Histological Findings in Very Low Risk Prostate Cancer Patients Managed with Radical Prostatectomy
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Sep 27, 2017
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Objectives: To describe the histological findings in patients with prostate cancer (PCa) clinically classified as very low risk who underwent treatment with radical prostatectomy (RP). Material and methods: A retrospective observational study was conducted. Clinical records of patients who underwent RP between 2007-2015 who met Epstein criteria for very low risk disease were reviewed. Histological diagnosis was described and analyzed to determine if such criteria predicted very low risk. Results: A total of 609 records were reviewed; 83 (13.6%) met Epstein’s criteria. Mean age was 59 (SD±7) years and median PSA at diagnosis was 5.4 ng/dl (IQR 4.3 – 6.8). Pathology showed a median tumor volume of 4% (IQR 1 – 10%). Gleason score was 3+3 in 55 (66.3%) cases, but 28 (33.7%) were reclassified to a greater score. Two (2.4%) patients were reclassified as pT3a, 80 (96.4%) as pT2 and 1 (1.2%) was found to be pT0. In those subjected to pelvic lymphadenectomy (42.2%) no positive lymph nodes were found. Conclusions: Up to one-third of the patients clinically classified with very low risk PCa had a greater Gleason score. Only 3% had locally advanced tumors, which is comparable to previous studies. Epstein’s criteria seem to be adequate in predicting organ-confined disease.
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References
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15. Epstein JI, Chan DW, Sokoll LJ, et al. Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. J Urol. 1998;160:2407-11.
16. Kattan MW, Eastham JA, Wheeler TM, et al. Counseling men with prostate cancer: a nomogram for predicting the presence of small, moderately differentiated confined tumors. J Urol. 2003;170:1792-7.
17. Chun FK-H, Steuber T, Erbersdobler A, et al. Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol. 2006;49:820-6.
18. Bastian PJ, Mangold LA, Epstein JI, Partin AW. Characteristics of insignificant clinical T1c prostate tumors: A contemporary analysis. Cancer. 2004;101:2001-5.
19. Beauval JB, Ploussard G, Soulié M, Pfister C, Vanagt S, Vincendeau S, Larue S. Pathologic findings in radical prostatectomy specimens from patients eligible for active surveillance with highly selective criteria: a multicenter study. J. Urology. 2012;80:656-60.
20. Tosoian J, Sundi D, Trock BJ, Landis P, Epstein J, Schaeffer EM. Pathologic outcomes in favorable-risk prostate cancer: comparative analysis of men electing active surveillance and immediate surgery. Eur Urol. 2016;69:575-81.
21. Kulkarni JN, Valsangkar RS, Jadhav YR, Singh DP. Impact of Gleason pattern up gradation after radical prostatectomy for carcinoma prostate patients with low biopsy score (≤6). J Cancer Res Ther. 2011;7:459-62.
22. Cookson MS, Fleshner NE, Soloway SM, Fair WR. Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J Urol. 1997;157:559-62.
23. Chang JM, Lee HJ, Lee SE, et al. Pictorial review: unusual tumors involving the prostate: radiological-pathological findings. Br J Radiol. 2008;81:907-15.
24. Dall’Era MA, Konety BR, Cowan JE, et al. Active surveillance for the management of prostate cancer in a contemporary cohort. Cancer. 2008;112:2664-70.
25. Villers A, Lemaitre L, Haffner J, Puech P. Current status of MRI for the diagnosis, staging and prognosis of prostate cancer: Implications for local therapy and active surveillance. Curr Opin Urol. 2009;19:274-82.
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27. Bouchelouche K, Choyke PL. Prostate-specific membrane antigen positron emission tomography in prostate cancer: A step toward personalized medicine. Curr Opin Oncol. 2016;28:216-21.
2. Venderos Lionne DF, Roobol M, De Hoogh A. Active surveillance for prostate cáncer: A legal perspective. Am J Clin Exp Urol. 2014;2(4):323-31.
3. Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L. et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33(3):272-7.
4. Schroder F, Roach M, Scardino P. Management of prostate cancer. N Engl J Med. 2008;359:2605-9.
5. Tosoian JJ, Carter HB, Lepor A, Loeb S. Active surveillance for prostate cancer: current evidence and contemporary state of practice. Nat Rev Urol. 2016;13(4):205-15.
