CONCLUSIONS. The Epstein Criteria has a suboptimal accuracy for predicting for insignificant prostate cancer.
|
|
- Ralph Carter
- 5 years ago
- Views:
Transcription
1 ; 2011 EPSTEIN CRITERIA FOR INSIGNIFICANT PROSTATE CANCER OON ET AL. BJUI Epstein criteria for insignificant prostate cancer Sheng F. Oon*, R. William Watson*, John J. O Leary and John M. Fitzpatrick *Conway Institute, University College Dublin, Institute of Molecular Medicine, Trinity College Dublin, Mater Misericordae University Hospital, Dublin, Ireland Accepted for publication 31 August 2010 Study Type Prognosis (systematic review) Level of Evidence 2b OBJECTIVE To review the accuracy of the Epstein Criteria for insignificant prostate cancer and to explore the effect of the modified Gleason classification system on this system. METHODS We searched PubMed, EMBASE and the Cochrane Database using search terms Epstein Criteria, Prostate Cancer, Validation and Insignificant Cancer between 1994 to 2010 for validation articles. These were divided into pre-2005 and post-2005 and concordances for organconfined status, Gleason score 6 and insignificant cancer were analysed. What s known on the subject? and What does the study add? Overtreatment of prostate cancer is a major problem in contemporary urological practice. The Epstein Criteria reduces overtreatment by identifying insignificant prostate cancers that may be amenable to surveillance therapy. This systematic review of the Epstein Criteria validation studies provides a collective insight into the application and accuracy of the Epstein Criteria to predict for insignificant prostate cancer across different institutions and geographies. RESULTS A pre-2005 study showed concordance for insignificant prostate cancer, Gleason score 6 and organ-confined status at 84%, 90.3% and 91.6%, respectively. Five post-2005 validation studies were concordant for insignificant cancer, Gleason score 6 and organ-confined status at 37 76%, % and %, respectively. CONCLUSIONS The Epstein Criteria has a suboptimal accuracy for predicting for insignificant prostate cancer. The modification to Gleason scoring may be responsible for a reduced accuracy over time. However, significant heterogeneity in the validation studies means better quality validation studies are required. KEYWORDS prostate cancer, insignificant prostate cancer, epstein criteria, gleason score INTRODUCTION Prostate cancer is now the most common solid organ neoplasm in the western world and one of the leading causes of cancer death, with some countries considering screening for this disease [1,2]. Mortality rates for prostate cancer declined with PSA testing. However, PSA screening is a highly controversial topic. This controversy arises as a large number of patients with prostate cancer have clinically insignificant prostate cancer. Early autopsy studies revealed prostate cancer in 60 70% of older men dying from unrelated causes [3]. Conservative treatment of low-grade prostate cancers in this group also incurred no loss of life expectancy [4]. With an estimated 17% lifetime risk of prostate cancer diagnosis in the United States [5], it is clear that many prostate cancers pose no threat to life or health. PSA testing, however, has resulted in over diagnosis and overtreatment in prostate cancer, with the majority of prostate cancers likely to be clinically insignificant. In the Prostate cancer Intervention Versus Observation Trial, new cases of prostate cancer were estimated in 2007 with only deaths [6]. In the European Randomized study of Screening for Prostate Cancer trial, it was determined that 43% of the study population undergoing RP had minimal cancer and an estimated 1410 men needed to be screened with 48 prostatectomies performed to prevent a single death [7,8]. To reduce overtreatment and over diagnosis, watchful waiting and active surveillance measures were introduced. Watchful waiting refers to the symptomguided treatment of patients with prostate cancer where active treatment of cancer is completely deferred until the signs and symptoms of prostate cancer manifest themselves. Active surveillance (AS) refers to the therapeutic strategy of closely monitoring a patient with low-risk prostate cancer with regular follow-up of PSA, TRUS biopsy and DRE. When a progression of disease is detected by any of these monitoring measures, then the patient is referred for curative therapy. The Epstein Criteria, developed in 1994, is the most widely used tool for determining , doi: /j x x
2 EPSTEIN CRITERIA FOR INSIGNIFICANT PROSTATE CANCER TABLE 1 The Epstein Criteria as originally defined by Epstein, and in the Epstein Criteria validation studies Author PSA density (ng/ml) Gleason score Number of cores positive for tumour Volume of core positive for tumour Epstein [9] <0.1 <7 <3 50% or less Yes <7 1 <3 mm Yes Bastian [21] <0.15 <7 <3 50% or less Yes Jeldres [22] <7 1 <3 mm Yes Lee MC [26] <0.15 <7 <3 <50% Yes Lee SE [25] <7 <3 <50% Yes Hekal [24] <0.15 <7 <3 50% or less Yes Louie-Johnsun [23] <0.15 <7 <3 <50% Yes Clinically organ confined? FIG. 1. Comparison of the (a) original Gleason and (b) International Society of Urological Pathology 2005 modified Gleason grading systems for pattern 3 and pattern 4 carcinoma. Reproduced from Lotan TL, Epstein JI. Clinical implications of changing definitions within the Gleason grading system. Nat Rev Urol 2010; 7: , with permission. pattern 3 tumours to pattern 4. Pattern 3 was classically characterized by the presence of numerous small or large well-formed glands or cribriform patterns. In the modified Gleason system, most cribriform patterns were moved into pattern 4 (see Fig. 1) [14,15]. A comparison of the conventional and ISUPmodified Gleason systems is summarized in Table 2. prostate cancer significance. Epstein s original study was based on 157 men with clinical stage T1c prostate cancer compared with 64 similarly treated clinical T1a patients initially diagnosed via TURP [9]. In all, 16% of patients were deemed to harbour an insignificant tumour, and insignificant prostate cancer was defined as tumour volume <0.2 cm 3, organconfined and no Gleason patterns 4 or 5. The rationale for this volume was based on a previous study of 21 clinical T2 cases, where these tumour volumes exhibited no capsular penetration or evidence of biochemical relapse after 5 years [10,11]. Epstein also provided a minimal tumour category for tumours between cm 3 to account for disaccording opinions amongst clinicians over what tumour volumes should define insignificant tumour volume. These patients also showed no biochemical progression after RP but three out of 23 had extracapsular extension. Stamey [12] established the newly accepted tumour volume limit of 0.5 cm 3. The optimum preoperative criteria determined from Epstein s original study are summarized in Table 1. Epstein s criteria provided a positive predictive value of 95%, negative predictive value of 66% and overall predictive accuracy of 73% for insignificant cancer. The same criteria predicted 73% of minimal cancers. The Gleason scoring system was introduced in 1966 for the histological assessment of prostate cancer aggressiveness and is expressed as a formula: x + y = z. In biopsy specimens, the primary Gleason pattern (x) represents the most prevalent Gleason pattern observed in the biopsy. At the International Society of Urological Pathology (ISUP) Consensus Conference, the definition of the secondary Gleason pattern (y) was changed from the second most prevalent pattern to the highest cancer grade observable in the specimen [13]. The addition of the two Gleason patterns provides the overall Gleason score (z). The ISUP modification saw the upgrade of certain pathological features of Gleason Gleason 7 tumours are divided into two categories: (7a) and (7b). This is based on the evidence that prognostic differences exist between the two tumour subtypes (see Table 3). After the ISUP modification, the most frequently detected score was changed from Gleason 6 to 7, in particular [16 18]. The effect of the ISUP revision on the current application of the Gleason system and the need to specify in pathology reports and clinical trials which version of the Gleason system is used is already well recognized [19]. Instead of a formal re-classification, the ISUP version was intended to provide options in some areas for how to grade prostate cancers in RP specimens and biopsies. Many pathologists do not consider the ISUP recommendation newly derived, but a reflection of what the majority of urological pathologists were already doing in contemporary practice [20]. Others, who are against the consensus, claim that the ISUP version has not been properly validated and use a different style of grading. The inconsistency and variation in cancer grading methods for prostate cancer among pathologists is a limiting factor in determining cancer aggressiveness and significance, and uniformity of grading in prostate cancer specimens are required. The purpose of the present review was not to perform a meta-analysis of the data, but to
