Discordance rates of biopsy techniques among men with prostate cancer that are candidates for active surveillance

Q1Q1e887-e887INTRODUCTION AND OBJECTIVES: With the ongoing stage migration in the diagnosis of prostate cancer, there has been increased interest in management with active surveillance. Our study examines the ability of two prostate biopsy techniques to predict appropriate candidates for active surveillance.METHODS500 consecutive patients, between 2005 and 2007, that underwent trans-rectal ultrasound guided biopsy by either an office biopsy with 12 cores or a saturation biopsy with ≥18 cores, and subsequent radical prostatectomy were identified. Using criteria of: Gleason score ≤6, clinical stage T1 or T2a, Prostate Specific Antigen (PSA) <10 and ≤33% of cores involved, 220 patients were found to be candidates for active surveillance. Pathology results from the prostatectomy specimens were used determine the discordance rate of each biopsy technique.RESULTSOf the 220 candidates for active surveillance, 124 patients underwent an office biopsy with 12 cores, and 96 patients underwent a saturation biopsy. The median number of cores in the saturation biopsy cohort was 27. There was no statistically significant difference between the groups in terms of median age (p=0.18), pre-operative PSA (p=0.48) and clinical stage (p=0.2). At least one previous negative biopsy had been performed on 20 patients (16%) in the office cohort and 43 patients (45%) in the saturation cohort (p= <0.001). In the 12 core biopsy group, 17 patients (14%) were upgraded to Gleason 7 on pathology from the prostatectomy specimen. In the saturation biopsy group, 14 patients (15%) were upgraded to Gleason 7, and 1 patient (1%) was upgraded to Gleason 8. There was no statistically significant difference in the rate of upgrading between the office and saturation biopsy cohorts (p=0.69). In the office biopsy group, 2 patients (1.6%) were upstaged to pT3 disease, compared to 0 patients (0%) in the saturation biopsy group (p=0.58). No statistically significant difference in the estimated tumor volume of the prostatectomy specimen was seen between the cohorts (p=0.47).CONCLUSIONSCandidates for active surveillance can accurately be predicted with 12 core biopsies. In both cohorts, approximately 1 in 6 patients underwent upgrading based on the pathology of the prostatectomy specimen

Temas Socio-Jurídicos. Volumen 14 No. 30 Agosto de 1996

La Revista Temas Socio-Jurídicos en su edición número 30, desea anunciar a sus lectores, poniéndola a disposición de la comunidad científica nacional la adquisición de la obra completa de Galileo Galilei en su primera edición florentina de 1842.The Socio-Legal Issues Magazine, in its 30th edition, wishes to announce to its readers, making it available to the national scientific community the acquisition of the complete works of Galileo Galilei in its first Florentine edition of 1842

Temas Socio-Jurídicos. Volumen 13 No. 29 Diciembre 1995

Como homenaje póstumo dedicamos al profesor Valencia Zea, esta edición número 29 de la revista Temas Socio-Jurídicos, en la cula difundimos un ejercicio hermeneútico salido de su pluma en la sentencia proferida por la sala de casación civil de la Corte Suprema de Justicia de 23 de junio de 1958.As a posthumous tribute we dedicate to Professor Valencia Zea, this 29th edition of the Socio-Legal Issues magazine, in which we spread a hermeneutical exercise from his pen in the sentence pronounced by the civil cassation chamber of the Supreme Court of Justice of 23 June 1958

Temas Socio-Jurídicos. Volumen 14 No. 31 Diciembre de 1996

Con la edición número 31 de la Revista Temas Socio-jurídicos se pone a disposición de la comunidad universitaria parte de la actividad desarrollada por los docentes y estudiantes de la Facultad de Derecho de la Universidad Autónoma de Bucaramanga durante el segundo semestre de 1996.With the 31st edition of the Socio-legal Issues Magazine, part of the activity carried out by the teachers and students of the Faculty of Law of the Autonomous University of Bucaramanga during the second semester of 1996

Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer: Considerations for Active Surveillance

