Prospective characterization of pathological features of Prostatic Carcinomas Detected Via Serum Prostate Specific Antigen Based Screening

Humphrey, Peter A.; Keetch, David W.; Smith, Deborah S.; Shepherd, David L.; Catàlona, William J.

doi:10.1097/00005392-199603000-00004

Cited by 40 publications

(55 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…23 Pattern 3 has been characterized as having three distinctive appearances, designated patterns 3A, 3B, and 3C. It has been suggested that there is increased aggressiveness of pattern 3 carcinoma proceeding from pattern 3A to 3B to 3C, 10 but no data have been published in support of this notion.…”

Section: Gleason Pattern 3 (Grade 3)mentioning

confidence: 99%

See 1 more Smart Citation

Gleason grading and prognostic factors in carcinoma of the prostate

2004

View full text Add to dashboard Cite

Section: Gleason Pattern 3 (Grade 3)mentioning

confidence: 99%

“…23,40 These models are not perfect, but can provide an estimate of risk for the patient having a small, organ-confined cancer without a high-grade Gleason pattern in the whole gland.…”

Section: Relationship Of Gleason Grade To Pathologic and Clinical Endmentioning

confidence: 99%

Gleason grading and prognostic factors in carcinoma of the prostate

2004

View full text Add to dashboard Cite

“…With widespread screening, men are diagnosed with CaP at a younger age, exhibit lower stage disease and smaller tumors, and have lower serum PSA, Gleason score 6 or 7, and nonpalpable disease (75%) [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. While a great number of men are still diagnosed with advanced disease and approximately 25% of all CaP patients detected will recur [2,4,12], approximately 25% of men undergoing PSA testing in referral and screened populations will have well differentiated (Gleason score <7), small volume (<0.5 cc) tumors known to demonstrate a long natural history [8,9,15]. The Epstein criteria, PSA density <0.15 ng/ml/g without adverse biopsy pathology (Gleason score <7, <3 cores involved with cancer, and <50% cancer involving any single core), correctly predict small volume, low grade tumors in 73% of men undergoing radical prostatectomy [8].…”

Section: Introductionmentioning

confidence: 99%

Using nuclear morphometry to predict the need for treatment among men with low grade, low stage prostate cancer enrolled in a program of expectant management with curative intent

Makarov¹,

Marlow²,

Epstein

et al. 2007

The Prostate

View full text Add to dashboard Cite

PURPOSE-We assessed the use of quantitative clinical and pathologic information to predict which patients would eventually require treatment for prostate cancer (CaP) in an expectant management (EM) cohort.EXPERIMENTAL DESIGN-We identified 75 men having prostate cancer with favorable initial biopsy characteristics; 30 developed an unfavorable biopsy (Gleason grade >6, >2 cores with cancer, >50% of a core with cancer, or a palpable nodule) requiring treatment and 45 maintained favorable biopsies throughout a median follow-up of 2.7years. Demographic, clinical data and quantitative tissue histomorphometry determined by digital image analysis were analyzed.RESULTS-Logistic regression (LR) modeling generated a quantitative nuclear grade (QNG) signature based on the enrollment biopsy for differentiation of Favorable and Unfavorable groups using a variable LR selection criteria of P z < 0.05. The QNG signature utilized 12 nuclear morphometric descriptors (NMDs) and had an area under the receiver operator characteristic curve (ROC-AUC) of 87% with a sensitivity of 82%, specificity of 70% and accuracy of 75%. A multivariable LR model combining QNG signature with clinical and pathological variables yielded an AUC-ROC of 88% and a sensitivity of 81%, specificity of 78% and accuracy of 79%. A LR model using prostate volume, PSA density, and number of pre-diagnosis biopsies resulted in an AUC-ROC of 68% and a sensitivity of 85%, specificity of 37% and accuracy of 56%.CONCLUSIONS-QNG using EM prostate biopsies improves the predictive accuracy of LR models based on traditional clinicopathologic variables in determining which patients will ultimately develop an unfavorable biopsy. Our QNG-based model must be rigorously, prospectively validated prior to use in the clinical arena.Keywords prostate cancer; expectant management; quantitative nuclear grade; prostate biopsy; low grade and low stage cancer

