The new Epstein gleason score classification significantly reduces upgrading in prostate cancer patients

Nunzio, Cosimo De; Pastore, Antonio Luigi; Lombardo, Riccardo; Simone, Giuseppe; Leonardo, Costantino; Mastroianni, Riccardo; Collura, Devis; Muto, Giovanni; Gallucci, Michele; Carbone, Antonio; Fuschi, Andrea; Dutto, Lorenzo; Witt, J.; Dominicis, C. De; Tubaro, Andrea

doi:10.1016/j.ejso.2017.12.003

Cited by 34 publications

(26 citation statements)

References 26 publications

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“…Compared with the previous Gleason scoring system, the upgrade rate was lower in the modified ISUP Gleason grade used today. However, even in the new system, the GU at RP was reported as 40% in patients whose bioptical pathologies were Gleason 6 (Gleason Grade Group 1 in the new system) …”

Section: Discussionmentioning

confidence: 90%

“…6 However the rate was reported between 14% and 51% in patients who underwent deferred RP following AS. 2 In the PRIAS trial with a large patient cohort, it has been shown that CSS did not differ between the low-risk patients receiving AS, and patients treated with curative intent. 7 However, the follow-up was over than 10 years, and almost three-quarters of AS patients were reported to receive definitive treatment in that study.…”

Section: Introductionmentioning

confidence: 97%

“…The GU rates varied between 30% and 40% in the literature in patients undergoing RP . However the rate was reported between 14% and 51% in patients who underwent deferred RP following AS …”

Section: Introductionmentioning

confidence: 98%

“…Prostate cancer (PCa) is the second most common type of cancer in men . It may be detected in a wide range between clinically indolent, and advanced stage metastatic disease . Radical prostatectomy (RP), and radiotherapy (RT) are both the standard treatments in organ‐confined PCa for curative intent.…”

Section: Introductionmentioning

confidence: 99%

“…1 It may be detected in a wide range between clinically indolent, and advanced stage metastatic disease. 2 Radical prostatectomy (RP), and radiotherapy (RT) are both the standard treatments in organconfined PCa for curative intent. However, overdiagnosis and overtreatment were frequently discussed in the last decade.…”

Section: Introductionmentioning

confidence: 99%

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The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

et al. 2019

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Background Active surveillance (AS) is one of the treatment alternatives in low‐risk prostate cancer (PCa). The pathological upgrading after radical prostatectomy (RP) were investigated in patients who were eligible for AS in the present study. Methods Between August 2006 and July 2017, 627 patients underwent RP in our institution. One hundred and thirty‐six patients who were eligible for AS at the time of RP were included in this study. The previously defined AS criteria Gleason 3 + 3=6 adenocarcinoma at maximum two biopsy cores, prostate‐specific antigen (PSA) < 10 ng/mL and clinical T stage ≤ 2a were used in the study. The demographics, clinical, and histopathological outcomes were retrospectively compared between two groups, which were divided in accordance with the upgrading status at final pathology as Group 1 (n = 67, upgrading) and Group 2 (n = 69, nonupgrading). Results Gleason upgrading (GU) was found in 67 (49.3%) patients, and 17 patients (12.5%) were upstaged to pT3a. The upgrading to Gleason 3 + 4 was reported in 38.7% of patients, however, 7.4%, and 3.7% of the patients were upgraded to Gleason 4 + 3, and Gleason 4 + 4, respectively. The 10.3% of the patients had extraprostatic involvement, and the rate (19.4% vs 1.4%, P = .002) was significantly higher in Group 1. PSA density (P = .001), tumor size (P < .001), tumor percentage (P < .001), apical involvement (P = .013), and perineural invasion (P < .001) in RP specimen were higher in Group 1. Multivariate analysis showed that perineural invasion (OR = 4.26; 95%CI: 1.76‐10.33; P = .001) and pathologic T stage (OR = 5.45; 95%CI: 1.08‐27.4; P = .04) were independently associated with GU. Conclusions Since 12.5% of the patients upstaged to pT3a disease, and there is a possible risk of Gleason 4 pattern, upgrading of the tumor should carefully be kept in mind before offering AS to low‐risk patients with PCa.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 97%