PURPOSE: Recent NCCN® (National Comprehensive Cancer Network®) Guidelines® show that patients with biopsy Gleason score 3 + 4/Grade Group 2 but otherwise favorable features are active surveillance candidates. However, little is known about the long-term outcomes compared to that in men in the low risk Gleason score 6/Grade Group 1 group. We sought to clarify the risk of adverse features and oncologic outcomes in surgically treated, favorable Grade Group 2 vs 1 cases. MATERIALS AND METHODS: We queried our prospectively maintained radical prostatectomy database for all 8,095 patients with biopsy Grade Group 1 or 2 prostate cancer who otherwise fulfilled the NCCN low risk definition of prostate specific antigen less than 10 ng/ml and cT2a or less, and who underwent radical prostatectomy from 1987 to 2014. Multivariable logistic regression and Kaplan-Meier methods were used to compare pathological and oncologic outcomes. RESULTS: Organ confined disease was present in 93.9% and 82.6% of Grade Group 1 and favorable intermediate risk Grade Group 2 cases while seminal vesicle invasion was noted in 1.7% and 4.7%, and nodal disease was noted in 0.3% and 1.8%, respectively (all p <0.0001). On multivariable logistic regression biopsy proven Grade Group 2 disease was associated with a threefold greater risk of nonorgan confined disease (OR 3.1, 95% CI 1.7-5.7, p <0.001). The incidence of late treatment (more than 90 days from surgery) in Grade Group 1 vs 2 was 3.1% vs 8.5% for hormonal therapy and 6.0% vs 12.2% for radiation (p <0.001). In the Grade Group 1 vs 2 cohorts the 10-year biochemical recurrence-free survival rate was 88.9% vs 81.2% and the 10-year systemic progression-free survival rate was 99% vs 96.5% (each p <0.001). CONCLUSIONS: Men at favorable risk with Grade Group 2 disease who are considering active surveillance should be informed of the risks of harboring adverse pathological features which impact secondary therapies and an increased risk of cancer progression

Adverse Disease Features in Gleason Score 3 + 4 \u201cFavorable Intermediate-Risk\u201d Prostate Cancer: Implications for Active Surveillance

BACKGROUND: According to a recent National Comprehensive Cancer Network (NCCN) guidelines update, patients with Gleason score (GS) 3 + 4 prostate cancer (PCa) and "favorable intermediate-risk" (FIR) characteristics might be offered active surveillance (AS). However, the risk of unfavorable disease features and its prediction in this subset of patients is not completely understood. OBJECTIVE: To identify the risk of unfavorable disease and potential predictors of adverse outcomes among GS 3 + 4 FIR PCa patients. DESIGN, SETTING, AND PARTICIPANTS: The study included patients with biopsy GS 3 + 4 and otherwise fulfilling the NCCN low-risk definition (prostate-specific antigen [PSA] <10 ng/ml, cT2a or lower) undergoing radical prostatectomy (RP) from 2006 to 2014 at a single institution. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Complete information on PSA, PSA density (PSAD), clinical stage, percentage of positive cores, percentage of maximum surface specimen involvement, and RP pathology were available. GS upgrade and downgrade, non-organ-confined and non-specimen-confined disease, unfavorable disease (pT3-T4 and/or pN1 and/or a pGS 654 + 3) were the outcomes. Statistical analysis included descriptive statistics and multivariable logistic regression. RESULTS AND LIMITATIONS: A total of 156 patients (13.1%) experienced GS upgrade; 201 (16.9%) were downgraded. Overall, 205 men (17.2%) harbored non-organ-confined disease, and 295 (24.8%) had unfavorable disease. Age (odds ratio [OR]: 1.06), percentage surface involvement (OR: 1.01), and PSAD (OR: 1.83) were the only significant predictors of upgrade. Age (OR: 1.05), clinical stage (OR: 1.74), percentage of positive cores >50% (OR 1.57), percentage of surface area (OR: 1.02), and perineural invasion (OR: 1.89) were significant predictors of unfavorable disease at RP. The retrospective design is a limitation. CONCLUSIONS: AS is a possible option for a subset of men with FIR GS 3 + 4. However, clinical models alone have a limited role in GS upgrade prediction, and alternative tools warrant further investigation. PATIENT SUMMARY: Patients with Gleason score 3 + 4 at biopsy, low prostate-specific antigen, and low stage might consider the option of active surveillance, but the use of clinical information alone might be not adequate for thorough risk-adapted counseling

The impact of incontinence etiology on artificial urinary sphincter outcomes

Purpose: To evaluate the impact of incontinence etiology on artificial urinary sphincter (AUS) device outcomes. Materials and Methods: We identified 925 patients who underwent primary AUS placement from 1983 to 2011. The etiology of incontinence was categorized as radical prostatectomy alone, radical prostatectomy with radiation, benign prostate resection, and those with cryotherapy as a salvage prostate cancer treatment. Hazard regression and competing risk analyses were used to determine the association of the etiology of incontinence with device outcomes. Results: The distribution of the 4 etiologies of incontinence included: 598 patients (64.6%) treated with prostatectomy alone, 206 (22.2%) with prostatectomy and pelvic radiation therapy, 104 (11.2%) with benign prostate resection, and 17 (1.8%) with prior cryotherapy. With a median follow-up of 4.9 years (interquartile range, 1.2–8.8 years), there was significant difference in the cumulative incidence of device infection/urethral erosion events between the four etiologies (p=0.003). On multivariable analysis, prior cryotherapy (reference prostatectomy alone; hazard ratio [HR], 3.44; p=0.01), older age (HR, 1.07; p=0.0009) and history of a transient ischemic attack (HR, 2.57; p=0.04) were associated with an increased risk of device infection or erosion. Notably, pelvic radiation therapy with prostatectomy was not associated with an increased risk of device infection or erosion (reference prostatectomy alone, p=0.30). Conclusions: Compared to prostatectomy alone, prior treatment with salvage cryotherapy for recurrent prostate cancer was associated with an increased risk of AUS infection/erosion, whereas radiation (in addition to prostatectomy) was not

