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Claus G Roehrborn - One of the best experts on this subject based on the ideXlab platform.
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Does Prostate Size Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from the REDUCE Trial☆
European urology, 2015Co-Authors: Ross Simon, Claus G Roehrborn, Lauren E. Howard, Daniel M. Moreira, Adriana C. Vidal, Ramiro Castro-santamaria, Stephen J. FreedlandAbstract:Abstract Background It has been shown that increased Prostate Size is a risk factor for lower urinary tract symptom (LUTS) progression in men who currently have LUTS presumed due to benign prostatic hyperplasia (BPH). Objective To determine if Prostate Size is a risk factor for incident LUTS in men with mild to no symptoms. Design, setting, and participants We conducted a post hoc analysis of the REDUCE study, which contained a substantial number of men ( n =3090) with mild to no LUTS (International Prostate Symptom Score [IPSS] Outcome measurements and statistical analysis Our primary outcome was determination of the effect of Prostate Size on incident LUTS presumed due to BPH defined as two consecutive IPSS values >14, or receiving any medical (α-blockers) or surgical treatment for BPH throughout the study course. To determine the risk of developing incident LUTS, we used univariable and multivariable Cox models, as well as Kaplan-Meier curves and the log-rank test. Results and limitations Among men treated with placebo during the REDUCE study, those with a Prostate Size of 40.1–80ml had a 67% higher risk (hazard risk 1.67, 95% confidence interval 1.23-2.26, p =0.001) of developing incident LUTS compared to men with a Prostate Size 40.0ml or smaller. There was no association between Prostate Size and risk of incident LUTS in men treated with 0.5mg of dutasteride. The post hoc nature of our study design is a potential limitation. Conclusions Men with mild to no LUTS but increased Prostate Size are at higher risk of incident LUTS presumed due to BPH. This association was negated by dutasteride treatment. Patient summary Benign prostatic hyperplasia (BPH) is a very common problem among older men, which often manifests as lower urinary tract symptoms (LUTS), and can lead to potentially serious side effects. In our study we determined that men with mild to no current LUTS but increased Prostate Size are much more likely to develop LUTS presumed due to BPH in the future. This association was not seen in men treated with dutasteride, a drug approved for treatment of BPH. Our study reveals that men with a Prostate Size of 40.1–80ml are potential candidates for closer follow-up.
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effect of estimated Prostate volume on silodosin mediated improvements in the signs and symptoms of bph does Prostate Size matter
Open Access Journal of Urology, 2011Co-Authors: Steven A Kaplan, Claus G Roehrborn, Lawrence A Hill, Weining VolinnAbstract:OBJECTIVE The uroselective α-blocker silodosin significantly improved International Prostate Symptom Score (IPSS) in two 12-week, double-blind (DB), placebo-controlled Phase III studies in men aged ≥ 50 years with symptoms of benign prostatic hyperplasia (BPH) and maintained symptom improvement during a 9-month open-label (OL) extension. This post-hoc analysis evaluated the effects of estimated Prostate volume (EPV) on silodosin-mediated symptom improvement. METHODS Patients were stratified by EPV (<30 mL or ≥ 30 mL) calculated from Prostate-specific antigen (PSA) concentrations using a published algorithm. Group comparisons were done by analysis of covariance with last observations carried forward. RESULTS Of 890 patients with PSA baseline data, 192 had EPV < 30 mL and 698 had EPV ≥ 30 mL. During DB treatment, silodosin was associated with significant symptom improvement (adjusted mean difference versus placebo) in men with EPV < 30 mL (-2.0; P = 0.038) and those with EPV ≥ 30 mL (-3.0; P < 0.0001). Among patients who received silodosin during DB treatment, changes from baseline in IPSS to the end of OL extension (mean ± standard deviation) were similar for EPV < 30 mL (n = 60, -7.0 ± 6.8) and EPV ≥ 30 mL (n = 242, -8.0 ± 7.1; P = 0.416). Also, among patients who received placebo as DB treatment, symptom improvement at the end of OL extension was similar for EPV < 30 mL (n = 62, -6.2 ± 8.1) and EPV ≥ 30 mL (n = 275, -6.7 ± 6.1; P = 0.339). CONCLUSION Silodosin effectively relieved BPH-related symptoms for up to 12 months, irrespective of Prostate Size, including in patients with enlarged Prostates.