3 OON ET AL. TABLE 2 Some differences between the conventional and 2005 ISUP Gleason scoring methods (adapted from Uemura H, Hoshino K, Sasaki T, Miyoshi Y, Ishiguro H, Inayama Y, et al. Usefulness of the 2005 International Society of Urologic Pathology Gleason grading system in prostate biopsy and radical prostatectomy specimens, BJU Int 2009; ) Conventional Gleason scoring A diagnosis of Gleason score <4 is possible on biopsy Gleason pattern 3 includes a partial cribriform pattern, large cribriform Biopsy and prostatectomy specimens use the same Gleason scoring system Small quantities of high-grade tumour (<5%) on biopsy should be excluded Biopsy tumours are graded by listing the primary (most prevalent grade) and secondary (second most prevalent) patterns The Gleason score of prostatectomy specimens is assigned based on the primary and secondary patterns only In needle biopsies, the cores may either be assessed separately or assigned an overall score In prostatectomy specimens, the Gleason score of the largest volume of cancer seen is assigned to whole specimen, even if smaller volumes of higher Gleason score are seen 2005 ISUP Gleason scoring A diagnosis of Gleason Score <4 on biopsy is rarely if ever made. The majority of cribriform patterns are Gleason pattern 4. Only specimens with rare cribriform lesions are considered pattern 3 Biopsies and prostatectomy specimens use different Gleason scoring systems High-grade tumours of any quantity on biopsy should be included Biopsy tumours are graded by listing the primary (most prevalent grade) and secondary (highest grade seen) patterns The Gleason score of prostatectomy specimens are assigned based on the primary and secondary patterns with a comment on the tertiary pattern if seen Each core should be scored separately Where separate grades of tumour nodules exist in a prostatectomy specimen, the dominant nodules are assigned their own Gleason scores ISUP, International Society of Urological Pathology. investigate the application of the Epstein Criteria in contemporary practice given the changes in Gleason scoring. METHODS A literature search was conducted using PubMed, EMBASE and the Cochrane Library from 1994 to The search terms used were Prostate Cancer, Epstein Criteria, Validation and Insignificant Cancer. We restricted our searches to the English language and included only studies conducted with the specific purpose of validating the Epstein Criteria. Articles using similar criteria to the Epstein Criteria but which were conducted with the aim of developing predictive tables instead were excluded. We included all articles that included the use of PSA density, biopsy Gleason score, number of biopsy cores positive and percentage of core involvement. One reviewer conducted the literature search and appraised the retrieved articles. RESULTS Of 62 articles retrieved, six articles were relevant to the subject of Epstein Criteria validation. One article was published before 2005 and five after All five post-2005 articles were conducted spanning the time during which the ISUP version was introduced and no article indicated which version of Gleason scoring was used. We assumed that the articles published after 2005 had converted to the modified version of the Gleason system, and that those articles published before 2005 used the conventional Gleason system only. Studies limited by low population numbers were also included in the present review. No article complied completely with Epstein s original Criteria but all were included for analysis. The demographic details of these studies are summarized in Table 4. The parameters used to define the Epstein Criteria in these studies are summarized in Table 1. The concordance rates of these studies for organ-confined disease, Gleason score, insignificant prostate cancer and other pathological outcomes are summarized in Table 5. Bastian s study was the only validation study of the Epstein Criteria published before the ISUP concensus update [21]. Bastian s definition of Epstein s Criteria using PSA density at a limit of 0.15 ng/ml was already a subtle departure from the Epstein s original criterion of 0.1 ng/ml. Despite this, Bastian s PSA density range was ng/ml, which suggests that some patients who exceeded the limit for qualification into insignificant disease were included in the study. This may have been because of PSA density in the study being calculated post-operatively through the division of the absolute PSA by the prostate specimen weight minus the seminal vesicles, as opposed to the preoperative estimation of prostate volume on TRUS. Nevertheless, Bastian achieved a 91.6% concordance with organ-confined status and 90.3% concordance with a Gleason score 6 at surgery. In all, 21 patients were upgraded to Gleason 7 and two to Gleason 8. The overall accuracy of the Epstein Criteria to predict for insignificant prostate cancer was 84%. Jeldres single academic European institution study of 366 men took place between 1996 and 2006 [22]. All biopsy and RP specimens were assessed by a single uropathologist. The study obtained a 91.7% concordance with organ-confined disease and 76% concordance with Gleason patients were upgraded to Gleason 7, 82 of which were (93.2%) and 6 were (6.8%). Of all Gleason 7 patients, 34.1% had non-organ confined disease, whereas all Gleason 6 patients had organ-confined disease. The accuracy of the Epstein Criteria to predict for insignificant cancer was 76%. Louie-Johnsun et al. [23] studied the outcomes of patients in the United Kingdom undergoing RP for low-risk disease. Of 549 patients who qualified for low-risk disease
4 EPSTEIN CRITERIA FOR INSIGNIFICANT PROSTATE CANCER TABLE 3 Comparison of prognostic and pathological outcomes in Gleason 7a and 7b disease Chan [36] Lau [37] Khoddami [38] Han [39] Tollefson [40] Rasiah [41] Kang [42] Burdick [43] Study pt1 (%) pt2 (%) pt3 (%) pt2-t3 (%) ECE (%) SVI (%) PSM (%) PNI (%) LNI (%) Metastases within 5 years (%) year actuarial risk of biochemical progression (%) year actuarial risk of biochemical progression (%) year actuarial risk of biochemical progression (%) year cancer-specific survival (%) year risk of systemic recurrence (%) 8 15 ECE, extracapsular extension; SVI, seminal vesicle invasion; PSM, positive surgical margins; PNI, perineural invasion; LNI, lymph node invasion. according to the D Amico risk classification criteria, 74 were also deemed to have insignificant cancer as determined by the Epstein Criteria. Sixty-one per cent of these were upgraded to significant disease at surgery (insignificant cancer was defined as total tumour volume <0.5 ml and no Gleason pattern 4 or higher). Sixteen per cent were upgraded to Gleason 7 and 3% had extracapsular extension. The authors do not account for the remainder of upgrades to significant cancer and these may have been because of significant tumour volumes uncovered at surgery (the mean tumour volume was 2.5 ml) or higher upgrades to Gleason It was not stated how many patients comprised of and tumours but a bar graph provided by the authors comparing individual specimen Gleason scores demonstrated a clear predominance of tumours over tumours at surgery. Hekal et al. [24] examined a Middle Eastern cohort of 35 patients who underwent RP for T1c prostate cancer (2 via laparoscopic prostatectomy). Although the authors do not specifically define the criteria used in their methodology, they imply the use of Bastian s criteria in their discussion. They obtained an 80% concordance with organ-confined disease and 54.3% concordance with Gleason % were Gleason 7 (20% 3 + 4, 11.4% 4 + 3) and 14.3% were Gleason In all, 11.4% of patients had lymph node positive disease and in the 8-year retrospective study, 8.6% of patients developed metastases. Lee (SE) [25] studied 131 Korean men with Epstein-Criteria determined insignificant prostate cancer. At RP, 40 men had Gleason 7 disease [37 had disease (92.5%), three had (7.5%)], with no Gleason 8 10 tumours. All four patients with extracapsular extension in the study had Gleason 7 disease (3 had disease, 1 had 4 + 3). All Gleason 6 patients had organ-confined disease. The predictive accuracy of the Epstein Criteria for insignificant cancer was 69.5%. Lee (MC) [26] validated the Epstein Criteria in a cohort of 268 men who underwent RP. The authors compared a cohort of patients that fulfilled the Epstein Criteria (n = 136), against a cohort of patients with Gleason 6 prostate cancer on biopsy but did not fulfil the Epstein Criteria for significant disease (n = 132). Outcomes compared were insignificant cancer, organ-confined status and
5 OON ET AL. TABLE 4 Population demographics for the Epstein sriteria validation studies Study Bastian [21] Jeldres [22] Lee M [26] Lee S [25] Hekal [24] Louie-Johnsun [23] Study period No. of patients Mean age Mean preoperative PSA (ng/ml) Mean PSA density (ng/ml 2 ) NA Biopsy Number of cores taken > One core positive Two cores positive Mean percentage core Involvement Percentage core involvement: 50% 31.5 <50% 68.5 <5% % % % % % % % 8.44 Max percentage cancer in any core (range) 27 (1 100) 13.3 ( ) TABLE 5 Predictive accuracies of the Epstein Criteria in determining organ-confined disease, pathological Gleason score 6 and overall insignificant disease Study Bastian [21] Jeldres [22] Lee MC [26] Lee SE [25] Hekal [24] Louie-Johnsun [23] Preoperative Gleason score <6 (%) 22 (6%) 2 (1.5%) 28 (80%) =6 (%) 237 (100%) 344 (94%) 136 (100) 129 (98.5%) 7 (20%) Year of publication Post-operative Gleason Score <6 (%) 1 (0.4%) 55 (15%) 0 (0) 0 (0) 4 (11.4) =6 (%) 213 (89.9%) 223 (60.9%) 82 (60.3) 91 (69.5) 15 (42.9) =7 (%) 21 (8.9%) 88 (24.0%) 52 (38.2) 40 (30.5) 11 (31.4) =7a (%) N/A 82 (22.4%) N/A 37 (28.2) 7 (20.0) =7b (%) N/A 6 (1.6%) N/A 3 (2.3) 4 (11.4) =8 10 (%) 2 (0.8%) 0 (0%) 2 (1.5) 0 (0) 5 (14.3) Undergraded 23 (9.7%) 88 (24.1%) 54 (39.7%) 40 (30.5) 14 (40.0) 16 (21.6) Overgraded 1 (0.4%) 2 (0.5%) 0 (0) 2 (5.7) Organ confined (%) 217 (91.6) 336 (91.8) 126 (92.6) 129 (96.9) 28 (80.0) 71 (95.9) Non-organ confined (%) 20 (8.4) 30 (8.2) 10 (7.4) 4 (3.1) 7 (20.0) 3 (4.1) (lymph node invasion) 0 (0) 0 (0) 0 (0) 0 (0) 4 (11.4%) Overall insignificant prostate cancer (%) biochemical relapse-free survival. Lee used two definitions of insignificant disease: a classic Epstein definition (defined as organconfined, Gleason score <6 and tumour volume <0.5 cm 3 ) and a liberal Epstein definition (defined as organ confined, Gleason <6 and tumour of any volume). The authors reasoned that a liberal definition could be used because studies had shown that the majority of pathologically proven Gleason 6 tumours were organ-confined regardless of tumour volume [27,28]. A largescale multi-institutional trial also showed that only 0.03% of patients with organconfined Gleason <6 disease died from prostate cancer after 15 years of follow-up [29]. Overall, the Epstein Criteria cohort showed a 92% concordance with organconfined status (vs 75% concordance in the non-epstein Criteria cohort) and 60% concordance with Gleason 6 disease at RP (vs