6. Epstein JI, Walsh PC, Carmichael M, et al. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA. 1994;271:368-74.
7. Wein A, Kavoussi L, Partin A, Peters C. Campbell-Walsh urology. 10 th ed. Philadelphia: Elsevier; 2012.
8. Klotz L. Active surveillance for favorable-risk prostate cancer: Who, how and why? Nat Clin Pract Oncol. 2007;4:692-8.
9. D’Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280(11):969-74.
10. Laurence. Active surveillance for prostate cancer: Trials and tribulations. World J Urol. 2008;26:437-42.
11. Parker C. Active surveillance: towards a new paradigm in the management of early prostate cancer. Lancet Oncol. 2004;5:101-6.
12. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer [internet]. Available from: http://www.nccn.org/professionals/physician_gls/PDF/prostate.pdf
13. American Urological Association. Guideline for the management of clinically localized prostate cancer [internet]. Available from: https://www.auanet.org/documents/education/clinical-
guidance/Prostate-Cancer.pdf
14. Jeldres C, Suardi N, Walz J, et al. Validation of the contemporary Epstein criteria for insignificant prostate cancer in European men. Eur Urol. 2008;54:1306-13.
15. Epstein JI, Chan DW, Sokoll LJ, et al. Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. J Urol. 1998;160:2407-11.
16. Kattan MW, Eastham JA, Wheeler TM, et al. Counseling men with prostate cancer: a nomogram for predicting the presence of small, moderately differentiated confined tumors. J Urol. 2003;170:1792-7.
17. Chun FK-H, Steuber T, Erbersdobler A, et al. Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol. 2006;49:820-6.
18. Bastian PJ, Mangold LA, Epstein JI, Partin AW. Characteristics of insignificant clinical T1c prostate tumors: A contemporary analysis. Cancer. 2004;101:2001-5.
19. Beauval JB, Ploussard G, Soulié M, Pfister C, Vanagt S, Vincendeau S, Larue S. Pathologic findings in radical prostatectomy specimens from patients eligible for active surveillance with highly selective criteria: a multicenter study. J. Urology. 2012;80:656-60.
20. Tosoian J, Sundi D, Trock BJ, Landis P, Epstein J, Schaeffer EM. Pathologic outcomes in favorable-risk prostate cancer: comparative analysis of men electing active surveillance and immediate surgery. Eur Urol. 2016;69:575-81.
21. Kulkarni JN, Valsangkar RS, Jadhav YR, Singh DP. Impact of Gleason pattern up gradation after radical prostatectomy for carcinoma prostate patients with low biopsy score (≤6). J Cancer Res Ther. 2011;7:459-62.
22. Cookson MS, Fleshner NE, Soloway SM, Fair WR. Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J Urol. 1997;157:559-62.
23. Chang JM, Lee HJ, Lee SE, et al. Pictorial review: unusual tumors involving the prostate: radiological-pathological findings. Br J Radiol. 2008;81:907-15.
24. Dall’Era MA, Konety BR, Cowan JE, et al. Active surveillance for the management of prostate cancer in a contemporary cohort. Cancer. 2008;112:2664-70.
25. Villers A, Lemaitre L, Haffner J, Puech P. Current status of MRI for the diagnosis, staging and prognosis of prostate cancer: Implications for local therapy and active surveillance. Curr Opin Urol. 2009;19:274-82.
26. Lindenberg L, AhLman M, Turkbey B, Mena E, Choyke P. Advancement of MR and PET/MR in Prostate Cancer. Semin Nucl Med. 2016;46(6):536-43.
27. Bouchelouche K, Choyke PL. Prostate-specific membrane antigen positron emission tomography in prostate cancer: A step toward personalized medicine. Curr Opin Oncol. 2016;28:216-21.
Como Citar
Trujillo Ordoñez, C. G., Ramos Hernández, A., Robledo Cárdenas, D., Mariño Álvarez, Ángela M., Cataño Cataño, J. G., Caicedo Cárdenas, J. I., Escobar Monroy, R., & Plata Salazar, M. (2017). Histological Findings in Very Low Risk Prostate Cancer Patients Managed with Radical Prostatectomy. Universitas Medica, 58(3). https://doi.org/10.11144/Javeriana.umed58-3.risk
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