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Jonathan I Epstein - One of the best experts on this subject based on the ideXlab platform.

  • incidence of extraprostatic extension at radical prostatectomy with pure Gleason Score 3 3 6 grade group 1 cancer implications for whether Gleason Score 6 prostate cancer should be renamed not cancer and for selection criteria for active surveillance
    The Journal of Urology, 2018
    Co-Authors: Oudai Hassan, Misop Han, Amy G Zhou, Adina Paulk, Yue Sun, Abdullah M Alharbi, Ahmed Alrajjal, Filipa Baptista Dos Santos, Jonathan I Epstein
    Abstract:

    Purpose: We assessed the risk of locally aggressive behavior in pure Gleason Score 6 (Grade Group 1) prostate cancer using contemporary grading criteria. To our knowledge this has been studied in only 1 prior cohort.Materials and Methods: We evaluated consecutive radical prostatectomy specimens from an academic institution, including those from 3,291 men with Gleason Score 6 and 4,202 with Gleason Score 3 + 4 = 7 (Grade Group 2) disease between 2005 and 2016. For dichotomous variables the Pearson chi-square test was used.Results: Of the 3,288 Gleason Score 6 cancer cases 128 (3.9%) showed focal extraprostatic extension compared to 593 of the 4,202 (14.1%) with Gleason Score 3 + 4 = 7 (p <0.0001). Of the 3,288 Gleason Score 6 cancer cases 79 (2.4%) showed nonfocal extraprostatic extension compared to 639 of the 4,202 (15.2%) with Gleason Score 3 + 4 = 7 (p <0.0001). The incidence of focal extraprostatic extension with Gleason Score 3 + 4 = 7 with less than 5% Gleason pattern 4 was 129 of 1,147 cases (11.2%...

  • new prostate cancer grading system predicts long term survival following surgery for Gleason Score 8 10 prostate cancer
    European Urology, 2017
    Co-Authors: Won Sik Ham, Heather J Chalfin, Zhaoyong Feng, Bruce J Trock, Jonathan I Epstein, Carling Cheung, Elizabeth B Humphreys, Alan W Partin, Misop Han
    Abstract:

    Abstract Background The newly proposed five-tiered prostate cancer grading system (PCGS) divides Gleason Score (GS) 8–10 disease into GS 8 and GS 9–10 on the basis of biochemical recurrence (BCR) following radical prostatectomy (RP) as an outcome. However, BCR does not necessarily portend worse survival outcomes. Objective To assess the significance of distinguishing GS 8 versus 9–10 disease in terms of long-term survival outcomes for both the preoperative setting using biopsy (Bx) GS and the postoperative setting with RP GS. Design, setting, and participants Of 23918 men who underwent RP between 1984 and 2014, there were 721 men with biopsy GS 8–10, and 1047 men with RP GS 8–10. Outcome measures and statistical analysis Clinicopathologic characteristics were compared between men with GS 8 and those with GS 9–10. We compared all-cause mortality (ACM) and prostate cancer–specific mortality (PCSM) risk between the groups using Cox regression and competing-risks analyses, adjusting for other perioperative variables and death from other causes as the competing event. Results and limitations Compared to men with GS 8, men with GS 9–10 had later RP year and higher pathologic stage. Among men with Bx GS 8–10, 115 died (82 due to PC) with median follow-up of 3 yr (interquartile range [IQR] 1–7) for both overall and cancer-specific survival. Of men with RP GS 8–10, 221 died (151 due to PC) with median follow-up of 4 yr (IQR 2–8) and 4 yr (IQR 2–9) for overall and cancer-specific survival, respectively. PC-specific survival rates were significantly lower for men with GS 9–10 compared to men with GS 8 for both Bx (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.37–3.30; p p Conclusions Men with GS 9–10 had higher ACM and PCSM rates compared to those with GS 8. GS 8 and GS 9–10 PC should be considered separately in both the preoperative and postoperative setting as suggested by the new PCGS. Patient summary The prostate cancer grading system can predict mortality risk after radical prostatectomy (RP) for men with Gleason Score 8–10 disease based on both biopsy and RP Gleason Scores. There are significant differences in all-cause mortality and prostate cancer–specific mortality following surgery between men with Gleason Score 8 and those with Gleason Score 9–10 disease.

  • prediction of pathological stage based on clinical stage serum prostate specific antigen and biopsy Gleason Score partin tables in the contemporary era
    BJUI, 2017
    Co-Authors: Jeffrey J Tosoian, Zhaoyong Feng, Jonathan I Epstein, Elizabeth B Humphreys, Alan W Partin, Misop Han, Meera Chappidi, Christian P Pavlovich, Bruce J Trock
    Abstract:

    Objective To update the Partin Tables for prediction of pathological stage in the contemporary setting and examine trends in patients treated with radical prostatectomy (RP) over the past three decades. Patients and Methods From January 2010 to October 2015, 4459 men meeting inclusion criteria underwent RP and pelvic lymphadenectomy for histologically confirmed prostate cancer at the Johns Hopkins Hospital. Preoperative clinical stage, serum prostate-specific antigen (PSA) level, and biopsy Gleason Score (i.e. prognostic Grade Group) were used in a polychotomous logistic regression model to predict the probability of pathological outcomes categorised as: organ-confined (OC), extraprostatic extension (EPE), seminal vesicle involvement (SV+), or lymph node involvement (LN+). Preoperative characteristics and pathological findings in men treated with RP since 1983 were collected and clinical-pathological trends were described. Results The median (range) age at surgery was 60 (34–77) years and the median (range) PSA level was 4.9 (0.1–125.0) ng/mL. The observed probabilities of pathological outcomes were: OC disease in 74%, EPE in 20%, SV+ in 4%, and LN+ in 2%. The probability of EPE increased substantially when biopsy Gleason Score increased from 6 (Grade Group 1, GG1) to 3 + 4 (GG2), with smaller increases for higher grades. The probability of LN+ was substantially higher for biopsy Gleason Score 9–10 (GG5) as compared to lower Gleason Scores. Area under the receiver operating characteristic curves for binary logistic models predicting EPE, SV+, and LN+ vs OC were 0.724, 0.856, and 0.918, respectively. The proportion of men treated with biopsy Gleason Score ≤6 cancer (GG1) was 47%, representing a substantial decrease from 63% in the previous cohort and 77% in 2000–2005. The proportion of men with OC cancer has remained similar during that time, equalling 73–74% overall. The proportions of men with SV+ (4.1% from 3.4%) and LN+ (2.3% from 1.4%) increased relative to the preceding era for the first time since the Partin Tables were introduced in 1993. Conclusions The Partin Tables remain a straightforward and accurate approach for projecting pathological outcomes based on readily available clinical data. Acknowledging these data are derived from a tertiary care referral centre, the proportion of men with OC disease has remained stable since 2000, despite a substantial decline in the proportion of men with biopsy Gleason Score 6 (GG1). This is consistent with the notion that many men with Gleason Score 6 (GG1) disease were over treated in previous eras.

  • accuracy of grading Gleason Score 7 prostatic adenocarcinoma on needle biopsy influence of percent pattern 4 and other histological factors
    The Prostate, 2017
    Co-Authors: Abdelrazak Meliti, Evita Sadimin, Mario Diolombi, Francesca Khani, Jonathan I Epstein
    Abstract:

    BACKGROUND Recognition of Gleason pattern 4 in prostatic needle biopsies is crucial for both prognosis and therapy. Recently, it has been recommended to record percent pattern 4 when Gleason Score 7 cancer is the highest grade in a case. METHODS Four hundred and five prostate needle core biopsies received for a second opinion at our institution from February–June, 2015 were prospectively diagnosed with prostatic adenocarcinoma Gleason Score 7 as the highest Score on review by a consultant urological pathologist. Percentage of core involvement by cancer, percentage of Gleason pattern 4 per core, distribution of Gleason pattern 4 (clustered, scattered), morphology of pattern 4 (cribriform, non-cribriform), and whether the cancer was continuous or discontinuous were recorded. RESULTS Better agreement was noted between the consultant and referring pathologists when pattern 4 was clustered as opposed to dispersed in biopsies (P = 0.009). The percentage of core involvement by cancer, morphology of pattern 4, and continuity of cancer did not affect the agreement between the consultant and referring pathologists. There was a trend (P = 0.06) for better agreement based on the percent of pattern 4. CONCLUSIONS When pattern 4 is scattered amongst pattern 3 as opposed to being discrete foci, there is less interobserver reproducibility in grading Gleason Score 7 cancer, and in this setting pathologists should consider obtaining second opinions either internally within their group or externally. Prostate 77: 681–685, 2017. © 2017 Wiley Periodicals, Inc.

  • significance of Gleason Score 7 with tertiary pattern 5 at radical prostatectomy
    Urology, 2017
    Co-Authors: Walaa Borhan, Jonathan I Epstein
    Abstract:

    Objective To study the prognostic influence of tertiary pattern 5 (TP5) in radical prostatectomy specimens with a Gleason Score of 7. Materials and Methods A total of 4060 specimens with a Gleason Score of 7 with and without TP5 seen between 2005 and 2015 were retrospectively reviewed. Cases were subdivided into 3 + 4 = 7, 3 + 4 = 7 with TP5, 4 + 3 = 7, and 4 + 3 = 7 with TP5. We compared prostate-specific antigen, clinical stage, pathologic stage, and surgical margin status between the groups. The impact of TP5 on biochemical recurrence was also assessed. Results The median age was 68 years old with a median prostate-specific antigen level of 9.3 ng/mL. TP5 was present in 259 patients (6.4%) with a Gleason Score 3 + 4 = 7 and in 361 patients (8.9%) with a Gleason Score of 4 + 3 = 7. The mean follow-up without progression was 3 years. The presence of a tertiary pattern correlated with pathologic stage; the only exception was that there was no statistically significant difference between Gleason Score 3 + 4 = 7 with TP5 and 4 + 3 = 7. Multivariate analysis showed that TP5 was independently associated with biochemical recurrence among patients with a Gleason Score of 7 (P  Conclusion The impact of TP5 of Gleason Score 7 in radical prostatectomy specimens is still significant using contemporary grading. Moreover, TP5 was independently associated with biochemical recurrence. However, 3 + 4 = 7 with TP5 behaves like 4 + 3 = 7 in terms of biochemical recurrence-free survival rate.