“…The GU rates varied between 30% and 40% in the literature in patients undergoing RP . However the rate was reported between 14% and 51% in patients who underwent deferred RP following AS …”

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

et al. 2019

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Urotensin II receptor expression in prostate cancer patients: A new possible marker

Giulianelli¹,

Nardoni²,

Falavolti³

et al. 2018

The Prostate

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Background: Urotensin II receptor has been poorly studied in prostate cancer. To evaluate the expression of urotensin II receptor (UII-R) in patients undergoing radical prostatectomy.Methods: Overall, we identified 140 patients treated with retropubic radical prostatectomy (RP) in one center. UII-R was evaluated in prostate biopsies with immunohistochemical staining, resulting in a granular cytoplasmic positivity, through automated system using the kit Urotensin II Receptor Detection System provided by Pharmabullet srl. Immunostained slides were independently and blindly evaluated by ten uro-pathologists. To evaluate UTII-R expression three different parameters were considered: localization, granules dimensions and intensity of expression. A score from 0 to 3 was applied to each parameter to obtain a score from 0 to 9. Each parameter and the total score were evaluated as predictors of high grade disease on surgical pathology and of advanced stage disease. Accuracy of total score for the prediction of upgrading and upstaging was analyzed using receiver operator characteristics curve and decision curve analysis (DCA).Results: On radical prostatectomy 92/140 (66%) presented high grade disease on surgical pathology. Patients with high grade disease presented an apical distribution of the receptor, larger granules and a more intense expression when compared to patients with low grade disease. A well they presented a higher total score. Subscores and total scores were found to be predictors of upgrading and upstaging. On ROC analysis total score presented an AUC of 0.72 and 0.70, respectively, for the prediction of upgrading and upstaging. On DCA total score showed a clinical benefit in the prediction of adverse pathological outcomes.Conclusion: Urotensin II receptor is a potential marker of adverse pathological outcomes. Further studies should confirm our data and evaluate its role as a prognostic marker. K E Y W O R D S accuracy, upgrading, upstaging, urotensin 288 |

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Prostate cancer adverse pathology reclassification in patients undergoing active surveillance in a long‐term follow‐up series

et al. 2019

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BackgroundActive surveillance (AS) has become a valid option for patients with a very low risk of prostate cancer (PC) with a widespread application. There are still a few series, with a medium follow‐up longer than 5 years, reporting data on pathological upgrading. The objective is to evaluate the changes in surveillance biopsies of patients with low‐risk PC in a long‐term follow‐up and determine if a longer stay in AS could involve worse pathological findings.Materials and MethodsA retrospective analysis of our institutional database of patients with PC undergoing AS during 2004 to 2018 was performed. The inclusion criteria were prostate‐specific antigen (PSA) ≤ 10 ng/mL, Gleason grade 1 and T1c/T2a. Patients were assessed by serum PSA level and digital rectal examination at 6‐month intervals. Transrectal ultrasound‐guided prostate biopsies were performed during the first year of follow‐up, and every 2 or 3 years thereafter. The pathology details of biopsies were analyzed and compared with the current series on AS.ResultsThree‐hundred nineteen patients undergoing AS were evaluated with a median follow‐up of 5.3 years and a mean age of 67.4 years. Sixty‐three patients did not meet all the criteria to be considered low‐risk PC but were included in the analysis. Overall, 128 patients (40.1%) underwent active treatment (84.7% of them due to pathological progression in surveillance biopsies). The proportion of patients with a reported upgrading ranged between 19.4% and 35.3%, although only the fourth biopsy showed an upgrading proportion of over 30%. Limitations include the retrospective design of the study and the existence of different protocols between other cohorts that make it difficult to compare their results.ConclusionsFor patients who remained in surveillance the percentage of upgrading increased slightly with the time, being more frequent after the third‐surveillance biopsy. These findings support the importance of extending surveillance biopsies for patients who remain candidates for curative treatment.

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The new Epstein gleason score classification significantly reduces upgrading in prostate cancer patients

Cited by 34 publications

References 26 publications

The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

Urotensin II receptor expression in prostate cancer patients: A new possible marker

Prostate cancer adverse pathology reclassification in patients undergoing active surveillance in a long‐term follow‐up series

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