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tolterodine extended release with or without tamsulosin in men with lower urinary tract symptoms including overactive bladder symptoms effects of Prostate Size
European Urology, 2009Co-Authors: Claus G Roehrborn, Steven A Kaplan, Stephen J Jones, Joseph T Wang, Tamara Bavendam, Zhonghong GuanAbstract:Abstract Background Some men with lower urinary tract symptoms (LUTS) including overactive bladder (OAB) symptoms may benefit from antimuscarinic therapy, with or without an α-adrenergic antagonist. Objectives To evaluate the safety and efficacy of tolterodine extended release (ER), tamsulosin, or tolterodine ER+tamsulosin in men meeting symptom entry criteria for OAB and prostatic enlargement trials, stratified by Prostate Size. Design, setting, and participants Subjects with an International Prostate Symptom Score (IPSS) ≥12; frequency and urgency, with or without urgency urinary incontinence; postvoid residual volume (PVR) max ) >5mL/s were randomized to receive placebo, tolterodine ER (4mg), tamsulosin (0.4mg), or tolterodine ER+tamsulosin for 12 wk. Data were stratified by median baseline Prostate volume ( Measurements Endpoints included week 12 changes in bladder diary variables, IPSS scores, and safety variables. Results and limitations Among men with larger Prostates, tolterodine ER+tamsulosin significantly improved frequency ( p =0.001); urgency ( p =0.006); and IPSS total ( p =0.001), storage ( p p p =0.030). Among men with smaller Prostates, tolterodine ER significantly improved frequency ( p =0.016), UUI episodes ( p =0.036), and IPSS storage scores ( p =0.005). Tolterodine ER+tamsulosin significantly improved frequency ( p =0.001) and IPSS storage scores ( p =0.018). Tamsulosin significantly improved nocturnal frequency ( p =0.038) and IPSS voiding ( p =0.036) and total scores ( p =0.044). There were no clinically or statistically significant changes in Q max or PVR; incidence of acute urinary retention (AUR) was low in all groups (≤2%). Conclusions Men with smaller Prostates and moderate-to-severe LUTS including OAB symptoms benefited from tolterodine ER. Therapy with tolterodine ER+tamsulosin was effective regardless of Prostate Size. Tolterodine ER, with or without tamsulosin, was well tolerated and not associated with increased incidence of AUR.
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Prostate Size: Does It Matter?
Reviews in urology, 2000Co-Authors: Claus G RoehrbornAbstract:Occasionally, one can witness, in a relatively short period, a significant change in either a diagnostic or a therapeutic approach to a certain condition. Such changes may be triggered by a very important basic research finding or a number of clinical observations that when taken together, convincingly demonstrate the validity of a new concept. One such example is the issue of Prostate Size and its role in the diagnostic evaluation of, and the therapeutic decision making in, men with lower urinary tract symptoms (LUTS) and clinical benign prostatic hyperplasia (BPH). In the past, urologists often assessed the Prostate by such imaging modalities as urethrocystoscopy, intravenous urography, voiding cystourethrography, or retrograde urethrography; if the Prostate was significantly enlarged, surgery was indicated. A more recent position has been that Prostate Size is completely unimportant in determining the need for treatment. The 1994 Agency for Health Care Policy (AHCPR) BPH treatment guideline, in fact, recommended Prostate Size measurement as “optional testing to plan an invasive procedure, and not to be used to determine the need for treatment.”1 The guideline stated that urethrocystoscopy or transabdominal bladder/Prostate ultrasonography—to help surgeons plan Prostate surgery or balloon dilation by determining Prostate Size and configuration—would be the appropriate tests to conduct in this setting. This was the only mention of Prostate Size included in the guideline. In the same document, a chapter on future research needs in natural history and epidemiology emphaSized the need to “define the natural history of untreated BPH (progression) in terms of the probabilities and rates of further prostatic enlargement; changes in symptom severity, uroflow, and measures of urodynamic obstruction; urinary retention, infection; bladder dysfunction; and renal insufficiency,” and to “determine whether disease progression (worsening of symptoms or development of complications) can be predicted by baseline assessment of symptoms, Prostate Size, uroflow, residual urine, or degree of urodynamic obstruction.” In this context, it is worthwhile to review a sequence of articles published during the past 12 months that at least partly address the challenge set forth by the AHCPR guideline panel.