Alan W Partin - One of the best experts on this subject based on the ideXlab platform.

  • new prostate cancer grading system predicts long term survival following surgery for Gleason Score 8 10 prostate cancer
    European Urology, 2017
    Co-Authors: Won Sik Ham, Heather J Chalfin, Zhaoyong Feng, Bruce J Trock, Jonathan I Epstein, Carling Cheung, Elizabeth B Humphreys, Alan W Partin, Misop Han
    Abstract:

    Abstract Background The newly proposed five-tiered prostate cancer grading system (PCGS) divides Gleason Score (GS) 8–10 disease into GS 8 and GS 9–10 on the basis of biochemical recurrence (BCR) following radical prostatectomy (RP) as an outcome. However, BCR does not necessarily portend worse survival outcomes. Objective To assess the significance of distinguishing GS 8 versus 9–10 disease in terms of long-term survival outcomes for both the preoperative setting using biopsy (Bx) GS and the postoperative setting with RP GS. Design, setting, and participants Of 23918 men who underwent RP between 1984 and 2014, there were 721 men with biopsy GS 8–10, and 1047 men with RP GS 8–10. Outcome measures and statistical analysis Clinicopathologic characteristics were compared between men with GS 8 and those with GS 9–10. We compared all-cause mortality (ACM) and prostate cancer–specific mortality (PCSM) risk between the groups using Cox regression and competing-risks analyses, adjusting for other perioperative variables and death from other causes as the competing event. Results and limitations Compared to men with GS 8, men with GS 9–10 had later RP year and higher pathologic stage. Among men with Bx GS 8–10, 115 died (82 due to PC) with median follow-up of 3 yr (interquartile range [IQR] 1–7) for both overall and cancer-specific survival. Of men with RP GS 8–10, 221 died (151 due to PC) with median follow-up of 4 yr (IQR 2–8) and 4 yr (IQR 2–9) for overall and cancer-specific survival, respectively. PC-specific survival rates were significantly lower for men with GS 9–10 compared to men with GS 8 for both Bx (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.37–3.30; p p Conclusions Men with GS 9–10 had higher ACM and PCSM rates compared to those with GS 8. GS 8 and GS 9–10 PC should be considered separately in both the preoperative and postoperative setting as suggested by the new PCGS. Patient summary The prostate cancer grading system can predict mortality risk after radical prostatectomy (RP) for men with Gleason Score 8–10 disease based on both biopsy and RP Gleason Scores. There are significant differences in all-cause mortality and prostate cancer–specific mortality following surgery between men with Gleason Score 8 and those with Gleason Score 9–10 disease.

  • prediction of pathological stage based on clinical stage serum prostate specific antigen and biopsy Gleason Score partin tables in the contemporary era
    BJUI, 2017
    Co-Authors: Jeffrey J Tosoian, Zhaoyong Feng, Jonathan I Epstein, Elizabeth B Humphreys, Alan W Partin, Misop Han, Meera Chappidi, Christian P Pavlovich, Bruce J Trock
    Abstract:

    Objective To update the Partin Tables for prediction of pathological stage in the contemporary setting and examine trends in patients treated with radical prostatectomy (RP) over the past three decades. Patients and Methods From January 2010 to October 2015, 4459 men meeting inclusion criteria underwent RP and pelvic lymphadenectomy for histologically confirmed prostate cancer at the Johns Hopkins Hospital. Preoperative clinical stage, serum prostate-specific antigen (PSA) level, and biopsy Gleason Score (i.e. prognostic Grade Group) were used in a polychotomous logistic regression model to predict the probability of pathological outcomes categorised as: organ-confined (OC), extraprostatic extension (EPE), seminal vesicle involvement (SV+), or lymph node involvement (LN+). Preoperative characteristics and pathological findings in men treated with RP since 1983 were collected and clinical-pathological trends were described. Results The median (range) age at surgery was 60 (34–77) years and the median (range) PSA level was 4.9 (0.1–125.0) ng/mL. The observed probabilities of pathological outcomes were: OC disease in 74%, EPE in 20%, SV+ in 4%, and LN+ in 2%. The probability of EPE increased substantially when biopsy Gleason Score increased from 6 (Grade Group 1, GG1) to 3 + 4 (GG2), with smaller increases for higher grades. The probability of LN+ was substantially higher for biopsy Gleason Score 9–10 (GG5) as compared to lower Gleason Scores. Area under the receiver operating characteristic curves for binary logistic models predicting EPE, SV+, and LN+ vs OC were 0.724, 0.856, and 0.918, respectively. The proportion of men treated with biopsy Gleason Score ≤6 cancer (GG1) was 47%, representing a substantial decrease from 63% in the previous cohort and 77% in 2000–2005. The proportion of men with OC cancer has remained similar during that time, equalling 73–74% overall. The proportions of men with SV+ (4.1% from 3.4%) and LN+ (2.3% from 1.4%) increased relative to the preceding era for the first time since the Partin Tables were introduced in 1993. Conclusions The Partin Tables remain a straightforward and accurate approach for projecting pathological outcomes based on readily available clinical data. Acknowledging these data are derived from a tertiary care referral centre, the proportion of men with OC disease has remained stable since 2000, despite a substantial decline in the proportion of men with biopsy Gleason Score 6 (GG1). This is consistent with the notion that many men with Gleason Score 6 (GG1) disease were over treated in previous eras.