6 EPSTEIN CRITERIA FOR INSIGNIFICANT PROSTATE CANCER 39% in the non-epstein Criteria cohort). In all, 38% of the Epstein Criteria population were upgraded to Gleason 7 and 2% had Gleason 8 10 disease (vs 60% and 1%, respectively, in the non-epstein Criteria group). The overall concordance for insignificant disease was 37% when the classic definition of cancer significance was used, and 58% concordance with the liberal definition. Of all 268 patients, 12% experienced biochemical failure within 6 years of the study. The actuarial estimated 1- and 5-year progression-free probability rates were 100% and 100% for the patients meeting Epstein s Criteria, and 98% and 83% for those that did not meet Epstein s Criteria. DISCUSSION Since its introduction in 1994, the accuracy of the Epstein Criteria for predicting for organconfined disease remains remarkable (91.6% before 2005 vs % after 2005). However, its concordance with Gleason 6 cancer fell from 91% to % before and after 2005, respectively. The overall predictability for insignificant prostate cancer also fell from 84% to 37 76%. These results suggest that the ISUP modification to Gleason grading is at least in part responsible for the reduced accuracy of the Epstein Criteria. A weakness of this review is the assumption that all the post-2005 validation articles used the modified Gleason system. In reality, it is unlikely that all these studies complied completely with the novel updated classifications throughout the timeframes of the study. In fact, it is more probable that the conventional system or indeed, both versions of the Gleason system may have been used at some stage. No validation study was also completely compliant with Epstein s initial criteria, and Bastian s study appeared to set the new limit for PSA density at 0.15 ng/ml for the studies that followed. There is considerable heterogeneity in the studies, with variations seen in the number of biopsies taken (Epstein s initial cohort had a mean and median of five cores of prostatic tissue), interpretation of biopsies, calculations of PSA densities and non-uniformity of surgical techniques. Many studies omitted the analysis of specimen tumour volumes, for example, the studies by Jeldres, Hekal and Lee (MC) which determined cancer significance based on organ-confined status and Gleason score alone. The inclusion of tumour volumes into their studies would probably increase the number of significant cancers detected, and further reduce the overall accuracy of the Epstein Criteria. By modifying the Gleason system, the qualifying criteria for the Epstein Criteria was also correspondingly changed, making the comparison of studies between the two eras difficult. As demonstrated in a recent review, the ISUP revision results in significant amounts of disease upgrading. When the conventional and modified classification systems were compared on needle biopsy specimens, the overall numbers of Gleason 6 tumours diagnosed fell from 48.4% to 22% whereas Gleason 7 numbers rose from 25.5% to 67.9% [20]. The present review shows that the Epstein Criteria validation studies also demonstrated a majority of tumour upgrades to If this finding is translated to Epstein s original study dataset, the re-evaluation of the biopsy and prostatectomy tissues under the ISUP system could possibly also see some tumours upgraded to 3 + 4, with a resultant different concordance for insignificant prostate cancer. However, with stricter criteria for Gleason scoring and fewer cases assigned a Gleason score 6 on needle biopsies under the ISUP modification, a biopsy score of 6 should actually predict insignificant cancer more accurately. If all the samples in these validation studies were re-graded under the modified system, insignificant cancers would probably be picked up with a greater accuracy, albeit at the cost of increased over diagnosis of significant cancers. After re-grading under the modified Gleason system, 95% of Gleason tumours now remain organ-confined whereas 79% of Gleason tumours are non-organ confined. The 10-year cancer-specific survival rates for Gleason and tumours are also similar at % and %, respectively. A further upgrade to Gleason status confers a reduced 10-year survival of % and three-fold risk of bone metastases [30 33]. With these statistics in mind, could it be possible for tumours to represent a key treatment point in active surveillance patients? The finding of disease could prompt the conversion of surveillance to curative therapy, allowing curative treatment of prostate cancer to commence at a point where overall prognosis is similar to disease while avoiding the poor outcome of without overtreatment. However, longer-term followup studies to compare Gleason against outcomes are required before a confident conclusion can be made, especially as most studies to date have compared only Gleason against (see Table 3). None of these comparisons were also performed on populations after 2005 or in cohorts with specifically Epstein Criteria-determined insignificant disease. Longer-term follow-up of the validation studies in the present review would help indicate if Gleason patients are, in fact, associated with similar outcomes to Recently, a long-term study on active surveillance patients also demonstrated that 30% of patients were upgraded to higher risk and were offered definitive therapy (the criteria for definitive intervention was PSA doubling time <3 years or biopsy Gleason score progression of or higher). Fifty per cent of these radically treated patients experienced PSA failure, even although the overall and 10-year cancer specific survival was 78.6% and 97.2%, respectively [34]. Another criticism of this review is that most of the validation articles did not include tumour volumes in their analyses. Lee (MC) and other authors challenged the role of tumour volumes in determining cancer significance, given that the majority of tumours were organ-confined regardless of tumour volume and associated with excellent 15-year survivals independent of disease stage [27 29]. An article by Isbarn, however, showed that high volume Gleason cancers (three or more biopsy cores positive) actually fared more poorly than low volume tumours (two or less biopsy cores positive) and were more closely related to low volume cancers. High volume tumours were associated with twice the rate of extraprostatic disease compared with low volume tumours (11.7% vs 23.3%, respectively), and lower 5-year biochemical recurrence-free survival (RFS) (77.8% vs 95%, respectively) [35]. Again, Isbarn s results were collected between 1991 and 2006, meaning that many patients could now be under the modified system. The results, however, provide some leverage towards the consideration of low volume tumours (2 or less positive cores) to count as insignificant cancers (the 5-year biochemical RFS rate for these patients was 81.2%, higher than that for high volume patients)
7 OON ET AL. Lee s (MC) validation study [21] used two different classifications of insignificant disease based on tumour volumes. They did not, however, provide a comparison of outcomes in these two groups, providing only a comparison of Epstein Criteria vs non- Epstein Criteria patients. By increasing the threshold for tumour volume in insignificant cancer, the authors naturally demonstrated an increased detection rate of insignificant cancer in the Epstein Criteria and non-epstein Criteria groups. The analysis of individual outcomes and pathological characteristics of the groups with different tumour volumes would have contributed better to the understanding of tumour volumes in cancer significance. In conclusion, the Epstein Criteria is the most commonly used tool for predicting insignificant prostate cancer. After the 2005 ISUP modification to the Gleason grading system, the accuracy of the Epstein Criteria to predict for insignificant prostate cancer fell from 73 84% to 39 76%. The accuracy for predicting a Gleason score 6 was also reduced from 90.3% to %, but organ-confined status predictive ability remained favourable. Most of the Epstein Criteria validation studies did not apply the criteria in a proper way, which leads to a lack of valuable validation, regardless of ISUP updates of Gleason score. As no article indicated what Gleason system was in use in their study, it is also difficult to determine if the ISUP modification is