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Accurate determination of Prostate Size via digital rectal examination and transrectal ultrasound.
Urology, 1998Co-Authors: Claus G RoehrbornAbstract:Previously, Prostate Size did not play a significant role in the choice of treatment for benign prostatic hyperplasia (BPH). It has been postulated that Prostate Size does not correlate with symptom severity, flow rate, or the presence or absence of obstruction. However, in a published study of community-dwelling men, the odds of having moderate to severe symptoms were five times higher for men with enlarged Prostates than for those with normal Prostates. Response to certain types of BPH therapy, especially finasteride, depends on actual Prostate volume. Therefore, it is important to have a simple way to accurately determine if a patient's Prostate is enlarged. In an analysis of four studies, there was a distinct underestimation of Prostate Size by digital rectal examination (DRE) when compared with transrectal ultrasound (TRUS) measurement. The underestimation of Prostate volume increased with increasing TRUS volume, particularly if the volume was greater than 30 mL. The average underestimation was between 9% and 12% for Prostate volumes 30 to 39 mL and between 17% and 27% for Prostate volumes 40 to 49 mL. Because of these results, a prospective study is currently in progress to develop models or visual aids to assist physicians in more accurately predicting a threshold Prostate volume via DRE.
Thomas A. Stamey - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Prostate Size in university and Veterans Affairs Health Care System patients with negative Prostate biopsies
Urology, 1998Co-Authors: Martha K. Terris, Anthony F. Prestigiacomo, Thomas A. StameyAbstract:Abstract Objectives. Many important Prostate studies take place at Veterans Affairs hospitals. We have examined whether the patient population at these institutions is comparable to the population presenting for Prostate evaluation at university hospitals. Methods. We included all patients presenting for transrectal ultrasound (TRUS) and biopsy in whom systematic biopsies failed to reveal Prostate cancer at both Stanford University Medical Center (90 patients) and the Palo Alto Veterans Affairs Health Care System (103 patients) from August 1, 1995 to July 31, 1996. Identical techniques and equipment for TRUS examination and Prostate Size determination were used at both institutions. Results. There was no significant difference in the age or Prostate-specific antigen (PSA) levels of the patients at the two institutions. The mean prostatic volume of the Stanford University patients was 71 cm 3 (median 63 cm 3 ), whereas the mean prostatic volume of patients at the Palo Alto Veterans Affairs hospital was 52 cm 3 (median 43 cm 3 ), a highly statistically significant difference ( P = 0.0009). Conclusions. The smaller Size of the Prostate glands in Veterans Affairs patients may be the result of differences in referral base, socioeconomic factors, or environmental factors. These data may have significance for trials conducted only on the Prostates of men who are seen at Veterans Affairs hospitals.
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Effect of flutamide and flutamide plus castraton on Prostate Size in patients with previously untreated Prostate cancer
Urology, 1996Co-Authors: Joachim Noldus, Michelle Ferrari, Anthony Prestigiacomo, Thomas A. StameyAbstract:Abstract Objectives. Transrectal ultrasonography (TRUS) was used in previously untreated men with Prostate cancer undergoing hormonal therapy to provide objective observations on the decrease in Prostate Size and to assess the usefulness of Prostate Size in estimating treatment response. Methods. In this retrospecive study, 31 patients with previously untreated Prostate cancer (Stage T1c to D2) who received hormonal therapy (flutamide, n = 18; flutamide plus castration, n = 13) were followed with serial estimations of Prostate Size by TRUS and by serum Prostate-specific antigen (PSA). Results. In both treatment groups, the major decreases in Prostate Size were noted within the first 6 months of therapy, whereas further follow-up examinations failed to show statistically significant changes. Prostate Size decreased by 48% in men treated with flutamide, whereas those treated with flutamide plus castration showed a statistically significant greater decrease, mean of 56% ( P ≤0.01). Six patients (33%) in the flutamide group and 5 (38%) men in the total androgen deprivation group ultimately failed therapy as indicated by a rising PSA level. Only 55% (n = 6) of the patients who progressed showed an increase in Prostate Size. Conclusions. Total androgen deprivation in comparison to flutamide alone caused a larger reduction in Prostate Size. As a marker of hormonal failure, a rising PSA was more sensitive than an increase in Prostate Size.
