Stratification of Contemporary Patients Undergoing Radical Prostatectomy for High-risk Prostate Cancer

Jo, Jung Ki; Kook, Ha Rim; Byun, Seok‐Soo; Lee, Sang Eun; Hong, Sung Kyu

doi:10.1245/s10434-014-4183-7

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…Our findings are similar to those of 2 single institution retrospective reviews of post-radical prostatectomy cases in which Gleason pattern 5 on biopsy was associated with biochemical recurrence. 18,19…”

Section: Discussionmentioning

confidence: 99%

Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer

et al. 2017

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Preoperative subclassification of high risk prostate cancer by biopsy Gleason grade (4 + 4 vs any Gleason pattern 5) identified men at highest risk for progression. Any Gleason 5 on biopsy is associated with a greater risk of metastasis, and prostate cancer specific and overall mortality. Grouping all Gleason 8-10 tumors together as high risk lesions may fail to fully stratify men at highest risk for poor outcomes.

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Section: Discussionmentioning

confidence: 99%

Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer

et al. 2017

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“…To enhance the chance of long-term survival in high-risk patients, new treatment options including pre-surgical systemic chemotherapy, hormonal therapy, and targeted agents are being investigated [24]. A recent study suggested that high-risk patients undergoing RP should be further stratified based on primary Gleason pattern and the number of high-risk criteria [3]. By noninvasively providing metabolic information reflecting Gleason score and tumor volume, MRSI may have the ability to aid in substratification of these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Candidates for radical prostatectomy (RP) may have clinically low, intermediate, or high-risk disease and further prognostic data would aid the physician making treatment decisions [2,3]. Proton MR spectroscopic imaging ( 1 H-MRSI) permits the analysis of metabolism as reflected by the levels of choline-containing compounds, polyamines (spermine and spermidine), creatine, and citrate in PCa [4].…”

Section: Introductionmentioning

confidence: 99%

Prostate MRSI predicts outcome in radical prostatectomy patients

Zakian

Hatfield²,

Aras³

et al. 2016

Magnetic Resonance Imaging

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Background New non-invasive methods are needed for sub-stratifying high-risk prostate cancer patients. Magnetic resonance spectroscopic imaging (MRSI) maps metabolites in prostate cancer, providing information on tumor aggressiveness and volume. Purpose To investigate the correlation between MRSI and treatment failure (TF) after radical prostatectomy (RP). Methods Two-hundred sixty-two patients who underwent endorectal MRI/MRSI followed by RP at our institution from 2003 to 2007 were studied. MRI stage, number of voxels in the MRSI index lesion (NILV), number of high-grade voxels (NHGV), and number of voxels containing undetectable polyamines (NUPV) were derived. Clinical outcome was followed until August, 2014. Treatment failure was defined as 1) biochemical recurrence (BCR), 2) persistently detectable PSA after RP, or 3) adjuvant therapy initiated in the absence of BCR. MRI/MRSI features and clinical parameters were compared to TF by univariate Cox Proportional Hazards Regression. After backward selection, each MRSI parameter was included in a separate regression model adjusted for NCCN-based clinical risk score (CRS), number of biopsy cores positive (NPC), and MRI stage. Results In univariate analysis, all clinical variables were associated with TF in addition to MRI stage, NILV, NHGV, and NUPV. In multivariate analysis, NILV, NHGV, and NUPV were also significant risk factors for TF (p=0.016, p=0.002, p=0.006, respectively). The association between the number of tumor voxels with undetectable polyamines and the probability of treatment failure has not been previously reported. The number of MRSI cancer voxels correlated with ECE (p < 0.0001). Conclusions MRSI was associated with post-radical prostatectomy treatment failure in models adjusted for the number of positive biopsy cores and clinical risk score. This is the first report that in radical prostatectomy patients MRSI has an association with treatment failure independent of the number of positive biopsy cores. MRSI may help the clinician determine whether patients with high risk disease who undergo RP are candidates for specialized additional treatment.

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“…The authors suggested stratification of patients with high-risk PCa into the following three subgroups: good prognosis subgroup (1 high-risk factor); intermediate prognosis subgroup (PSA level > 20 ng/ mL and stage cT3-4); and poor prognosis subgroup (Gleason score 8-10 in combination with at least 1 other high-risk factor). Because of the lack of a definition of high-risk PCa, studies have subclassified high-risk PCa into different prognostic categories [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…our study indicated which patients may require surgery and which patients may not require surgery. Most previous studies aimed to validate the subset of the high-risk group according to the oncological outcomes within each risk group [ 20 , 24 , 25 ]. The present study identified the oncological outcomes of each subgroup based on the number of risk factors after comparison with those in the other risk groups in patients with high-risk PCa.…”

Section: Discussionmentioning

confidence: 99%

Re-stratification of Patients with High-Risk Prostate Cancer According to the NCCN Guidelines among Patients Who Underwent Radical Prostatectomy: An Analysis Based on the K-CaP Registry

et al. 2018

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PurposeThe present study aimed to re-stratify patients with high-risk prostate cancer according to the National Comprehensive Cancer Network guidelines among patients who underwent radical prostatectomy (RP).Materials and MethodsThis study used the Korean Prostate Cancer Database registry and identified 1,060 patients with high-risk prostate cancer who underwent RP between May 2001 and April 2013. All patients were categorized into risk groups, and subgroups were identified according to the type and number of high-risk factors.ResultsOf the 1,060 high-risk patients, 599 (56.5%), 408 (38.5%), and 53 (5.0%) had 1, 2, and 3 risk factors, respectively. In multivariate analysis, the Gleason score, percentage of positive biopsy cores, and number of risk factors present were identified as independent predictors of biochemical recurrence. There were significant differences in the 5-year postoperative biochemical failure-free survival (BCFFS) rate among the different high-risk factor subgroups (log-rank p < 0.001). There were no significant differences in the BCFFS rate between the subgroup of high-risk patients with a prostate-specific antigen level > 20 ng/mL alone and the intermediate-risk group with all factors (log-rank p=0.919 and p=0.781, respectively). Additionally, no significant difference was noted in the BCFFS rate between high-risk patients having all factors and those in the very-high-risk group (p=0.566).ConclusionWe successfully re-stratified patients with high-risk prostate cancer and identified the combinations of high-risk criteria that will help in the selection of patients for RP.

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Stratification of Contemporary Patients Undergoing Radical Prostatectomy for High-risk Prostate Cancer

Cited by 5 publications

References 27 publications

Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer

Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer

Prostate MRSI predicts outcome in radical prostatectomy patients

Re-stratification of Patients with High-Risk Prostate Cancer According to the NCCN Guidelines among Patients Who Underwent Radical Prostatectomy: An Analysis Based on the K-CaP Registry

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