directly responsible for the decreased accuracy of the Epstein Criteria. However, the abrupt change in predictive ability of Gleason score and overall cancer significance after this time suggests that the Gleason grading system is at least in part responsible. Regardless of whether the ISUP modification has affected the Epstein Criteria or not, based on these validation studies, the present review has demonstrated a slippage in the accuracy of the Epstein Criteria and a need for an agreed system to determine for insignificant prostate cancer. As a result of the heterogeneity of these validation studies, the Epstein Criteria has not been properly validated and the conclusions are not transferable into routine daily practice. It will therefore be necessary to perform a large single or multicentre assessment with clearly defined criteria. The present review highlights a potential limitation in contemporary predictive nomograms that incorporate parameters such as Gleason scoring which are liable to amendments. A change in these scoring parameters could result in subtle yet major effects to the nomogram itself, with subsequent reduced accuracy of the entire predictive tool. PSA-screening appears to be inevitable in many countries, and efforts should be directed towards the development of better methods for identifying insignificant prostate cancer in the preoperative patient, so as to minimize over diagnosis and overtreatment in patients with insignificant prostate cancer while not compromising on the detection of early and significant prostate cancer in others. ACKNOWLEDGEMENTS This work was supported by the Royal College of Surgeons in Ireland, The Urological Foundation and the Prostate Cancer Research Consortium, funded by the Irish Cancer Society. CONFLICT OF INTEREST None declared. REFERENCES 1 Oliver SE, May MT, Gunnell D. International trends in prostate-cancer mortality in the PSA ERA. Int J Cancer 2001; 92: Helgesen F, Holmberg L, Johansson JE, Bergström R, Adami HO. Trends in prostate cancer survival in Sweden, 1960 through 1988: evidence of increasing diagnosis of nonlethal tumors. J Natl Cancer Inst 1996; 88: Albertsen PC, Fryback DG, Storer BE, Kolon TF, Fine J. Long-term survival among men with conservatively treated localized prostate cancer. JAMA 1995; 274: Rullis I, Schaeffer JA, Lilien OM. Incidence of prostatic carcinoma in the elderly. Urology 1975; 6: Ilic D, O Connor D, Green S, Wilt T. Screening for prostate cancer: a Cochrane systematic review. Cancer Causes Control 2007; 18: Wilt TJ, Brawer MK, Barry MJ et al. The Prostate Cancer Intervention Versus Observation Trial: VA/NCI/AHRQ Cooperative Studies Program #407 (PIVOT): design and baseline results of a randomized controlled trial comparing radical prostatectomy to watchful waiting for men with clinically localized prostate cancer. Contemp Clin Trials 2009; 30: Schröder FH, Hugosson J, Roobol MJ et al. ERSPC Investigators. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360: Postma R, Schröder FH, van Leenders GJ et al. Cancer detection and cancer characteristics in the The European Randomized Screening for Prostate Cancer (ERSPC) Section Rotterdam. A comparison of two rounds of screening. Eur Urol 2007; 52: Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 1994; 271: Epstein JI, Pizov G, Walsh PC. Correlation of pathologic findings with progression following radical retropubic prostatectomy. Cancer 1993; 71: Epstein JI, Carmichael M, Partin AW, Walsh PC. Is tumor volume an independent predictor of progression following radical prostatectomy? A multivariate analysis of 185 clinical stage B adenocarcinomas of the prostate with five years follow-up. J Urol 1993; 149: Stamey TA, Freiha FS, McNeal JE, Redwine EA, Whittemore AS, Schmid HP. Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer 1993; 71: Epstein JI, Allsbrook WC, Amin MB, Egevad L, ISUP Grading Committee. The 2005 International Society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2005; 29: Helpap B, Egevad L. Modified Gleason Grading. An updated review. Histol Histopathol 2009; 24: Gleason DF. Classification of prostatic carcinomas. Cancer Chemother Rep 1966; 50: Helpap B, Egevad L. The significance of modified Gleason grading of prostatic carcinoma in biopsy and radical prostatectomy specimens. Virchows Arch 2006; 449: Helpap B, Egevad L. [The value of the modified Gleason grading system of
8 EPSTEIN CRITERIA FOR INSIGNIFICANT PROSTATE CANCER prostatic carcinoma in routine urological diagnostics]. Urologe A 2007; 46: Helpap B, Egevad L. [Clinical insignificance of prostate cancer, are there morphological findings]. Urologe A 2009; 48: Montironi R, Cheng L, Lopez-Beltran A et al. Original Gleason system versus 2005 ISUP modified Gleason system: the importance of indicating which system is used in the patient s pathology and clinical reports. Eur Urol 2010; 58: Epstein JI. An update of the Gleason grading system. J Urol 2010; 183: Bastian PJ, Mangold LA, Epstein JI, Partin AW. Characteristics of insignificant clinical T1c prostate tumors. A contemporary analysis. Cancer 2004; 101: Jeldres C, Suardi N, Walz J et al. Validation of the contemporary epstein criteria for insignificant prostate cancer in European men. Eur Urol 2008; 54: Louie-Johnsun M, Neill M, Treurnicht K, Jarmulowicz M, Eden C. Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically. BJU Int 2009; 104: Hekal IA, El-Tabey NA, Nabeeh MA et al. Validation of Epstein criteria of insignificant prostate cancer in Middle East patients. Int Urol Nephrol 2010; 42: Lee SE, Kim DS, Lee WK et al. Application of the Epstein criteria for prediction of clinically insignificant prostate cancer in Korean men. BJU Int 2010; 105: Lee MC, Dong F, Stephenson AJ, Jones JS, Magi-Galluzzi C, Klein EA. The Epstein Criteria predict for organconfined but not insignificant disease and a high likelihood of cure at Radical Prostatectomy. Eur Urol 2010; 58: De la Taille A, Antiphon P, Salomon L et al. Prospective evaluation of a 21- sample needle biopsy procedure to designed to improve the prostate cancer detection rate. Urology 2003; 61: Makhlouf AA, Krupski TL, Kunkle D, Theodorescu D. The effect of sampling more cores on the predictive accuracy of pathological grade and tumor distribution in the prostate biopsy. BJU Int 2004; 93: Nelson WG, DeMarzo AM, Isaacs WB. Prostate cancer. N Engl J Med 2003; 349: Helpap B, Egevad L. Correlation of modified Gleason grading with pt stage of prostatic carcinoma after radical prostatectomy. Anal Quant Cytol Histol 2008; 30: Wright JL, Salinas CA, Lin DW et al. Prostate cancer specific mortality and Gleason 7 disease differences in prostate cancer outcomes between cases with Gleason and Gleason tumors in a population based cohort. J Urol 2009; 182: Isbarn H, Wanner M, Salomon G et al. Long-term data on the survival of patients with prostate cancer treated with radical prostatectomy in the prostatespecific antigen era. BJU Int 2010; 106: Stark JR, Perner S, Stampfer MJ et al. Gleason score and lethal prostate cancer: does = 4 + 3? J Clin Oncol 2009; 27: Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 2010; 28: Isbarn H, Karakiewicz PI, Ahyai SA et al. Differences in histopathological and biochemical outcomes in patients with low Gleason score prostate cancer. BJU Int 2010; 105: Chan TY, Partin AW, Walsh PC, Epstein JI. Prognostic significance of Gleason Score 3+4 versus Gleason Score 4+3 tumor at radical prostatectomy. Urology 2000; 56: Lau WK, Blute ML, Bostwick DG, Weaver AL, Sebo TJ, Zincke H. Prognostic factors for survival of patients with pathological Gleason score 7 prostate cancer: differences in outcome between 3 and 4. J Urol 2001; 166: Khoddami SM, Shariat SF, Lotan Y et al. Predictive value of primary Gleason pattern 4 in patients with Gleason score 7 tumours treated with radical prostatectomy. BJU Int 2004; 94: Han M, Snow PB, Epstein JI et al. A neural network predicts progression for men with gleason score 3+4 versus 4+3 tumors after radical prostatectomy. Urology 2000; 56: Tollefson MK, Leibovich BC, Slezak JM, Zincke H, Blute ML. Long-term prognostic significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer: impact on prostate cancer specific survival. J Urol 2006; 175: Rasiah KK, Stricker PD, Haynes AM et al. Prognostic significance of Gleason pattern in patients with Gleason score 7 prostate carcinoma. Cancer 2003; 98: Kang DE, Fitzsimons NJ, Presti JC Jr et al. SEARCH Database Study Group. Risk stratification of men with Gleason score 7 to 10 tumors by primary and secondary Gleason Score: results from the SEARCH Database. Urology 2007; 70: Burdick MJ, Reddy CA, Ulchaker J et al. Comparison of biochemical relapse-free survival between primary Gleason score 3 and primary Gleason score 4 for biopsy Gleason score 7 prostate cancer. Int J Radiat Oncol Biol Phys 2009; 73: Correspondence: Sheng F. Oon, Conway Institute, University College Dublin, Dublin 4, Ireland. sheng-fei.oon@ucd.ie Abbreviations: AS, active surveillance; RFS, recurrence-free survival; ECE, extracapsular extension; SVI, seminal vesicle invasion; PSM, positive surgical margins; PNI, perineural invasion; LNI, lymph node invasion
Since the beginning of the prostate-specific antigen (PSA) era in the. Characteristics of Insignificant Clinical T1c Prostate Tumors
2001 Characteristics of Insignificant Clinical T1c Prostate Tumors A Contemporary Analysis Patrick J. Bastian, M.D. 1 Leslie A. Mangold, B.A., M.S. 1 Jonathan I. Epstein, M.D. 2 Alan W. Partin, M.D., Ph.D.