Martha K. Terris - One of the best experts on this subject based on the ideXlab platform.
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the association between Prostate Size and gleason score upgrading depends on the number of biopsy cores obtained results from the shared equal access regional cancer hospital database
BJUI, 2008Co-Authors: Ryan S Turley, Christopher L. Amling, Martha K. Terris, Christopher J. Kane, William J. Aronson, Joseph C. Presti, Stephen J. FreedlandAbstract:OBJECTIVE To test the hypothesis that the association between Prostate Size and risk of Gleason grade upgrading varies as a function of sampling. PATIENTS AND METHODS We examined the association between pathological Prostate weight, Prostate biopsy scheme and Gleason upgrading (Gleason ≥7 at radical Prostatectomy, RP) among 646 men with biopsy Gleason 2–6 disease treated with RP between 1995 and 2007 within the Shared Equal Access Regional Cancer Hospital Database using logistic regression. In all, 204 and 442 men had a sextant (six or seven cores) or extended-core biopsy (eight or more cores), respectively. Analyses were adjusted for centre, age, surgery, preoperative Prostate-specific antigen level, clinical stage, body mass index, race, and percentage of cores positive for cancer. RESULTS In all, 281 men (44%) were upgraded; a smaller Prostate was positively associated with the risk of upgrading in men who had an extended-core biopsy (P < 0.001), but not among men who had a sextant biopsy (P = 0.22). The interaction between biopsy scheme and Prostate Size was significant (P interaction = 0.01). CONCLUSIONS These data support the hypothesis that the risk of upgrading is a function of two opposing contributions: (i) a more aggressive phenotype in smaller Prostates and thus increased risk of upgrading; and (ii) more thorough sampling in smaller Prostates and thus decreased risk of upgrading. When sampled more thoroughly, the phenotype association dominates and smaller Prostates are linked with an increased risk of upgrading. In less thoroughly sampled Prostates, these opposing factors nullify, resulting in no association between Prostate Size and risk of upgrading. These findings help to explain previously published disparate results of the importance of Prostate Size as a predictor of Gleason upgrading.
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The association between Prostate Size and Gleason score upgrading depends on the number of biopsy cores obtained: results from the Shared Equal Access Regional Cancer Hospital Database.
BJU international, 2008Co-Authors: Ryan S Turley, Christopher L. Amling, Martha K. Terris, Christopher J. Kane, William J. Aronson, Joseph C. Presti, Stephen J. FreedlandAbstract:OBJECTIVE To test the hypothesis that the association between Prostate Size and risk of Gleason grade upgrading varies as a function of sampling. PATIENTS AND METHODS We examined the association between pathological Prostate weight, Prostate biopsy scheme and Gleason upgrading (Gleason ≥7 at radical Prostatectomy, RP) among 646 men with biopsy Gleason 2–6 disease treated with RP between 1995 and 2007 within the Shared Equal Access Regional Cancer Hospital Database using logistic regression. In all, 204 and 442 men had a sextant (six or seven cores) or extended-core biopsy (eight or more cores), respectively. Analyses were adjusted for centre, age, surgery, preoperative Prostate-specific antigen level, clinical stage, body mass index, race, and percentage of cores positive for cancer. RESULTS In all, 281 men (44%) were upgraded; a smaller Prostate was positively associated with the risk of upgrading in men who had an extended-core biopsy (P
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Do Racial Differences in Prostate Size Explain Higher Serum Prostate-Specific Antigen Concentrations Among Black Men?