Impact of metabolic syndrome on oncologic outcomes at radical prostatectomy

PURPOSE: The associations between metabolic syndrome (MetS) and prostate cancer (CaP) outcomes following radical prostatectomy (RP) are not clear. This study aims to understand the role of MetS in influencing oncological outcomes at RP. MATERIALS AND METHODS: Patients who underwent RP for CaP at our institution from 2000 to 2010 were identified; MetS prior to RP was ascertained with a modified version of the IDF-AHA/NHLBI using ICD-9 codes. Histopathological outcomes included surgical margins, pathological stage, and Gleason score (GS) upgrading. Long-term outcomes included biochemical recurrence (BCR), local recurrence, systemic progression, and CaP-specific mortality. Multivariable adjusted logistic regression and Cox proportional hazards regression assessed the association between MetS status and histopathological and long-term outcomes, respectively. RESULTS: Of 8,504 RP patients, 1,054 (12.4%) had MetS at the time of RP. MetS patients were older, had higher biopsy GS, but lower pre-op prostatic specific antigen (PSA), higher pathological GS, and larger prostate volume. Adjusted logistic regression suggested an association between MetS and positive margins (odds ratio [OR] = 1.22, P\u202f=\u202f0.025) and GS upgrading (OR\u202f=\u202f1.28, P\u202f=\u202f0.002). There was evidence of an increased risk of local recurrence (hazard ratio [HR] = 1.33, P\u202f=\u202f0.037) and CaP-specific mortality (HR\u202f=\u202f1.58, P < 0.001) for MetS patients. There was no evidence to suggest an association with BCR or systemic progression. CONCLUSION: Men with MetS are at higher risk of GS upgrade and positive surgical margins at surgery, local recurrence, and CaP-specific mortality. Pathological stage, BCR, and systemic progression were not associated with MetS. Our data may be useful in patients' counseling, especially when active surveillance is an option

Mid-term Outcomes Following Salvage Lymph Node Dissection for Prostate Cancer Nodal Recurrence Status Post\ue2\u80\u93radical Prostatectomy

Background: Patients with oligometastatic prostate cancer lymph node recurrence can be treated with many options including salvage lymph node dissection (sLND). Objective: EvaluationofoutcomesofsLNDandidentificationofclinicopathologicfeatures in predicting further biochemical and radiological relapse after sLND for prostate cancer. Design, setting, and participants: Between November 1, 2009 and March 31, 2015, 117 patients with biochemical recurrence (BCR) after radical prostatectomy (RP) un- derwent sLND by a single surgeon after a standardized 11C-choline positron emission tomography/computed tomography. Outcomemeasurementsandstatisticalanalysis: Biochemicalresponse(BR)wasdefined as a prostate-specific antigen (PSA) < 0.2ng/ml after sLND, BCR was defined as a PSA greater than 0.2 ng/ml with an increased trend after sLND, and radiological recurrence (RAR) was defined as a positive 11C-choline positron emission tomography/computed tomography imaging study or biopsy proven metastasis after sLND. Kaplan-Meier method was used to assess time to BCR, RAR, and cancer-specific mortality. Preoperative and postoperative predictors of BCR and RAR were assessed with Cox regression analyses. Results and limitations: All patients had confirmed lymph node metastasis on final sLND pathology. Median follow-up after sLND was 20.2 mo (interquartile range: 11.8\u2013 33.6). All but one patient had a decrease in PSA while 93/117 (79.5%) patients achieved BR after sLND. In those who achieved BR, a subsequent BCR occurred in 40% of cases (n = 37/93). The 5-yr BCR, RAR, and cancer-specific mortality-free survival rates were 31%, 51%, and 97% respectively. At multivariate analyses, predictors of both BCR and RAR were pathological stage of the tumor at original RP and whether the nodes were castrate resistant prostate cancer. Given the nonrandomized nature, it is not known how these men would have fared according to survival or quality of life by observation, and/or other systemic therapy. Conclusions: An optimal candidate for sLND tends to have pT2 at the original RP and a castration sensitive disease state. sLND could be considered part of a multimodal treatment approach in select patients with castrate-resistant prostate cancer in which delayed/reduced cancer progression could be achieved with a cytoreductive surgery. Patient summary: We found that by performing a salvage lymph node dissection there are many men that can experience a biochemical response and eliminate further 11C- choline positron emission tomography/computed tomography radiographic recurrences