More informationPrognostic value of the Gleason score in prostate cancer
BJU International (22), 89, 538 542 Prognostic value of the Gleason score in prostate cancer L. EGEVAD, T. GRANFORS*, L. KARLBERG*, A. BERGH and P. STATTIN Department of Pathology and Cytology, Karolinska
More informationPercent Gleason pattern 4 in stratifying the prognosis of patients with intermediate-risk prostate cancer
Review Article Percent Gleason pattern 4 in stratifying the prognosis of patients with intermediate-risk prostate cancer Meenal Sharma 1, Hiroshi Miyamoto 1,2,3 1 Department of Pathology and Laboratory
More informationIn 2005, International Society of Urological Pathology
ORIGINAL ARTICLE Gleason Score 3+4=7 Prostate Cancer With Minimal Quantity of Gleason Pattern 4 on Needle Biopsy Is Associated With Low-risk Tumor in Radical Prostatectomy Specimen Cheng Cheng Huang, MD,*
More informationin 32%, T2c in 16% and T3 in 2% of patients.
BJUI Gleason 7 prostate cancer treated with lowdose-rate brachytherapy: lack of impact of primary Gleason pattern on biochemical failure Richard G. Stock, Joshua Berkowitz, Seth R. Blacksburg and Nelson
More informationUrological Society of Australia and New Zealand PSA Testing Policy 2009
Executive summary Urological Society of Australia and New Zealand PSA Testing Policy 2009 1. Prostate cancer is a major health problem and is the second leading cause of male cancer deaths in Australia
More informationCONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM
RAPID COMMUNICATION CME ARTICLE CONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM ALAN W. PARTIN, LESLIE A. MANGOLD, DANA M. LAMM, PATRICK C. WALSH, JONATHAN
More informationJ Clin Oncol 28: by American Society of Clinical Oncology INTRODUCTION
VOLUME 28 NUMBER 1 JANUARY 1 2010 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Clinical Results of Long-Term Follow-Up of a Large, Active Surveillance Cohort With Localized Prostate Cancer
More informationEarly outcomes of active surveillance for localized prostate cancer
Original Article ACTIVE SURVEILLANCE FOR LOCALIZED PROSTATE CANCER HARDIE et al. Early outcomes of active surveillance for localized prostate cancer CLAIRE HARDIE, CHRIS PARKER, ANDREW NORMAN*, ROS EELES,
More informationCorrelation of Gleason Scores Between Needle-Core Biopsy and Radical Prostatectomy Specimens in Patients with Prostate Cancer
ORIGINAL ARTICLE Correlation of Gleason Scores Between Needle-Core Biopsy and Radical Prostatectomy Specimens in Patients with Prostate Cancer Teng-Fu Hsieh, Chao-Hsian Chang, Wen-Chi Chen, Chien-Lung
More informationNIH Public Access Author Manuscript World J Urol. Author manuscript; available in PMC 2012 February 1.
NIH Public Access Author Manuscript Published in final edited form as: World J Urol. 2011 February ; 29(1): 11 14. doi:10.1007/s00345-010-0625-4. Significance of preoperative PSA velocity in men with low
More informationAre Clinically Insignificant Prostate Cancers Really Insignificant among Korean Men?
Original Article http://dx.doi.org/10.3349/ymj.2012.53.2.358 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 53(2):358-362, 2012 Are Clinically Insignificant Prostate Cancers Really Insignificant among
More informationAnatomic distribution and pathologic characterization of small-volume prostate cancer (o0.5 ml) in whole-mount prostatectomy specimens
& 2005 USCAP, Inc All rights reserved 0893-3952/05 $30.00 www.modernpathology.org Anatomic distribution and pathologic characterization of small-volume prostate cancer (o0.5 ml) in whole-mount prostatectomy
More informationDisease-specific death and metastasis do not occur in patients with Gleason score 6 at radical prostatectomy
Disease-specific death and metastasis do not occur in patients with at radical prostatectomy Charlotte F. Kweldam, Mark F. Wildhagen*, Chris H. Bangma* and Geert J.L.H. van Leenders Departments of Pathology,
More informationDivision of Oncology, S Orsola-Malpighi Hospital, Bologna, Italy. Department of Surgery, Cordoba University Medical School, Cordoba, Spain
Prostate cancer glands with cribriform architecture and with glomeruloid features should be considered as Gleason pattern 4 and not pattern 3 Daniele Minardi,1, Roberta Mazzucchelli,, Marina Scarpelli,
More informationGUIDELINES ON PROSTATE CANCER
10 G. Aus (chairman), C. Abbou, M. Bolla, A. Heidenreich, H-P. Schmid, H. van Poppel, J. Wolff, F. Zattoni Eur Urol 2001;40:97-101 Introduction Cancer of the prostate is now recognized as one of the principal
More informationSupplemental Information
Supplemental Information Prediction of Prostate Cancer Recurrence using Quantitative Phase Imaging Shamira Sridharan 1, Virgilia Macias 2, Krishnarao Tangella 3, André Kajdacsy-Balla 2 and Gabriel Popescu
More informationCorrespondence should be addressed to Taha Numan Yıkılmaz;
Advances in Medicine Volume 2016, Article ID 8639041, 5 pages http://dx.doi.org/10.1155/2016/8639041 Research Article External Validation of the Cancer of the Prostate Risk Assessment Postsurgical Score
More informationPost Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series
Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series E. Z. Neulander 1, Z. Wajsman 2 1 Department of Urology, Soroka UMC, Ben Gurion University,
More informationOncologic Outcomes of Patients With Gleason Score 7 and Tertiary Gleason Pattern 5 After Radical Prostatectomy
www.kjurology.org http://dx.doi.org/10.4111/kju.2013.54.9.587 Urological Oncology Oncologic Outcomes of Patients With Gleason Score 7 and Tertiary Gleason Pattern 5 After Radical Prostatectomy Yi-Hsueh
More informationPreoperative Gleason score, percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy
JBUON 2013; 18(4): 954-960 ISSN: 1107-0625, online ISSN: 2241-6293 www.jbuon.com E-mail: editorial_office@jbuon.com ORIGINAL ARTICLE Gleason score, percent of positive prostate and PSA in predicting biochemical
More informationThe Role of the Pathologist Active Surveillance for Prostate Cancer
The Role of the Pathologist Active Surveillance for Prostate Cancer Thomas M. Wheeler, M.D. W. L. Moody, Jr., Professor and Chair Department of Pathology & Immunology Baylor College of Medicine Houston,
More informationUC San Francisco UC San Francisco Previously Published Works
UC San Francisco UC San Francisco Previously Published Works Title The quantitative Gleason score improves prostate cancer risk assessment Permalink https://escholarship.org/uc/item/9wq7g6k5 Journal Cancer,
More informationRadical prostatectomy is the most widely used treatment. Partial Sampling of Radical Prostatectomy Specimens
ORIGINAL ARTICLE Detection of Positive Margins and Extraprostatic Extension Viacheslav Iremashvili, MD, PhD,* Soum D. Lokeshwar,* Mark S. Soloway, MD,* Lise tpelaez,md,w Saleem A. Umar, MD,w Murugesan
More informationProstate Cancer. Axiom. Overdetection Is A Small Issue. Reducing Morbidity and Mortality
Overdetection Is A Small Issue (in the context of decreasing prostate cancer mortality rates and with appropriate, effective, and high-quality treatment) Prostate Cancer Arises silently Dwells in a curable
More informationUndergrading and Understaging in Patients with Clinically Insignificant Prostate Cancer who Underwent Radical Prostatectomy
Clinical Urology Clinically Insignificant Prostate Cancer International Braz J Urol Vol. 36 (3): 292-299, May - June, 2010 doi: 10.1590/S1677-55382010000300005 Undergrading and Understaging in Patients
More informationDetection & Risk Stratification for Early Stage Prostate Cancer
Detection & Risk Stratification for Early Stage Prostate Cancer Andrew J. Stephenson, MD, FRCSC, FACS Chief, Urologic Oncology Glickman Urological and Kidney Institute Cleveland Clinic Risk Stratification:
More informationS1.04 PRINCIPAL CLINICIAN G1.01 COMMENTS S2.01 SPECIMEN LABELLED AS G2.01 *SPECIMEN DIMENSIONS (PROSTATE) S2.03 *SEMINAL VESICLES
Prostate Cancer Histopathology Reporting Proforma (Radical Prostatectomy) Includes the International Collaboration on Cancer reporting dataset denoted by * Family name Given name(s) Date of birth Indigenous
More informationPredictive criteria of insignificant prostate cancer: what is the correspondence of linear extent to percentage of cancer in a single core?