Urology, 2007Co-Authors: John C Mavropoulos, Alan W. Partin, Christopher L. Amling, Martha K. Terris, Christopher J. Kane, William J. Aronson, Joseph C. Presti, Leslie A. Mangold, Stephen J. FreedlandAbstract:Objectives To determine whether elevated serum Prostate-specific antigen (PSA) values in black men are due, at least partially, to larger Prostate Size among black men. Methods The study population consisted of two cohorts: (1) 1410 men undergoing radical Prostatectomy between 1988 and 2005 at five equal-access medical centers comprising the Shared Equal Access Regional Cancer Hospital (SEARCH) Database; and (2) 9601 men undergoing radical Prostatectomy between 1988 and 2004 at the Johns Hopkins Hospital. We evaluated the association between race and serum PSA value and Prostate weight using multivariable linear regression while adjusting for demographic and clinicopathologic cancer characteristics. Results In both cohorts, black men had higher serum PSA values ( P ≤0.001). After adjusting for either demographic characteristics or demographic and cancer-specific characteristics, there were no significant associations between race and Prostate Size in either cohort. After adjusting for multiple demographic, clinical, and pathologic cancer-specific characteristics, black men had 15% higher serum PSA values relative to white men in both the SEARCH ( P = 0.001) and Hopkins cohorts ( P Conclusions In this study of patients undergoing radical Prostatectomy in two very different practice settings, black men in both cohorts had higher serum PSA values relative to white men, despite adjustment for demographic and cancer-specific characteristics, including Prostate weight. The lack of significant association between race and Prostate Size suggests that alternative reasons are needed to explain higher serum PSA values in black men.
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Comparison of Prostate Size in university and Veterans Affairs Health Care System patients with negative Prostate biopsies
Urology, 1998Co-Authors: Martha K. Terris, Anthony F. Prestigiacomo, Thomas A. StameyAbstract:Abstract Objectives. Many important Prostate studies take place at Veterans Affairs hospitals. We have examined whether the patient population at these institutions is comparable to the population presenting for Prostate evaluation at university hospitals. Methods. We included all patients presenting for transrectal ultrasound (TRUS) and biopsy in whom systematic biopsies failed to reveal Prostate cancer at both Stanford University Medical Center (90 patients) and the Palo Alto Veterans Affairs Health Care System (103 patients) from August 1, 1995 to July 31, 1996. Identical techniques and equipment for TRUS examination and Prostate Size determination were used at both institutions. Results. There was no significant difference in the age or Prostate-specific antigen (PSA) levels of the patients at the two institutions. The mean prostatic volume of the Stanford University patients was 71 cm 3 (median 63 cm 3 ), whereas the mean prostatic volume of patients at the Palo Alto Veterans Affairs hospital was 52 cm 3 (median 43 cm 3 ), a highly statistically significant difference ( P = 0.0009). Conclusions. The smaller Size of the Prostate glands in Veterans Affairs patients may be the result of differences in referral base, socioeconomic factors, or environmental factors. These data may have significance for trials conducted only on the Prostates of men who are seen at Veterans Affairs hospitals.
Zhonghong Guan - One of the best experts on this subject based on the ideXlab platform.
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tolterodine extended release with or without tamsulosin in men with lower urinary tract symptoms including overactive bladder symptoms effects of Prostate Size
European Urology, 2009Co-Authors: Claus G Roehrborn, Steven A Kaplan, Stephen J Jones, Joseph T Wang, Tamara Bavendam, Zhonghong GuanAbstract:Abstract Background Some men with lower urinary tract symptoms (LUTS) including overactive bladder (OAB) symptoms may benefit from antimuscarinic therapy, with or without an α-adrenergic antagonist. Objectives To evaluate the safety and efficacy of tolterodine extended release (ER), tamsulosin, or tolterodine ER+tamsulosin in men meeting symptom entry criteria for OAB and prostatic enlargement trials, stratified by Prostate Size. Design, setting, and participants Subjects with an International Prostate Symptom Score (IPSS) ≥12; frequency and urgency, with or without urgency urinary incontinence; postvoid residual volume (PVR) max ) >5mL/s were randomized to receive placebo, tolterodine ER (4mg), tamsulosin (0.4mg), or tolterodine ER+tamsulosin for 12 wk. Data were stratified by median baseline Prostate volume ( Measurements Endpoints included week 12 changes in bladder diary variables, IPSS scores, and safety variables. Results and limitations Among men with larger Prostates, tolterodine ER+tamsulosin significantly improved frequency ( p =0.001); urgency ( p =0.006); and IPSS total ( p =0.001), storage ( p p p =0.030). Among men with smaller Prostates, tolterodine ER significantly improved frequency ( p =0.016), UUI episodes ( p =0.036), and IPSS storage scores ( p =0.005). Tolterodine ER+tamsulosin significantly improved frequency ( p =0.001) and IPSS storage scores ( p =0.018). Tamsulosin significantly improved nocturnal frequency ( p =0.038) and IPSS voiding ( p =0.036) and total scores ( p =0.044). There were no clinically or statistically significant changes in Q max or PVR; incidence of acute urinary retention (AUR) was low in all groups (≤2%). Conclusions Men with smaller Prostates and moderate-to-severe LUTS including OAB symptoms benefited from tolterodine ER. Therapy with tolterodine ER+tamsulosin was effective regardless of Prostate Size. Tolterodine ER, with or without tamsulosin, was well tolerated and not associated with increased incidence of AUR.