  • importance of reporting the Gleason Score at the positive surgical margin site analysis of 4 082 consecutive radical prostatectomy cases
    The Journal of Urology, 2016
    Co-Authors: Max Kates, Misop Han, Alan W Partin, Nikolai A Sopko, Jonathan I Epstein
    Abstract:

    Purpose: Since 2010 pathologists at our institution have routinely been documenting the Gleason Score at the margin and length of the positive surgical margin after prostatectomy. In this study we evaluate how the Gleason Score and positive surgical margin length correlate with the grade and adverse pathological characteristics of the final specimen, and whether the positive surgical margin Gleason Score affects the risk of early biochemical recurrence.Materials and Methods: A total of 4,082 consecutive patients undergoing radical prostatectomy and pelvic lymph node dissection between 2010 and 2014 for localized prostate cancer were included in the study, of whom 405 had a Gleason Score of 7 or greater of the primary nodule and a positive surgical margin with the length and Gleason Score recorded at the margin. Concordance rates between the Gleason Score at the margin and the final pathological specimen were compared. Logistic regression models were used to predict the risk of unfavorable pathology. Cox p...

  • Gleason Score 6 adenocarcinoma should it be labeled as cancer
    Journal of Clinical Oncology, 2012
    Co-Authors: Ballentine H Carter, Bruce J Trock, Alan W Partin, Patrick C Walsh, Robert W Veltri, William G Nelson, Donald S Coffey, Eric A Singer, Jonathan I Epstein
    Abstract:

    Overtreatment of low-grade prostate cancer (Gleason Score 6) is a recognized problem today, with systematic prostate gland sampling triggered by prostate-specific antigen (PSA) measurements. The extent to which overtreatment is caused by fear of death resulting from cancer, fear of litigation from undertreatment, and misaligned incentives that reimburse more for treating rather than monitoring when appropriate is not known. Nevertheless, fear of death resulting from cancer likely plays some role, and removing the label “cancer” could reduce unnecessary treatment of low-grade disease. On the other hand, undertreatment of prostate cancer and a missed opportunity for cure in those who could benefit is a real risk of relabeling a cancer as noncancer. We have decided on an alternative modification of the Gleason scoring system and herein present the arguments for and against removing the label of cancer from Gleason 6 tumors. We believe that our alternative approach may help: one, ensure that patients receive the proper counseling/treatment; two, reduce the risk of overtreatment and its associated harms; and three, improve shared decision making.

  • Gleason Score 7 prostate cancer on needle biopsy relation of primary pattern 3 or 4 to pathological stage and progression after radical prostatectomy
    The Journal of Urology, 2011
    Co-Authors: Ali Amin, Alan W Partin, Jonathan Ira Epstein
    Abstract:

    Purpose: There have been only a few contradictory publications assessing whether Gleason Score 4 + 3 = 7 has a worse prognosis than 3 + 4 = 7 on biopsy material in predicting pathological stage and biochemical recurrence. Older studies predated the use of the modified Gleason grading system established in 2005.Materials and Methods: We retrospectively studied 1,791 cases of Gleason Score 7 on prostatic biopsy to determine whether the breakdown of Gleason Score 7 into 3 + 4 vs 4 + 3 has prognostic significance in the modern era.Results: There was no difference in patient age, preoperative serum prostate specific antigen, maximum tumor percent per core or the number of positive cores between Gleason Score 3 + 4 = 7 and Gleason Score 4 + 3 = 7. Gleason Score 4 + 3 = 7 showed an overall correlation with pathological stage (organ confined, focal extraprostatic extension, nonfocal extraprostatic extension, seminal vesicle invasion/lymph node metastases, p = 0.005). On multivariate analysis Gleason Score 4 + 3 =...

Anthony V Damico - One of the best experts on this subject based on the ideXlab platform.

  • surgical management versus combination radiotherapy in Gleason Score 9 10 prostate cancer
    Journal of Clinical Oncology, 2020
    Co-Authors: Edward Christopher Dee, Brandon A Mahal, Paul L Nguyen, Anthony V Damico, Martin T King, Santino Butler, Sybil T Sha, David D Yang, Kent W Mouw, Vinayak Muralidhar
    Abstract:

    135Background: For men with Gleason Score 9-10 prostate cancer, studies have demonstrated conflicting results on the outcomes from combination radiation therapy (ComboRT) with external beam radiati...

  • advancing age and the risk of adverse pathology at radical prostatectomy in men with biopsy Gleason Score 6 prostate cancer
    Journal of Clinical Oncology, 2020
    Co-Authors: Daniel Kim, Ming-hui Chen, Hartwig Huland, Markus Graefen, Derya Tilki, Anthony V Damico
    Abstract:

    289Background: We evaluated the impact of age > 65 years versus younger on the odds of finding adverse pathologic features (pT3/T4 and/or R1 and/or Gleason Score 8, 9, 10) at radical prostatectomy ...

