Elsevier

Urology

Volume 80, Issue 3, September 2012, Pages 649-655
Urology

Oncology
Results of a Surgically Derived Nomogram to Predict Gleason Score Upgrading Applied to a Cohort of Patients With “Favorable-risk” Prostate Cancer Treated With Permanent Seed Brachytherapy

https://doi.org/10.1016/j.urology.2012.03.051Get rights and content

Objective

To examine a 2-year cohort of patients treated with brachytherapy to determine the likelihood of unfavorable pathologic features using a nomogram recently developed at our center to estimate the likelihood of Gleason score upgrading for patients with favorable prostate cancer undergoing radical prostatectomy. The brachytherapy outcomes for patients with a high likelihood of upgrading were compared with those with a lower likelihood to affirm the effectiveness of brachytherapy in this setting. Information on the likelihood of upgrading could help in the selection between active treatment and surveillance for patients with favorable-risk prostate cancer.

Methods

The records were examined for 259 men undergoing prostate brachytherapy in 2006 to 2007, of whom 217 had favorable risk cancer. The likelihood of Gleason score upgrading (GSU) was predicted using the radical prostatectomy-derived nomogram.

Results

The median age was 62 years (range 44-77), and the median prostate-specific antigen level was 4.71 ng/mL (range 0.56-9.87). Central pathology review was available for 88%, and 83% had undergone extended biopsies. Two men had received androgen deprivation therapy for prostate downsizing. The median predicted likelihood of GSU was 51.2%. The median prostate-specific antigen level for 199 patients without treatment failure after a median follow-up of 4.2 years in this cohort was 0.07 ng/mL (interquartile range undetectable to 0.23).

Conclusion

In the present cohort of patients with favorable-risk prostate cancer treated with brachytherapy, the estimated likelihood of GSU using the surgically derived nomogram was substantial. Follow-up with prostate-specific antigen measurement has indicated that brachytherapy is a highly effective treatment option despite less favorable clinical and pathologic factors. Patients should not be discouraged from brachytherapy on the basis of a high likelihood of GSU.

Section snippets

Study Population

From January 1, 2006 to December 31, 2007, 259 patients received permanent iodine-125 BT at Princess Margaret Hospital. The 217 patients with favorable risk disease according to the Canadian Consensus Guidelines11 (clinical Stage T1 or T2, biopsy Gleason score ≤6, and pretreatment prostate-specific antigen [PSA] ≤10 ng/mL), were included in the present study. All patients had undergone diagnostic transrectal prostate ultrasonography (TRUS) at Princess Margaret Hospital, and 88% had received

Results

In 2006 and 2007, 217 patients with favorable-risk prostate cancer were treated with BT. The clinical and pathologic information was available for 204 patients to allow completion of the Kulkarni nomogram. The baseline characteristics of the patients are listed in Table 1. The median prostate volume was 33.4 cm3 (range 15.0-72.3). Data from the central pathology review was available for 88%, and 83% had undergone extended biopsies. The median percentage of positive cores was 25% (range

Comment

In a population of men with favorable-risk prostate cancer treated with BT, the estimated likelihood of GSU using this surgically derived nomogram from the same center was substantial. Long-term data on the biochemical recurrence rates and survival for patients included in the current study are not yet available, although our cohort was taken from a larger population of patients treated during a 10-year period. For that larger population, the 7-year disease-free survival rate was 95.2%.9

Conclusions

A high likelihood of GSU was predicted using a surgically derived nomogram from the same institution for a cohort of patients with favorable-risk prostate cancer treated with permanent seed BT. The PSA outcomes have indicated that BT is equally effective in those patients predicted to have a high likelihood of occult high-grade disease. Permanent seed BT is a highly effective treatment option for patients with favorable-risk disease even in the presence of less favorable clinical and pathologic

References (30)

Cited by (5)

  • Validation of the Combination Gleason Score as an Independent Favorable Prognostic Factor in Prostate Cancer Treated With Dose-Escalated Radiation Therapy

    2023, Practical Radiation Oncology
    Citation Excerpt :

    It has been demonstrated that the standard transrectal ultrasound guided biopsy may not reflect the true extent of disease. GS upgrading (GSU) and downgrading at time of prostatectomy is estimated to be as high as 33% to 50%.6-8 In an attempt to narrow the disparity between transrectal ultrasound guided biopsy and prostatectomy, Phillips et al9 evaluated the utility of including a combination of the lowest and highest GS at biopsy (ComboGS) with respect to GSU and prostate cancer specific survival (PCSM).

  • Gleason group concordance between biopsy and radical prostatectomy specimens: A cohort study from Prostate Cancer Outcome Registry – Victoria

    2016, Prostate International
    Citation Excerpt :

    Studies have demonstrated significant histopathological discordance rates up to 62.8%,4 with inaccurate biopsy specimens more typically undergraded than overgraded when compared with RP. Many studies have examined variables that may help to predict pathological upgrading of GS from biopsy to RP, including high prostate-specific antigen (PSA) level,5 advanced patient age,5 the level of pathologist expertise,6 time from biopsy to surgery,7 serum testosterone level,8 treatment with brachytherapy,9 percentage tumor involvement,10 prostate size or volume,1 and number of core biopsies.11 A new PCa prognostic grading system has been proposed based on the contemporary GS, which is known as Gleason groups (GGs).

  • The effect of differing gleason scores at biopsy on the odds of upgrading and the risk of death from prostate cancer

    2014, Clinical Genitourinary Cancer
    Citation Excerpt :

    Approximately one-third of men with clinically localized PCa will be upgraded at the time of radical prostatectomy (RP) because of undersampling of occult high-grade PCa at the time of transrectal ultrasound-guided (TRUS) prostate needle biopsy (PNB) and therefore have a worse prognosis than would have been predicted based on the highest biopsy GS.6-9 To improve counseling regarding prognosis, investigators have identified predictors of upgrading based on information available at the time of diagnosis.6-16 However, only a single study17 has observed that the presence of differing GSs (ie, a lower in addition to the highest GS) at biopsy (termed ComboGS in the current study) lowered the odds of upgrading at the time of RP.

Financial Disclosure: The authors declare that they have no relevant financial interests.

View full text