ORIGINAL ARTICLE Vol. 41 (2): 367-372, March - April, 2015 doi: 10.1590/S1677-5538.IBJU.2015.02.26 Predictive criteria of insignificant prostate cancer: what is the correspondence of linear extent to percentage
More informationImpact of tertiary Gleason pattern 5 on prostate cancer aggressiveness: Lessons from a contemporary single institution radical prostatectomy series
Asian Journal of Urology (2015) 2, 53e58 HOSTED BY Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/ajur ORIGINAL ARTICLE Impact of tertiary Gleason pattern
More informationPredictive Factors of Gleason Score Upgrading in Localized and Locally Advanced Prostate Cancer Diagnosed by Prostate Biopsy
www.kjurology.org DOI:10.4111/kju.2010.51.10.677 Urological Oncology Predictive Factors of Gleason Score Upgrading in Localized and Locally Advanced Prostate Cancer Diagnosed by Prostate Biopsy Seung Jin
More informationReducing overtreatment of prostate cancer by radical prostatectomy in Eastern Ontario: a population-based cohort study
Reducing overtreatment of prostate cancer by radical prostatectomy in Eastern Ontario: a population-based cohort study Luke Witherspoon MD MSc, Johnathan L. Lau BSc, Rodney H. Breau MD MSc, Christopher
More informationCase Discussions: Prostate Cancer
Case Discussions: Prostate Cancer Andrew J. Stephenson, MD FRCSC FACS Chief, Urologic Oncology Glickman Urological and Kidney Institute Cleveland Clinic Elevated PSA 1 54 yo, healthy male, family Hx of
More informationDiagnosis, pathology and prognosis including variant pathology
PROSTATE CANCER Diagnosis, pathology and prognosis including variant pathology No Conflict of Interest Universitat Autónoma de Barcelona F.Algaba Section of Pathology PROSTATE CANCER Diagnosis, pathology
More informationPercentage of Gleason Pattern 4 and 5 Predicts Survival After Radical Prostatectomy
1967 Percentage of Gleason Pattern 4 and 5 Predicts Survival After Radical Prostatectomy Liang Cheng, MD 1,2 Darrell D. Davidson, MD, PhD 1 Haiqun Lin, MD, PhD 3 Michael O. Koch, MD 2 1 Department of Pathology
More informationInterobserver reproducibility of modified Gleason score in radical prostatectomy specimens
Virchows Arch (2004) 445:17 21 DOI 10.1007/s00428-004-1034-0 ORIGINAL ARTICLE Axel Glaessgen Hans Hamberg Carl-Gustaf Pihl Birgitta Sundelin Bo Nilsson Lars Egevad Interobserver reproducibility of modified
More informationIntroduction. Key Words: high-grade prostatic intraepithelial neoplasia, HGPIN, radical prostatectomy, prostate biopsy, insignificant prostate cancer
Prostate cancer after initial high-grade prostatic intraepithelial neoplasia and benign prostate biopsy Premal Patel, MD, 1 Jasmir G. Nayak, MD, 1,2 Zlatica Biljetina, MD, 4 Bryan Donnelly, MD 3, Kiril
More informationShort ( 1 mm) positive surgical margin and risk of biochemical recurrence after radical prostatectomy
Short ( 1 mm) positive surgical margin and risk of biochemical recurrence after radical prostatectomy Sergey Shikanov, Pablo Marchetti, Vikas Desai, Aria Razmaria, Tatjana Antic, Hikmat Al-Ahmadie*, Gregory
More informationDong Hoon Lee, Ha Bum Jung, Seung Hwan Lee, Koon Ho Rha, Young Deuk Choi, Sung Jun Hong, Seung Choul Yang and Byung Ha Chung *
Jpn J Clin Oncol 2012;42(11)1079 1085 doi:10.1093/jjco/hys147 Advance Access Publication 17 September 2012 Comparison of Pathological Outcomes of Active Surveillance Candidates Who Underwent Radical Prostatectomy
More informationthree after the most recent release in These modifications were based primarily on data from clinical, not pathological, staging [1].
. 2010 BJU INTERNATIONAL Urological Oncology PATHOLOGICAL T2 SUB-DIVISIONS AS A PROGNOSTIC FACTOR IN PROSTATE CANCER CASO ET AL. BJUI BJU INTERNATIONAL Pathological T2 sub-divisions as a prognostic factor
More informationconcordance indices were calculated for the entire model and subsequently for each risk group.
; 2010 Urological Oncology ACCURACY OF KATTAN NOMOGRAM KORETS ET AL. BJUI Accuracy of the Kattan nomogram across prostate cancer risk-groups Ruslan Korets, Piruz Motamedinia, Olga Yeshchina, Manisha Desai
More informationProstate cancer ~ diagnosis and impact of pathology on prognosis ESMO 2017
Prostate cancer ~ diagnosis and impact of pathology on prognosis ESMO 2017 Dr Puay Hoon Tan Division of Pathology Singapore General Hospital Prostate cancer (acinar adenocarcinoma) Invasive carcinoma composed
More informationControversies in Prostate Cancer Screening
Controversies in Prostate Cancer Screening William J Catalona, MD Northwestern University Chicago Disclosure: Beckman Coulter, a manufacturer of PSA assays, provides research support PSA Screening Recommendations
More informationEUROPEAN UROLOGY 58 (2010)
EUROPEAN UROLOGY 58 (2010) 369 373 available at www.sciencedirect.com journal homepage: www.europeanurology.com Editorial Original Gleason System Versus 2005 ISUP Modified Gleason System: The Importance
More informationUpdate on Reporting Prostate Cancer Pathology
Update on Reporting Prostate Cancer Pathology Dr. Andrew J. Evans MD, PhD, FACP, FRCPC Consultant in Genitourinary Pathology University Health Network, Toronto, ON None Disclosures Learning Objectives
More informationAre Prostate Carcinoma Clinical Stages T1c and T2 Similar?
