].…”

Section: Criteria For Active Surveillancementioning

confidence: 99%

“…Table 3 displays the pathologic outcomes after the first repeat biopsy from the series identified [34][35][36]. Investigators from Memorial Sloan-Kettering Cancer Center used a strategy of early (within 3 mo) confirmatory biopsy in a cohort of men on AS [13]. Twenty-seven percent of men were identified with adverse pathologic features on 12-core confirmatory biopsy, rendering them ineligible for surveillance per their protocol, while 26% of men demonstrated negative histology.…”

Section: 4mentioning

confidence: 99%

Active Surveillance for Prostate Cancer: A Systematic Review of the Literature

et al. 2012

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Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. AbstractContext: Prostate cancer (PCa) remains an increasingly common malignancy worldwide. The optimal management of clinically localized, early-stage disease remains unknown, and profound quality of life issues surround PCa interventions. Objective: To systematically summarize the current literature on the management of low-risk PCa with active surveillance (AS), with a focus on patient selection, outcomes, and future research needs.

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“…GS is a well-validated factor and known to be a powerful predictor of disease progression, mortality, and outcomes (4,5). However, owing to random sampling, the GS determined through biopsies is known to differ from those determined following radical prostatectomy (6,7), as well as between immediate repeat biopsies (8). Therefore, the ability to automatically detect the GS with high accuracy from the diagnostic MRIs would have a significant impact on clinical decision making, treatment selection, and prediction of outcomes for patients and spare them from painful biopsies and their accompanying risk of complications.…”

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confidence: 99%

Automatic classification of prostate cancer Gleason scores from multiparametric magnetic resonance images

Fehr

Veeraraghavan

Wibmer

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

336

315

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Noninvasive, radiological image-based detection and stratification of Gleason patterns can impact clinical outcomes, treatment selection, and the determination of disease status at diagnosis without subjecting patients to surgical biopsies. We present machine learning-based automatic classification of prostate cancer aggressiveness by combining apparent diffusion coefficient (ADC) and T2-weighted (T2-w) MRI-based texture features. Our approach achieved reasonably accurate classification of Gleason scores (GS) 6(3 + 3) vs. ≥7 and 7(3 + 4) vs. 7(4 + 3) despite the presence of highly unbalanced samples by using two different sample augmentation techniques followed by feature selection-based classification. Our method distinguished between GS 6(3 + 3) and ≥7 cancers with 93% accuracy for cancers occurring in both peripheral (PZ) and transition (TZ) zones and 92% for cancers occurring in the PZ alone. Our approach distinguished the GS 7(3 + 4) from GS 7(4 + 3) with 92% accuracy for cancers occurring in both the PZ and TZ and with 93% for cancers occurring in the PZ alone. In comparison, a classifier using only the ADC mean achieved a top accuracy of 58% for distinguishing GS 6(3 + 3) vs. GS ≥7 for cancers occurring in PZ and TZ and 63% for cancers occurring in PZ alone. The same classifier achieved an accuracy of 59% for distinguishing GS 7(3 + 4) from GS 7(4 + 3) occurring in the PZ and TZ and 60% for cancers occurring in PZ alone. Separate analysis of the cancers occurring in TZ alone was not performed owing to the limited number of samples. Our results suggest that texture features derived from ADC and T2-w MRI together with sample augmentation can help to obtain reasonably accurate classification of Gleason patterns.

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Pathological Upgrading and Up Staging With Immediate Repeat Biopsy in Patients Eligible for Active Surveillance

Cited by 248 publications

References 24 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?

Active Surveillance for Prostate Cancer: A Systematic Review of the Literature

Automatic classification of prostate cancer Gleason scores from multiparametric magnetic resonance images

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