Preoperative characteristics of high-Gleason disease predictive of favourable pathological and clinical outcomes at radical prostatectomy

James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA.
BJU International (Impact Factor: 3.53). 02/2012; 110(8):1122-8. DOI: 10.1111/j.1464-410X.2012.10986.x
Source: PubMed


Study Type – Diagnostic (exploratory cohort)
Level of Evidence 2b
What's known on the subject? and What does the study add?
Men with high-risk prostate cancer experience recurrence, metastases and death at the highest rate in the prostate cancer population. Pathological stage at radical prostatectomy (RP) is the greatest predictor of recurrence and mortality in men with high-grade disease. Preoperative models predicting outcome after RP are skewed by the large proportion of men with low- and intermediate-risk features; there is a paucity of data about preoperative criteria to identify men with high-grade cancer who may benefit from RP.
The present study adds comprehensive biopsy data from a large cohort of men with high-grade prostate cancer at biopsy. By adding biopsy parameters, e.g. number of high-grade cores and >50% involvement of any core, to traditional predictors of outcome (prostate-specific antigen concentration, clinical stage and Gleason sum), we can better inform men who present with high-grade prostate cancer as to their risk of favourable or unfavourable disease at RP.

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    • "The relationship between Gleason score on needle-biopsy and pathological stage on radical prostatectomy has improved since the implementation of the modified Gleason score [15, 25]. For instance, 4315/5205 men (83%) with Gleason score 6 on biopsy had organ-confined disease (pT2) at radical prostatectomy, while increasing Gleason score on biopsy was strongly associated with extraprostatic extension (pT3a) and seminal vesicle invasion (pT3b) [25]. "
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    ABSTRACT: Prostate cancer is diverse in clinical presentation, histopathological tumor growth patterns, and survival. Therefore, individual assessment of a tumor's aggressive potential is crucial for clinical decision-making in men with prostate cancer. To date a large number of prognostic markers for prostate cancer have been described, most of them based on radical prostatectomy specimens. However, in order to affect clinical decision-making, validation of respective markers in pretreatment diagnostic needle-biopsies is essential. Here, we discuss established and promising histopathological and molecular parameters in diagnostic needle-biopsies.
    BioMed Research International 08/2014; 2014:12. DOI:10.1155/2014/341324 · 1.58 Impact Factor
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    • "Identifying the subset of patients with aggressive disease at the time of surgery (radical prostatectomy, RP) may allow for the use of more tailored therapeutic strategies. The probability of recurrent disease has been predicted on the basis of preoperative serum prostate-specific antigen (PSA) levels, sex steroids levels and other clinicopathological parameters such as tumor stage, biopsy Gleason score and surgical margins12345678910. Integration of gene expression profiling and clinical variables has increased prediction accuracy for recurrent and aggressive disease1112. "
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    ABSTRACT: Metastasis-associated protein 1 (MTA1), a negative epigenetic modifier, plays a critical role in prostate cancer (PCa) progression. We hypothesized that MTA1 overexpression in primary tumor tissues can predict PCa aggressiveness and metastasis. Immunohistochemical staining of MTA1 was done on archival PCa specimens from University of Mississippi Medical Center and University of Iowa. We found that nuclear MTA1 overexpression was positively correlated with the severity of disease progression reaching its highest levels in metastatic PCa. Nuclear MTA1 overexpression was significantly associated with Gleason > 7 tumors in African Americans but not in Caucasians. It was also a predictor of recurrent disease. We concluded that MTA1 nuclear overexpression may be a prognostic indicator and a future therapeutic target for aggressive PCa in African American men. Our findings may be useful for categorizing African American patients with a higher probability of recurrent disease and metastasis from those who are likely to remain metastasis-free.
    Scientific Reports 07/2013; 3(8 Supplement):2331. DOI:10.1038/srep02331 · 5.58 Impact Factor
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    • "For example, men with only one high-risk feature (compared with 2 or 3 features) have less biochemical recurrence, metastasis, and cancer-specific mortality, and a Gleason sum of 8-10 is the most adversely prognostic high-risk feature [23]. In addition, in men with high-risk prostate cancer according to a high Gleason score only (8-10) who underwent RP, the independent predictors of unfavorable pathology (seminal vesicle invasion or lymph node metastases) were a Gleason sum of 9-10, an increasing number of cores with a Gleason sum of 8-10, PSA >10 ng/ml, clinical stage ≥pT2b, and >50% core involvement [26]. Therefore, preoperative predictors can help to select the high-risk prostate cancer patients who are most likely to benefit from RP. "
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    ABSTRACT: Prostate cancer has a high prevalence and a rising incidence in many parts of the world. Although many screen-detected prostate cancers may be indolent, prostate cancer remains a major contributor to mortality in men. Therefore, the appropriate diagnosis and treatment of localized prostate cancer with lethal potential are of great importance. High-risk, localized prostate cancer has multiple definitions. Treatment options that should be individualized to each patient include observation, radical prostatectomy, external beam radiotherapy, brachytherapy, androgen deprivation, and combined modality treatment. Specific outcomes of radical prostatectomy and combined modality treatment for high-risk prostate cancer are reviewed. The rationale for extended pelvic lymphadenectomy at the time of surgery is discussed, as is the role for surgery in the setting of node-positive, high-risk disease. There is not yet a biomarker that accurately identifies lethal prostate cancer, but rigorous clinical studies have identified methods of optimizing oncologic outcomes in high-risk men.
    Korean journal of urology 12/2012; 53(12):815-20. DOI:10.4111/kju.2012.53.12.815
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