  • surgery vs radiotherapy in the management of biopsy Gleason Score 9 10 prostate cancer and the risk of mortality
    JAMA Oncology, 2019
    Co-Authors: Derya Tilki, Ming-hui Chen, Hartwig Huland, Markus Graefen, Michelle H Braccioforte, Brian J Moran, Anthony V Damico
    Abstract:

    Importance It is unknown how treatment with radical prostatectomy (RP) and adjuvant external beam radiotherapy (EBRT), androgen deprivation therapy (ADT), or both (termed MaxRP ) compares with treatment with EBRT, brachytherapy, and ADT (termed MaxRT ). Objective To investigate whether treatment of Gleason Score 9-10 prostate cancer with MaxRP vs MaxRT was associated with prostate cancer–specific mortality (PCSM) and all-cause mortality (ACM) risk. Design, Setting, and Participants The study cohort comprised 639 men with clinical T1-4,N0M0 biopsy Gleason Score 9-10 prostate cancer. Between February 6, 1992, and April 26, 2013, a total of 80 men were consecutively treated with MaxRT at the Chicago Prostate Cancer Center, and 559 men were consecutively treated with RP and pelvic lymph node dissection at the Martini-Klinik Prostate Cancer Center. Follow-up started on the day of prostate EBRT or RP and concluded on October 27, 2017. Exposures Of the 559 men managed with RP and pelvic lymph node dissection, 88 (15.7%) received adjuvant EBRT, 49 (8.8%) received ADT, and 50 (8.9%) received both. Main Outcomes and Measures Treatment propensity Score–adjusted risk of PCSM and ACM and the likelihood of equivalence of these risks between treatments using a plausibility index. Results The cohort included 639 men, with a mean (SD) age of 65.83 (6.52) years. After median follow-ups of 5.51 years (interquartile range, 2.19-6.95 years) among 80 men treated with MaxRT and 4.78 years (interquartile range, 4.01-6.05 years) among 559 men treated with RP-containing treatments, 161 men had died, 106 (65.8%) from prostate cancer. There was no significant difference in the risk of PCSM (adjusted hazard ratio, 1.33; 95% CI, 0.49-3.64; P  = .58) and ACM (adjusted hazard ratio, 0.80; 95% CI, 0.36-1.81; P  = .60) when comparing men who underwent MaxRP vs MaxRT, with plausibility indexes for equivalence of 76.75% for the end point of the risk of PCSM and 77.97% for the end point of the risk of ACM. Plausibility indexes for all other treatment comparisons were less than 63%. Conclusions and Relevance Results of this study suggest that it is plausible that treatment with MaxRP or MaxRT for men with biopsy Gleason Score 9-10 prostate cancer can lead to equivalent risk of PCSM and ACM.

  • Gleason Score 3 5 or 5 3 versus 4 4 prostate cancer the risk of death
    European Urology, 2016
    Co-Authors: Mai Anh Huynh, Ming-hui Chen, Michelle H Braccioforte, Brian J Moran, Anthony V Damico
    Abstract:

    Abstract The International Society of Urological Pathology recommends that Gleason Score (GS) 8 prostate cancer (PC) is one prognostic category, yet heterogeneity in cancer control potentially exists amongst men with GS 3+5/5+3 versus GS 4+4 PC. We compared PC-specific mortality (PCSM) and all-cause mortality (ACM) risk among men with GS 3+5/5+3 versus GS 4+4 PC using competing-risks and Cox regression analyses, adjusting for age, known PC prognostic factors, treatment, and a treatment propensity Score. Between 1998 and 2012, 462 men with GS 8 PC were treated using brachytherapy with supplemental external-beam radiation therapy and/or androgen deprivation therapy at the Chicago Prostate Cancer Center. After a median follow-up of 7.6 yr, 118 men died, 26 of PC. PCSM (adjusted hazard ratio [AHR] 2.77, 95% confidence interval [CI] 1.13–6.80; p =0.026) and ACM (AHR 1.75, 95% CI 1.06–2.87; p =0.028) were significantly higher for men with GS 3+5/5+3 PC than for men with GS 4+4 PC. Subcategorizing GS 8 into PC with or without grade 5 should be considered as a stratification factor in randomized trials. Patient summary Long-term success rates for men with Gleason Score 8 prostate cancer vary depending on whether the most aggressive type of cancer (grade 5) is present at biopsy.

  • advancing age within established Gleason Score categories and the risk of prostate cancer specific mortality pcsm
    BJUI, 2012
    Co-Authors: Andrea L Russo, Ming-hui Chen, Ayal A Aizer, Jona A Hattangadi, Anthony V Damico
    Abstract:

    Study Type - Prognosis (case series) Level of Evidence 4. What's known on the subject? and What does the study add? There is limited data that suggests that men aged >70 years have a higher proportion of Gleason 8-10 prostate cancer than men aged Objective To determine if advancing age is a risk factor for high-grade prostate cancer due to occult high-grade disease in elderly men with Gleason Score 6 or 7 prostate cancer. We investigated whether advancing age is associated with the risk of prostate cancer-specific mortality (PCSM) within established Gleason Score categories adjusting for known predictors of PCSM. Patients and methods Using data from the Surveillance, Epidemiology and End Results database between 1 January 2004 to 31 December 2007, 166 104 men with non-metastatic prostate cancer were identified and formed the study cohort. • Within established Gleason Score categories, Fine and Gray's multivariable competing risk regressions were used to evaluate whether increasing age at diagnosis was significantly associated with an increased risk of PCSM, adjusting for prostate-specific antigen level and T-category at diagnosis and whether treatment was curative or non-curative. Results After adjusting for treatment and prognostic factors, Gleason Score 8-10 and 7 as compared with ≤6 was associated with an increased risk of PCSM (P 70 years having Gleason Score 6 (AHR 1.10, 95% CI 1.07-1.13, P Conclusions PCSM increases with advancing age in men with Gleason Score 6 and 7 but not 8-10 prostate cancer. • Techniques to reduce biopsy sampling error in men, particularly those aged >70 years and healthy with Gleason Score 6 and 7 disease deserve further study.

Patrick C Walsh - One of the best experts on this subject based on the ideXlab platform.

  • Gleason Score 6 adenocarcinoma should it be labeled as cancer
    Journal of Clinical Oncology, 2012
    Co-Authors: Ballentine H Carter, Bruce J Trock, Alan W Partin, Patrick C Walsh, Robert W Veltri, William G Nelson, Donald S Coffey, Eric A Singer, Jonathan I Epstein
    Abstract:

    Overtreatment of low-grade prostate cancer (Gleason Score 6) is a recognized problem today, with systematic prostate gland sampling triggered by prostate-specific antigen (PSA) measurements. The extent to which overtreatment is caused by fear of death resulting from cancer, fear of litigation from undertreatment, and misaligned incentives that reimburse more for treating rather than monitoring when appropriate is not known. Nevertheless, fear of death resulting from cancer likely plays some role, and removing the label “cancer” could reduce unnecessary treatment of low-grade disease. On the other hand, undertreatment of prostate cancer and a missed opportunity for cure in those who could benefit is a real risk of relabeling a cancer as noncancer. We have decided on an alternative modification of the Gleason scoring system and herein present the arguments for and against removing the label of cancer from Gleason 6 tumors. We believe that our alternative approach may help: one, ensure that patients receive the proper counseling/treatment; two, reduce the risk of overtreatment and its associated harms; and three, improve shared decision making.

  • skeletal muscle involvement by limited Gleason Score 6 adenocarcinoma of the prostate on needle biopsy is not associated with adverse findings at radical prostatectomy
    The Journal of Urology, 2010
    Co-Authors: Patrick C Walsh, Jonathan I Epstein
    Abstract:

    Purpose: Skeletal muscle involvement by prostate cancer is considered to be ambiguous for extraprostatic extension when it is found at the apex, where benign prostatic glands naturally blend with the skeletal muscle of the rhabdosphincter. We investigated the significance of skeletal muscle involvement by cancer in needle biopsies in predicting adverse outcomes at radical prostatectomy.Materials and Methods: From 2000 to 2009, we retrospectively identified 40 cases with Gleason Score 6 adenocarcinoma involving up to 20% of 1 core, with skeletal muscle involvement. Outcomes of radical prostatectomy were compared with a control group of 82 cases with the same parameters without skeletal muscle involvement from the same period.Results: In radical prostatectomy specimens Gleason Score greater than 6, extraprostatic extension and positive margins were found in 15.0%, 7.5% and 12.5% of patients in the study group, compared to 20.7%, 11.0% and 4.9% of patients in the control group, respectively. No statistically...

  • natural history of pathologically organ confined pt2 Gleason Score 6 or less prostate cancer after radical prostatectomy
    Urology, 2008
    Co-Authors: David J Hernandez, Bruce J Trock, Alan W Partin, Misop Han, Patrick C Walsh, Matthew E Nielsen, Jonathan I Epstein
    Abstract:

    OBJECTIVES Men with pathologically organ-confined, Gleason Score 6 or less prostate cancer are considered to have an excellent prognosis after surgery as definitive monotherapy. We determined the incidence of biochemical recurrence (BR), local recurrence (LR), distant metastasis (DM), and prostate cancer-specific mortality (PCSM) among this low-risk cohort. METHODS A retrospective search of our radical prostatectomy database identified 6081 men with pathologically organ-confined (pT2), Gleason Score 6 or less prostate cancer treated from 1983 to 2005. Of these, 2551 (42%) had adequate follow-up information and were assessed for BR, LR, DM, and PCSM. The pathologic specimens of men with disease progression were reevaluated by an experienced genitourinary pathologist, and the patients with disease that was upgraded or upstaged (n = 25) were excluded from additional analysis, resulting in a final study cohort of 2526. The actuarial probabilities of BR and LR were estimated using the Kaplan-Meier method. RESULTS With a median follow-up of 5.0 years (range 2 to 22), BR occurred in 13 patients (0.5%). The 5, 10, and 15-year actuarial probability of BR was 0.3%, 0.9%, and 1.3%, respectively. Five patients (0.2%) developed LR, four of whom received salvage radiotherapy with a subsequently undetectable prostate-specific antigen level. The 5, 10, and 15-year actuarial probability of LR was 0.1%, 0.5%, and 0.5%, respectively. No DM or PCSM occurred. CONCLUSIONS With postoperative follow-up for more than 2500 patients with pathologically organ-confined, Gleason Score 6 or less prostate cancer, BR and LR after radical prostatectomy were extremely rare, and no patients experienced DM or PCSM.