show abstract

“…In a study conducted by Humphrey et al (4), 78 of 100 consecutive patients who underwent radical prostatectomy for cancer detected with PSA screening had clinical stage T1c disease.…”

mentioning

confidence: 99%

“…Patients with clinical stage T1c disease who are treated with radical prostatectomy may harbor either clinically nonimportant cancer or cancer that is substantial in size, grade, and extent at surgical-pathologic analysis (4)(5)(6). For example, in a case series of 157 consecutive men who underwent radical prostatectomy for clinical stage T1c prostate cancer, 26% of tumors were considered "insignificant" or "minimal" (no larger than 0.5 cm 3 , confined to the prostate, and Gleason score lower than 7), 37% were moderate (Gleason score lower than 7 and either larger than 0.5 cm 3 or with capsular penetration), and 37% were advanced (capsular penetration, Gleason score higher than or equal to 7 or positive margins, or tumor involvement of seminal vesicles or lymph nodes) (5).…”

mentioning

confidence: 99%

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Zhang¹,

Hricak²,

Shukla–Dave³

et al. 2009

Radiology

View full text Add to dashboard Cite

Purpose:To assess the diagnostic accuracy of endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging for prediction of the pathologic stage of prostate cancer and the presence of clinically nonimportant disease in patients with clinical stage T1c prostate cancer. Materials and Methods:The institutional review board approved-and waived the informed patient consent requirement for-this HIPAAcompliant study involving 158 patients (median age, 58 years; age range, 40 -76 years) who had clinical stage T1c prostate cancer, had not been treated preoperatively, and underwent combined 1.5-T endorectal MR imaging-MR spectroscopic imaging between January 2003 and March 2004 before undergoing radical prostatectomy. On the MR images and combined endorectal MR-MR spectroscopic images, two radiologists retrospectively and independently rated the likelihood of cancer in 12 prostate regions and the likelihoods of extracapsular extension (ECE), seminal vesicle invasion (SVI), and adjacent organ invasion by using a five-point scale, and they determined the probability of clinically nonimportant prostate cancer by using a four-point scale. Whole-mount step-section pathology maps were used for imaging-pathologic analysis correlation. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) were estimated nonparametrically for assessment of reader accuracy. Results:At surgical-pathologic analysis, one (0.6%) patient had no cancer; 124 (78%) patients, organ-confined (stage pT2) disease; 29 (18%) patients, ECE (stage pT3a); two (1%) patients, SVI (stage pT3b); and two (1%) patients, bladder neck invasion (stage pT4). Forty-six (29%) patients had a total tumor volume of less than 0.5 cm 3 . With combined MR imaging-MR spectroscopic imaging, the two readers achieved 80% accuracy in disease staging and AUCs of 0.62 and 0.71 for the prediction of clinically nonimportant cancer. Conclusion:Clinical Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article.I n American men, prostate cancer continues to be the most common cancer and the second leading cause of noncutaneous cancer-related mortality (1). The American Cancer Society estimated that in 2009, 192 280 new cases of prostate cancer would be diagnosed and 27 360 deaths would occur owing to this disease in the United States (1). Serum prostate-specific antigen (PSA) screening has led to a dramatic decrease in prostate cancer stage at the time of diagnosis, and stage T1c is now the most commonly diagnosed clinical stage (2).According to the TNM classification system, T1c prostate cancers are malignancies identified with needle biopsy (performed, for example, because of an elevated PSA level) that are not detectable at digital rectal examination or imaging (usually transrectal ultrasonography [US]) (3). In a study conducted by Humphrey et al (4), 78 of 100 consecutive patients who underwent rad...

show abstract

Prospective characterization of pathological features of Prostatic Carcinomas Detected Via Serum Prostate Specific Antigen Based Screening

Abstract: We concluded that the pathological features of most prostatic carcinomas detected via PSA based screening do not resemble those of autopsy cancers, and that most prostatic cancers detected in screening programs are likely to be clinically important.

Cited by 40 publications

References 22 publications

Gleason grading and prognostic factors in carcinoma of the prostate

Gleason grading and prognostic factors in carcinoma of the prostate

Using nuclear morphometry to predict the need for treatment among men with low grade, low stage prostate cancer enrolled in a program of expectant management with curative intent

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR Imaging and MR Spectroscopic Imaging

Contact Info

Product

Resources

About