Stephen J. Freedland - One of the best experts on this subject based on the ideXlab platform.
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Does Prostate Size Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from the REDUCE Trial☆
European urology, 2015Co-Authors: Ross Simon, Claus G Roehrborn, Lauren E. Howard, Daniel M. Moreira, Adriana C. Vidal, Ramiro Castro-santamaria, Stephen J. FreedlandAbstract:Abstract Background It has been shown that increased Prostate Size is a risk factor for lower urinary tract symptom (LUTS) progression in men who currently have LUTS presumed due to benign prostatic hyperplasia (BPH). Objective To determine if Prostate Size is a risk factor for incident LUTS in men with mild to no symptoms. Design, setting, and participants We conducted a post hoc analysis of the REDUCE study, which contained a substantial number of men ( n =3090) with mild to no LUTS (International Prostate Symptom Score [IPSS] Outcome measurements and statistical analysis Our primary outcome was determination of the effect of Prostate Size on incident LUTS presumed due to BPH defined as two consecutive IPSS values >14, or receiving any medical (α-blockers) or surgical treatment for BPH throughout the study course. To determine the risk of developing incident LUTS, we used univariable and multivariable Cox models, as well as Kaplan-Meier curves and the log-rank test. Results and limitations Among men treated with placebo during the REDUCE study, those with a Prostate Size of 40.1–80ml had a 67% higher risk (hazard risk 1.67, 95% confidence interval 1.23-2.26, p =0.001) of developing incident LUTS compared to men with a Prostate Size 40.0ml or smaller. There was no association between Prostate Size and risk of incident LUTS in men treated with 0.5mg of dutasteride. The post hoc nature of our study design is a potential limitation. Conclusions Men with mild to no LUTS but increased Prostate Size are at higher risk of incident LUTS presumed due to BPH. This association was negated by dutasteride treatment. Patient summary Benign prostatic hyperplasia (BPH) is a very common problem among older men, which often manifests as lower urinary tract symptoms (LUTS), and can lead to potentially serious side effects. In our study we determined that men with mild to no current LUTS but increased Prostate Size are much more likely to develop LUTS presumed due to BPH in the future. This association was not seen in men treated with dutasteride, a drug approved for treatment of BPH. Our study reveals that men with a Prostate Size of 40.1–80ml are potential candidates for closer follow-up.