  • prognostic significance of Gleason Score 3 4 versus Gleason Score 4 3 tumor at radical prostatectomy
    Urology, 2000
    Co-Authors: Theresa Y Chan, Alan W Partin, Patrick C Walsh, Jonathan I Epstein
    Abstract:

    Objectives. To determine the clinical significance of Gleason Score 3+4 versus 4+3 on radical prostatectomy. Methods. Of 2390 men who underwent radical prostatectomy by a single surgeon, 570 had Gleason Score 7 tumors without lymph node metastasis, seminal vesicle invasion, or tertiary Gleason pattern 5. Patients were evaluated for biochemical recurrence (prostate-specific antigen progression) and distant metastases. Results. Eighty percent of patients had Gleason Score 3+4, 20% had 4+3. The rate of established extraprostatic extension at radical prostatectomy for Gleason Score 3+4 and 4+3 tumors was 38.2% and 52.7%, respectively (P = 0.008). With a mean follow-up of 4.6 years for men without progression, Gleason Score 4+3 tumors had an increased risk of progression independent of stage and margin status (P <0.0001). The 5-year actuarial risk of progression was 15% and 40% for Gleason Score 3+4 and 4+3 tumors, respectively. The mean time to progression was 4.4 years for Gleason Score 3+4 tumors and 3.2 years for Gleason Score 4+3 tumors. We stratified the patients into four prognostic groups on the basis of organ-confined status, margin status, and Gleason Score (3+4 versus 4+3). The 5-year actuarial risk of progression was 10%, 35%, 45%, and 61%, with 10-year progression rates of 29%, 42%, 69%, and 84%, for the four groups. 3.9% of patients with Gleason Score 3+4 and 10.5% with Gleason Score 4+3 tumors developed metastatic disease within a mean of 5.7 and 5.6 years, respectively. A Gleason Score of 4+3 versus 3+4 was predictive of metastatic disease (P = 0.002) but not local recurrence. Conclusions. Gleason Score 7 tumors are heterogeneous in their biologic behavior. The differences in prognosis for patients with Gleason Scores 3+4 and 4+3 tumors at radical prostatectomy are significant. Although the assessment of the percentage of pattern 4 at radical prostatectomy is not likely to be reproducible, the distinction between Gleason Score 3+4 and 4+3 should be easier for pathologists to perform.

  • disease progression following radical prostatectomy in men with Gleason Score 7 tumor
    The Journal of Urology, 1998
    Co-Authors: Jonathan I Epstein, Alan W Partin, Charles R Pound, Patrick C Walsh
    Abstract:

    AbstractPurpose: The long-term prognosis of men with Gleason Score 7 adenocarcinoma of the prostate is uncertain.Materials and Methods: We studied 488 men whose radical prostatectomy specimen showed Gleason Score 7 tumor without involvement of the seminal vesicles or lymph nodes. Of the 400 men without progression 318 had been followed for 2 years or more and 93 for 7 years or more.Results: Cases of organ confined disease and negative margins regardless of extent of extraprostatic extension had roughly similar and better prognoses than cases of focal and established extraprostatic extension with positive margins. The greater influence of margin status on progression (p <0.0001) compared to extent of extraprostatic extension (p = 0.023) was evidenced in the multivariate analysis. Of 30 men with established extraprostatic extension and positive margins 6 (20%) had progression to distant metastases, which was similar to 14 of 58 (24%) without established extraprostatic extension and positive margins. There w...

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  • prostate specific antigen level stage or Gleason Score which is best for predicting outcomes after radical prostatectomy and does it vary by the outcome being measured results from shared equal access regional cancer hospital database
    International Journal of Urology, 2015
    Co-Authors: Prabhakar Mithal, Christopher J Kane, Martha K Terris, William J Aronson, Lauren E Howard, Matthew R Cooperberg, Christopher L Amling, Stephen J Freedland
    Abstract:

    © 2015 The Japanese Urological Association. Objectives: To assess the ability of preoperative prostate-specific antigen level, Gleason Score and stage to predict prostate cancer outcomes beyond biochemical recurrence, specifically castration-resistant prostate cancer, metastases and prostate cancer-specific mortality in radical prostatectomy patients. Methods: We carried out a retrospective study of 2735 men in the Shared Equal Access Regional Cancer Hospital database treated by radical prostatectomy from 1988 to 2011 with data available on pathological stage, grade and preoperative prostate-specific antigen. We used Cox hazards analyses to examine the predictive accuracy (c-index) of the preoperative prostate-specific antigen (log-transformed), path Gleason Score (≤7, 3+4, 4+3 and 8-10) and path stage grouping (pT2 negative margins; pT2 positive margins; pT3a negative margins; pT3a positive margins; pT3b; vs positive nodes) to predict biochemical recurrence, castration-resistant prostate cancer, metastases and prostate cancer-specific mortality. Results: Median follow up was 8.7years, during which, 937 (34%) had biochemical recurrence, 108 (4%) castration-resistant prostate cancer, 127 (5%) metastases and 68 (2%) prostate cancer-specific mortality. For the outcomes of biochemical recurrence, castration-resistant prostate cancer, metastases and prostate cancer-specific mortality, the c-indices were, respectively: prostate-specific antigen 0.65, 0.66, 0.64 and 0.69; Gleason Score 0.66, 0.83, 0.76 and 0.85; and pathological stage group 0.69, 0.76, 0.72 and 0.80. Conclusions: Gleason Score can predict with very high accuracy prostate cancer-specific mortality in patients undergoing radical prostatectomy. Thus, Gleason Score should be given more weight in nomograms to predict prostate cancer-specific mortality. Furthermore, men with a high Gleason Score should be given special consideration for adjuvant treatment or referral to clinical trials because of a higher risk of prostate cancer-specific mortality.