Clinical Urology Are Clinical Stages T1c and T2 Similar? International Braz J Urol Vol. 32 (2): 165-171, March - April, 2006 Are Prostate Carcinoma Clinical Stages T1c and T2 Similar? Athanase Billis,
More informationConceptual basis for active surveillance
Conceptual basis for active surveillance 1. Screening results in overdiagnosis 2. Clinically insignificant disease can be identified 3. All treatments have significant side effects and cost. 4. Delayed
More information3/23/2017. Significant Changes in Prostate Cancer Classification, Grading, Staging and Reporting. Disclosure of Relevant Financial Relationships
Disclosure of Relevant Financial Relationships Staging and Reporting of Prostate Cancer: Major Changes in 8 th Edition AJCC Staging and CAP Cancer Checklists USCAP requires that all planners (Education
More informationOutcomes of Radical Prostatectomy in Thai Men with Prostate Cancer
Original Article Outcomes of Radical Prostatectomy in Thai Men with Prostate Cancer Sunai Leewansangtong, Suchai Soontrapa, Chaiyong Nualyong, Sittiporn Srinualnad, Tawatchai Taweemonkongsap and Teerapon
More informationUnderstanding the risk of recurrence after primary treatment for prostate cancer. Aditya Bagrodia, MD
Understanding the risk of recurrence after primary treatment for prostate cancer Aditya Bagrodia, MD Aditya.bagrodia@utsouthwestern.edu 423-967-5848 Outline and objectives Prostate cancer demographics
More informationExpanded criteria for active surveillance in prostate cancer: a review of the current data
Review Article Expanded criteria for active surveillance in prostate cancer: a review of the current data Cameron Jones 1, Mina M. Fam 2, Benjamin J. Davies 2 1 University of Pittsburgh School of Medicine,
More informationA re-audit of Prostate biopsies from January to December 2010 and 2013.
A re-audit of Prostate biopsies from January to December 2010 and 2013. Dr. M S Siddiqui Consultant Histopathologist University Hospital of North Tees Stockton on Tees. Objectives To assess and compare
More informationOMPRN Pathology Matters Meeting 2017
OMPRN Pathology Matters Meeting 2017 Pathology of Aggressive Prostate Cancer Intraductal Carcinoma and Cribriform Carcinoma Dr. Michelle Downes, Staff Urologic Pathologist Sunnybrook Health Sciences Centre,
More informationOutcomes Following Negative Prostate Biopsy for Patients with Persistent Disease after Radiotherapy for Prostate Cancer
Clinical Urology Post-radiotherapy Prostate Biopsy for Recurrent Disease International Braz J Urol Vol. 36 (1): 44-48, January - February, 2010 doi: 10.1590/S1677-55382010000100007 Outcomes Following Negative
More informationEvaluation of pt2 subdivisions in the TNM staging system for prostate cancer
. JOURNAL COMPILATION 2008 BJU INTERNATIONAL Urological Oncology HONG et al. BJUI BJU INTERNATIONAL Evaluation of pt2 subdivisions in the TNM staging system for prostate cancer Sung Kyu Hong, Byung Kyu
More informationUpgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy
MOLECULAR AND CLINICAL ONCOLOGY 2: 1145-1149 Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy CAROLINA D'ELIA, MARIA ANGELA CERRUTO, ANTONIO CIOFFI, GIOVANNI NOVELLA,
More informationProstate Cancer Screening Guidelines in 2017
Prostate Cancer Screening Guidelines in 2017 Pocharapong Jenjitranant, M.D. Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital Prostate Specific Antigen (PSA) Prostate
More information1. Introduction. Department of Urology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba , Japan 2
Hindawi Publishing Corporation Prostate Cancer Volume 2011, Article ID 754382, 6 pages doi:10.1155/2011/754382 Clinical Study Development and External Validation of a Nomogram Predicting the Probability
More informationThe Role of Biopsy Core Number in Selecting Prostate Cancer Patients for Active Surveillance
EUROPEAN UROLOGY 56 (2009) 891 898 available at www.sciencedirect.com journal homepage: www.europeanurology.com Platinum Priority Prostate Cancer Editorial by Nazareno Suardi on pp. 899 900 of this issue
More informationInt. J. Cancer: 120, (2006)
Int. J. Cancer: 120, 170 174 (2006) ' 2006 Wiley-Liss, Inc. PSA doubling time predicts the outcome after active surveillance in screening-detected prostate cancer: Results from the European randomized
More informationestimating risk of BCR and risk of aggressive recurrence after RP was assessed using the concordance index, c.
. JOURNAL COMPILATION 2008 BJU INTERNATIONAL Urological Oncology PREDICTION OF AGGRESSIVE RECURRENCE AFTER RP SCHROECK et al. BJUI BJU INTERNATIONAL Do nomograms predict aggressive recurrence after radical
More informationCorrelation of Preoperative and Radical Prostatectomy Gleason Score: Examining the Predictors of Upgrade and Downgrade Results
ORIGINAL ARTICLE Correlation of Preoperative and Radical Prostatectomy Gleason Score: Examining the Predictors of Upgrade and Downgrade Results Gholamreza Pourmand, Shahram Gooran, Seyed Reza Hossieni,
More informationORIGINAL ARTICLE. Ja Hyeon Ku 1, Kyung Chul Moon 2, Sung Yong Cho 1, Cheol Kwak 1 and Hyeon Hoe Kim 1
(2011) 13, 248 253 ß 2011 AJA, SIMM & SJTU. All rights reserved 1008-682X/11 $32.00 www.nature.com/aja ORIGINAL ARTICLE Serum prostate-specific antigen value adjusted for non-cancerous prostate tissue
More informationInvasion of the muscular wall of the seminal vesicles by prostate cancer is generally
PROSTATE CANCER Seminal Vesicle Invasion by Prostate Cancer: Prognostic Significance and Therapeutic Implications Steven R. Potter, MD,* Jonathan I. Epstein, MD,* Alan W. Partin, MD, PhD* *The James Buchanan
More informationPrognostic Value of Surgical Margin Status for Biochemical Recurrence Following Radical Prostatectomy
Original Article Japanese Journal of Clinical Oncology Advance Access published January 17, 2008 Jpn J Clin Oncol doi:10.1093/jjco/hym135 Prognostic Value of Surgical Margin Status for Biochemical Recurrence
More informationProstate Cancer Grading, Staging and Reporting: An Update Cristina Magi-Galluzzi, MD, PhD
Prostate Cancer Grading, Staging and Reporting: An Update Cristina Magi-Galluzzi, MD, PhD Director, Genitourinary Pathology R.J. Tomsich Pathology & Laboratory Medicine Institute Professor of Pathology,
More informationProstate cancer volume estimations based on transrectal ultrasonography-guided biopsy in order to predict clinically significant prostate cancer
ORIGINAL ARTICLE Vol. 41 (3): 442-448, May - June, 2015 doi: 10.1590/S1677-5538.IBJU.2014.0251 Prostate cancer volume estimations based on transrectal ultrasonography-guided biopsy in order to predict
More informationInformation Content of Five Nomograms for Outcomes in Prostate Cancer
Anatomic Pathology / NOMOGRAMS IN PROSTATE CANCER Information Content of Five Nomograms for Outcomes in Prostate Cancer Tarek A. Bismar, MD, 1 Peter Humphrey, MD, 2 and Robin T. Vollmer, MD 3 Key Words:
More informationAJCC Cancer Staging 8 th Edition. Prostate Chapter 58. Executive Committee, AJCC. Professor and Director, Duke Prostate Center
AJCC Cancer Staging 8 th Edition Prostate Chapter 58 Judd W Moul, MD, FACS Executive Committee, AJCC Professor and Director, Duke Prostate Center Duke University Durham, North Carolina Validating science.
More informationPROSTATE BIOPSY: IS AGE IMPORTANT FOR DETERMINING THE PATHOLOGICAL FEATURES IN PROSTATE CANCER?
Clinical Urology International Braz J Urol Official Journal of the Brazilian Society of Urology AGE AND PATHOLOGY OF PROSTATE CA Vol. 31 (4): 331-337, July - August, 2005 PROSTATE BIOPSY: IS AGE IMPORTANT
More informationReceived: 11 Feb. 2013; Accepted: 7 Jun. 2013
ORIGINAL REPORT Inter-Observer Reproducibility before and after Web-Based Education in the Gleason Grading of the Prostate Adenocarcinoma among the Iranian Pathologists Alireza Abdollahi 1*, Sara Sheikhbahaei
More informationA NEURAL NETWORK PREDICTS PROGRESSION FOR MEN WITH GLEASON SCORE 3 4 VERSUS 4 3 TUMORS AFTER RADICAL PROSTATECTOMY
ADULT UROLOGY CME ARTICLE A NEURAL NETWORK PREDICTS PROGRESSION FOR MEN WITH GLEASON SCORE 3 4 VERSUS 4 3 TUMORS AFTER RADICAL PROSTATECTOMY MISOP HAN, PETER B. SNOW, JONATHAN I. EPSTEIN, THERESA Y. CHAN,
More informationInsignificant Prostate Cancer in Radical Prostatectomy Specimen: TimeTrends and Preoperative Prediction
European Urology European Urology 43 (2003) 455 460 Insignificant Prostate Cancer in Radical Prostatectomy Specimen: TimeTrends and Preoperative Prediction Herbert Augustin a,b, Peter G. Hammerer a,c,*,
More informationIRANIAN MEDICINE. Original Article
Arch Iran Med. vember 2018;21(11):518-523 http www.aimjournal.ir Original Article ARCHIVES OF IRANIAN MEDICINE Open Access Correlation of Prognostic Gleason Grade Grouping and Histopathological Parameters:
More informationincision into an otherwise organ-confined cancer [1,5].