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the association between Prostate Size and gleason score upgrading depends on the number of biopsy cores obtained results from the shared equal access regional cancer hospital database
BJUI, 2008Co-Authors: Ryan S Turley, Christopher L. Amling, Martha K. Terris, Christopher J. Kane, William J. Aronson, Joseph C. Presti, Stephen J. FreedlandAbstract:OBJECTIVE To test the hypothesis that the association between Prostate Size and risk of Gleason grade upgrading varies as a function of sampling. PATIENTS AND METHODS We examined the association between pathological Prostate weight, Prostate biopsy scheme and Gleason upgrading (Gleason ≥7 at radical Prostatectomy, RP) among 646 men with biopsy Gleason 2–6 disease treated with RP between 1995 and 2007 within the Shared Equal Access Regional Cancer Hospital Database using logistic regression. In all, 204 and 442 men had a sextant (six or seven cores) or extended-core biopsy (eight or more cores), respectively. Analyses were adjusted for centre, age, surgery, preoperative Prostate-specific antigen level, clinical stage, body mass index, race, and percentage of cores positive for cancer. RESULTS In all, 281 men (44%) were upgraded; a smaller Prostate was positively associated with the risk of upgrading in men who had an extended-core biopsy (P < 0.001), but not among men who had a sextant biopsy (P = 0.22). The interaction between biopsy scheme and Prostate Size was significant (P interaction = 0.01). CONCLUSIONS These data support the hypothesis that the risk of upgrading is a function of two opposing contributions: (i) a more aggressive phenotype in smaller Prostates and thus increased risk of upgrading; and (ii) more thorough sampling in smaller Prostates and thus decreased risk of upgrading. When sampled more thoroughly, the phenotype association dominates and smaller Prostates are linked with an increased risk of upgrading. In less thoroughly sampled Prostates, these opposing factors nullify, resulting in no association between Prostate Size and risk of upgrading. These findings help to explain previously published disparate results of the importance of Prostate Size as a predictor of Gleason upgrading.
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The association between Prostate Size and Gleason score upgrading depends on the number of biopsy cores obtained: results from the Shared Equal Access Regional Cancer Hospital Database.
BJU international, 2008Co-Authors: Ryan S Turley, Christopher L. Amling, Martha K. Terris, Christopher J. Kane, William J. Aronson, Joseph C. Presti, Stephen J. FreedlandAbstract:OBJECTIVE To test the hypothesis that the association between Prostate Size and risk of Gleason grade upgrading varies as a function of sampling. PATIENTS AND METHODS We examined the association between pathological Prostate weight, Prostate biopsy scheme and Gleason upgrading (Gleason ≥7 at radical Prostatectomy, RP) among 646 men with biopsy Gleason 2–6 disease treated with RP between 1995 and 2007 within the Shared Equal Access Regional Cancer Hospital Database using logistic regression. In all, 204 and 442 men had a sextant (six or seven cores) or extended-core biopsy (eight or more cores), respectively. Analyses were adjusted for centre, age, surgery, preoperative Prostate-specific antigen level, clinical stage, body mass index, race, and percentage of cores positive for cancer. RESULTS In all, 281 men (44%) were upgraded; a smaller Prostate was positively associated with the risk of upgrading in men who had an extended-core biopsy (P
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Do Racial Differences in Prostate Size Explain Higher Serum Prostate-Specific Antigen Concentrations Among Black Men?
Urology, 2007Co-Authors: John C Mavropoulos, Alan W. Partin, Christopher L. Amling, Martha K. Terris, Christopher J. Kane, William J. Aronson, Joseph C. Presti, Leslie A. Mangold, Stephen J. FreedlandAbstract:Objectives To determine whether elevated serum Prostate-specific antigen (PSA) values in black men are due, at least partially, to larger Prostate Size among black men. Methods The study population consisted of two cohorts: (1) 1410 men undergoing radical Prostatectomy between 1988 and 2005 at five equal-access medical centers comprising the Shared Equal Access Regional Cancer Hospital (SEARCH) Database; and (2) 9601 men undergoing radical Prostatectomy between 1988 and 2004 at the Johns Hopkins Hospital. We evaluated the association between race and serum PSA value and Prostate weight using multivariable linear regression while adjusting for demographic and clinicopathologic cancer characteristics. Results In both cohorts, black men had higher serum PSA values ( P ≤0.001). After adjusting for either demographic characteristics or demographic and cancer-specific characteristics, there were no significant associations between race and Prostate Size in either cohort. After adjusting for multiple demographic, clinical, and pathologic cancer-specific characteristics, black men had 15% higher serum PSA values relative to white men in both the SEARCH ( P = 0.001) and Hopkins cohorts ( P Conclusions In this study of patients undergoing radical Prostatectomy in two very different practice settings, black men in both cohorts had higher serum PSA values relative to white men, despite adjustment for demographic and cancer-specific characteristics, including Prostate weight. The lack of significant association between race and Prostate Size suggests that alternative reasons are needed to explain higher serum PSA values in black men.
