OncologyResults 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
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)
- et al.
Postoperative nomogram predicting the 9-year probability of prostate cancer recurrence after permanent prostate brachytherapy using radiation dose as a prognostic variable
Int J Radiat Oncol Biol Phys
(2010) - et al.
The prognostic significance of Gleason grade in patients treated with permanent prostate brachytherapy
Int J Radiat Oncol Biol Phys
(2003) - et al.
Clinical predictors of upgrading to Gleason grade 4 or 5 disease at radical prostatectomy: potential implications for patient selection for radiation and androgen suppression therapy
Int J Radiat Oncol Biol Phys
(1999) - et al.
Prostate cancers scored as Gleason 6 on prostate biopsy are frequently Gleason 7 tumors at radical prostatectomy: implication on outcome
J Urol
(2006) - et al.
ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer
Radiother Oncol
(2000) - et al.
American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy
Brachytherapy
(2012) - et al.
10-Year experience with I-125 prostate brachytherapy at the Princess Margaret Hospital: results for 1,100 patients
Int J Radiat Oncol Biol Phys
(2011) - et al.
Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference
Int J Radiat Oncol Biol Phys
(2006) - et al.
Prognostic significance of 5-year PSA value for predicting prostate cancer recurrence after brachytherapy alone and combined with hormonal therapy and/or external beam radiotherapy
Int J Radiat Oncol Biol Phys
(2009) Time to achieve a prostate specific antigen nadir of 0.2 ng/ml after simultaneous irradiation for prostate cancer
J Urol
(2002)
Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology
Eur Urol
Biopsy core number represents one of foremost predictors of clinically significant Gleason sum upgrading in patients with low-risk prostate cancer
Urology
Evidence for a biopsy derived grade artifact among larger prostate glands
J Urol
Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy: results from the SEARCH database
J Urol
Population-based study of biochemical and survival outcomes after permanent 125-I brachytherapy for low- and intermediate-risk prostate cancer
Urology
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 OncologyCitation 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 InternationalCitation 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 CancerCitation 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.
PSA-nadir at 1 year as a sound contemporary prognostic factor for low-dose-rate iodine-125 seeds brachytherapy
2014, World Journal of Urology
Financial Disclosure: The authors declare that they have no relevant financial interests.