28 The Authors. Journal compilation 28 BJU International Original Article IMPACT ON PROGRESSION OF POSITIVE SURGICAL MARGINS AFTER RP PFITZENMAIER et al. BJUI BJU INTERNATIONAL Positive surgical margins
More informationPSA. HMCK, p63, Racemase. HMCK, p63, Racemase
Case 1 67 year old male presented with gross hematuria H/o acute prostatitis & BPH Urethroscopy: small, polypoid growth with a broad base emanating from the left side of the verumontanum Serum PSA :7 ng/ml
More informationZonal Origin of Localized Prostate Cancer Does not Affect the Rate of Biochemical Recurrence after Radical Prostatectomy
european urology 51 (2007) 949 955 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer Zonal Origin of Localized Prostate Cancer Does not Affect the Rate of Biochemical
More informationElevated PSA. Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017
Elevated PSA Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017 Issues we will cover today.. The measurement of PSA,
More informationMultiinstitutional Validation of the UCSF Cancer of the Prostate Risk Assessment for Prediction of Recurrence After Radical Prostatectomy
2384 Multiinstitutional Validation of the UCSF Cancer of the Prostate Risk Assessment for Prediction of Recurrence After Radical Prostatectomy Matthew R. Cooperberg, MD, MPH 1 Stephen J. Freedland, MD
More informationPROSTATE CANCER SURVEILLANCE
PROSTATE CANCER SURVEILLANCE ESMO Preceptorship on Prostate Cancer Singapore, 15-16 November 2017 Rosa Nadal National Cancer Institute, NIH Bethesda, USA DISCLOSURE No conflicts of interest to declare
More informationProtocol. This trial protocol has been provided by the authors to give readers additional information about their work.
Protocol This trial protocol has been provided by the authors to give readers additional information about their work. Protocol for: Wilt TJ, Brawer MK, Jones KM, et al. Radical prostatectomy versus observation
More informationMetachronous anterior urethral metastasis of prostatic ductal adenocarcinoma
http://dx.doi.org/10.7180/kmj.2016.31.1.66 KMJ Case Report Metachronous anterior urethral metastasis of prostatic ductal adenocarcinoma Jeong Hyun Oh 1, Taek Sang Kim 1, Hyun Yul Rhew 1, Bong Kwon Chun
More informationEvaluation of the 7th American Joint Committee on Cancer TNM Staging System for Prostate Cancer in Point of Classification of Bladder Neck Invasion
Jpn J Clin Oncol 2013;43(2)184 188 doi:10.1093/jjco/hys196 Advance Access Publication 5 December 2012 Evaluation of the 7th American Joint Committee on Cancer TNM Staging System for Prostate Cancer in
More informationProstate Cancer: Is There Standard Treatment? Who has prostate cancer? In this article:
Focus on CME at l Université de Montréal Prostate Cancer: Is There Standard Treatment? Pierre I. Karakiewicz, MD, FRCSC; Paul Perrotte, MD, FRCSC; Fred Saad, MD, FRCSC In this article: 1. Risk factors
More informationUntreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course and Pathological Outcomes
Untreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course and Pathological Outcomes A. A. Hussein,* C. J. Welty,* N. Ameli,* J. E. Cowan, M. Leapman,*
More informationPredictive factors of late biochemical recurrence after radical prostatectomy
JJCO Japanese Journal of Clinical Oncology Japanese Journal of Clinical Oncology, 2017, 47(3) 233 238 doi: 10.1093/jjco/hyw181 Advance Access Publication Date: 9 December 2016 Original Article Original
More informationAccuracy of post-radiotherapy biopsy before salvage radical prostatectomy
Accuracy of post-radiotherapy biopsy before salvage radical prostatectomy Joshua J. Meeks, Marc Walker*, Melanie Bernstein, Matthew Kent and James A. Eastham Urology Service, Department of Surgery and
More informationIntroduction. Original Article
bs_bs_banner International Journal of Urology (2015) 22, 363 367 doi: 10.1111/iju.12704 Original Article Prostate-specific antigen level, stage or Gleason score: Which is best for predicting outcomes after
More informationGleason Scoring System 2017 JASREMAN DHILLON, MD ASSOCIATE PROFESSOR, DEPARTMENT OF ANATOMIC PATHOLOGY, MOFFITT CANCER CENTER, TAMPA, FLORIDA
Gleason Scoring System 2017 JASREMAN DHILLON, MD ASSOCIATE PROFESSOR, DEPARTMENT OF ANATOMIC PATHOLOGY, MOFFITT CANCER CENTER, TAMPA, FLORIDA Learners Objectives u Latest changes per ISUP 2014 that impact
More informationAccepted for publication 3 January 2005
Original Article RACIAL DIFFERENCES IN PSA DOUBLING TIME AND RECURRENCE TEWARI et al. In a multi-institutional study authors from the USA and Austria attempt to determine if there are differences in several
More informationPSA Screening and Prostate Cancer. Rishi Modh, MD
PSA Screening and Prostate Cancer Rishi Modh, MD ABOUT ME From Tampa Bay Went to Berkeley Prep University of Miami for Undergraduate - 4 years University of Miami for Medical School - 4 Years University
More informationA Comparative Analysis of Primary and Secondary Gleason Pattern Predictive Ability for Positive Surgical Margins after Radical Prostatectomy
168) Prague Medical Report / Vol. 112 (2011) No. 3, p. 168 176 A Comparative Analysis of Primary and Secondary Gleason Pattern Predictive Ability for Positive Surgical Margins after Radical Prostatectomy
More informationeuropean urology 52 (2007)
european urology 52 (2007) 733 745 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer Systematic Assessment of the Ability of the Number and Percentage of Positive
More informationPredictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era
ORIGINAL RESEARCH Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era Ahva Shahabi, MPH, PhD; 1* Raj Satkunasivam, MD; 2* Inderbir S. Gill, MD; 2 Gary Lieskovsky,
More informationInterval to biochemical recurrence following radical prostatectomy does not affect survival in men with low-risk prostate cancer
DOI 10.1007/s00345-013-1125-0 ORIGINAL ARTICLE Interval to biochemical recurrence following radical prostatectomy does not affect survival in men with low-risk prostate cancer D. M. Bolton A. Ta M. Bagnato
More informationUse of the cell cycle progression (CCP) score for predicting systemic disease and response to radiation of biochemical recurrence
Cancer Biomarkers 17 (2016) 83 88 83 DOI 10.3233/CBM-160620 IOS Press Use of the cell cycle progression (CCP) score for predicting systemic disease and response to radiation of biochemical recurrence Michael
More informationThe Impact of MRI-TRUS Cognitively Targeted Biopsy on the Incidence of Pathologic Upgrading After Radical Prostatectomy
Original Article World J Nephrol Urol. 2018;7(1):12-16 The Impact of MRI-TRUS Cognitively Targeted Biopsy on the Incidence of Pathologic Upgrading After Radical Prostatectomy Ragheed Saoud a, Albert El-Haj
More informationACCME/Disclosures. Cribriform Lesions of the Prostate. Case
Cribriform Lesions of the Prostate Ming Zhou, MD, PhD Departments of Pathology and Urology New York University Langone Medical Center New York, NY Ming.Zhou@NYUMC.ORG ACCME/Disclosures The USCAP requires
More informationBJUI. Follow-up of men with an elevated PCA3 score and a negative biopsy: does an elevated PCA3 score indeed predict the presence of prostate cancer?
. JOURNAL COMPILATION 2010 BJU INTERNATIONAL Urological Oncology FOLLOW-UP OF MEN WITH AN ELEVATED PCA3 SCORE AND A NEGATIVE BIOPSY REMZI ET AL. BJUI BJU INTERNATIONAL Follow-up of men with an elevated
More informationProstate Cancer: 2010 Guidelines Update
Prostate Cancer: 2010 Guidelines Update James L. Mohler, MD Chair, NCCN Prostate Cancer Panel Associate Director for Translational Research, Professor and Chair, Department of Urology, Roswell Park Cancer
More information