  • risk stratification of men with Gleason Score 7 to 10 tumors by primary and secondary Gleason Score results from the search database
    Urology, 2007
    Co-Authors: David E Kang, Nicholas J Fitzsimons, Joseph C Presti, Christopher J Kane, Martha K Terris, William J Aronson
    Abstract:

    OBJECTIVES Gleason Score 4+3 prostate cancer is associated with worse clinicopathologic outcomes than is Gleason Score 3+4. Whether the increased risk associated with Gleason Score 4+3 disease is equivalent to that of Gleason Score 4+4 or greater is unclear. METHODS We reviewed the data from two separate cohorts pulled from the Shared Equal Access Regional Cancer Hospital database. The first consisted of 374 men with biopsy Gleason Score 3+4 or greater disease and the second of 636 men with radical prostatectomy (RP) Gleason Score 3+4 or greater disease. We estimated the odds ratios of unfavorable surgical pathologic findings for the biopsy Gleason Score categories using logistic regression analysis. Using a Cox proportional hazards regression model, we estimated the relative risk of biochemical progression associated with each biopsy and RP Gleason Score category. RESULTS In the biopsy Gleason Score cohort, a Gleason Score of 4+3 was associated with an increased risk of extracapsular extension (P = 0.01) and seminal vesicle invasion (P 0.10), except for higher grade pathologic tumors among men with a biopsy Gleason Score of 4+4 or more (P = 0.001). After adjusting for multiple clinical characteristics, a biopsy Gleason Score of 4+3 was associated with an increased recurrence risk relative to a biopsy Gleason Score of 3+4 (P = 0.001), but a similar progression risk as that for a biopsy Gleason Score of 4+4 or more (P = 0.53). In the RP Gleason cohort, and after adjustment for multiple clinicopathologic features, an RP Gleason Score of 4+3 was associated with increased progression risk relative to an RP Gleason Score of 3+4 (P = 0.03), but similar progression risk as that for an RP Gleason Score of 4+4 or more (P = 0.24). CONCLUSIONS In a multicenter database using pooled data from multiple pathologists, Gleason Scores 4+3 and 4+4 or more exhibited similar clinicopathologic outcomes.

  • improved risk stratification for biochemical recurrence after radical prostatectomy using a novel risk group system based on prostate specific antigen density and biopsy Gleason Score
    The Journal of Urology, 2002
    Co-Authors: Stephen J Freedland, Frederick J Dorey, Jeffrey A Wieder, Gregory S Jack, Jean B Dekernion, William J Aronson
    Abstract:

    Purpose: Previous studies have suggested that prostate specific antigen (PSA) density is a significant independent predictor of biochemical failure after primary therapy. We determined whether pathological PSA density using surgical weight of the radical prostatectomy specimen was an independent predictor of adverse pathological features or biochemical recurrence after radical prostatectomy. We also examined whether combining pathological PSA density with biopsy Gleason Score improved risk stratification compared with serum PSA and biopsy Gleason Score for predicting PSA recurrence after prostatectomy.Materials and Methods: Multivariate analysis was used to determine whether pathological PSA density was an independent predictor of adverse pathology or PSA recurrence after radical prostatectomy in 325 patients treated at a Veterans Affairs medical center. Cutoff points of pathological PSA density were generated to identify patients at various risks for biochemical recurrence. These cutoffs were combined wi...

  • percent prostate needle biopsy tissue with cancer is more predictive of biochemical failure or adverse pathology after radical prostatectomy than prostate specific antigen or Gleason Score
    The Journal of Urology, 2002
    Co-Authors: Stephen J Freedland, Frederick J Dorey, George S Csathy, William J Aronson
    Abstract:

    Purpose: Biopsy Gleason Score, serum prostate specific antigen (PSA) levels, and clinical stage are known to be independent predictors of adverse pathological features and biochemical failure after radical prostatectomy. We determine whether various prostate needle biopsy parameters were predictive of either adverse pathological findings or disease recurrence after radical prostatectomy.Materials and Methods: A single pathologist reviewed the prostate needle biopsy specimens of 190 men who underwent radical prostatectomy between 1991 and 2000. Biopsy specimens were examined for Gleason Score, perineural invasion, number and percent of cores with cancer, and percent of total biopsy tissue with cancer and Gleason grade 4 or 5 cancer. Multivariate analysis was used to determine the prostate needle biopsy parameters and preoperative clinical variables, including serum PSA, clinical stage, patient age and race, that were most significant for predicting positive surgical margins, nonorgan confined disease, semi...