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1005 PREDICTABILITY OF PSA DOUBLING TIME FOR UNFAVORABLE PATHOLOGY AT RADICAL PROSTATECTOMY: RESULTS FROM A PROSPECTIVE JAPANESE ACTIVE SURVEILLANCE COHORT
1005
Predictability of PSA doubling time for unfavorable pathology at radical prostatectomy: Results from a prospective Japanese active surveillance cohort
Sugimoto M.1, Shiraishi T.2, Tsunemori H.1, Saito Y.3, Kamoto T.4, Kakehi Y.1 1 Kagawa University, Dept. of Urology, Kagawa, Japan, 2Mie University, Dept. of Pathologic Oncology, Mie, Japan, 3Shizuoka Cancer Center, Dept. of Urology, Shizuoka, Japan, 4Miyazaki University, Dept. of Urology, Miyazaki, Japan Introduction & Objectives: The objective of this study is to investigate relationship between PSA doubling time (PSADT) during active surveillance (AS) and pathological findings at radical prostatectomy. Materials & Methods: This is a multi-center prospective one-arm observational study. Seven cancer center hospitals and six university hospitals in Japan participated in this study. 184 patients with biopsy proven prostate cancer that met the following criteria were enrolled into the present study between January 2000 and December 2003. The selection criteria included (1) stage T1cN0M0, (2) age 50–80, (3) serum prostate specific antigen (PSA) <20 ng/ml, (4) one or two positive cores per 6–12 systematic biopsy cores, (5) Gleason score <6, and (6) maximum cancer involvement in positive core <50%, while (4), (5), (6) were confirmed by a central pathologist (TS). Candidate patients were encouraged to choose AS and 165 patients consequently started AS. Triggers to start curable treatment were PSADT of 2 years or shorter or pathological progression at 1-year re-biopsy. Until March 2010, 37 patients underwent radical prostatectomy for various reasons during active surveillance program. Elapsed time to operation was 3-65 months (median 15 months). Radical prostatectomy (RP) was carried out due to on-protocol triggers in 21 patients. Patients were stratified according to PSADT (cut-off: 2 years or 3 years), and compared them with pathological findings in prostatectomy specimens between each groups. PSADT was assessed based on all PSA measurements prior to RP. Results: Of 37 patients, PSADT in 8 patients showed 2 years or less and 12 patients showed 3 years or less. Pathological parameters including Gleason score, lymphatic invasion, venous invasion, capsular invasion and perineural infiltration were compared between shorter and longer PSADT cohorts, but failed to find any significant difference (Table). Conclusions: PSADT during AS did not adequately predict pathological outcomes of RP following AS. Results of the present study indicate significance of repeat biopsy during AS. PSADT < 2yrs
>2yrs
< 3yrs
>3yrs
(n=8)
(n=29)
(n=12)
(n=25)
pathological Gleason score 6 or less
3
10
4
9
3+4
4
10
6
8
4+3
0
7
8 or more
1
2
1
6
p=0.459
1
2
10
17
p=0.296
2
8
3
3
p=0.446
9
22
1
1
11
24
p=0.623
Gleason score 3+4 or less
7
20
4+3 or more
1
9
p=0.326
lymphatic invasion (+)
2
4
(-)
6
25
(+)
1
1
(-)
7
28
p=0.315
venous invasion p=0.316
p=0.585
(+)
2
7
6
22
3
6
p=0.960
9
19
(+)
4
11
4
18
5
10
p=0.538
7
15
Introduction & Objectives: The aim of the study was to investigate the correlation of biopsy Gleason score and Gleason Score of the corresponding radical prostatectomy specimen, in patients who met the inclusion criteria for active surveillance and underwent radical retropubic prostatectomy. Materials & Methods: Consecutive biopsy and prostatectomy specimens from 212 cases of prostate cancer, which were diagnosed by prostatic needle biopsy and underwent consecutive radical prostatectomy, were reviewed retrospectively. We defined arbitrary thresholds as inclusion criteria for active surveillance: PSA<10, Gleason score ≤6 and ≤2 cancer-positive cores in needle biopsy. Results: 88 patients (41,5%) had identical Gleason scores on needle biopsy and prostatectomy specimens. Undergrading of needle biopsy specimen was seen in a total of 90 cases (42,4%) and overgrading was seen in 34 subjects (16,1%). Conclusions: We could show that a main part of patients treated by radical prostatectomy at our institution who would have met the inclusion criteria for active surveillance, had a higher Gleason score than obtained at the needle biopsy, and therefore would not have been destined to be treated in an active surveillance strategy. This should be considered in the preoperative decision process regarding the treatment of patients with localized prostate cancer.
1007
What is the role of transperineal template biopsies in the assessment of men on active surveillance?
Ayres B.E.1, Montgomery B.S.I.1, Barber N.J.1, Pereira N.1, Langley S.E.M.2, Denham P.3, Bott S.R.J.1 1 Frimley Park Hospital, Dept. of Urology, Camberley, United Kingdom, 2Royal Surrey County Hospital, Dept. of Urology, Guildford, United Kingdom, 3Frimley Park Hospital, Dept. of Histopathology, Camberley, United Kingdom Introduction & Objectives: There has been a stage migration in prostate cancer with an increasing incidence of localized disease. Active surveillance (AS) aims to reduce treatment-related morbidity by restricting radical treatment to patients whose cancer becomes more aggressive. The optimal method of surveillance remains unknown. Previously we have found that 16% of men on AS have more significant disease on repeat transrectal biopsies, which is consistent with other published AS cohorts. However, transperineal template biopsies in the diagnostic setting are more accurate than transrectal biopsies and we examined their role in the follow-up of men on AS. Materials & Methods: All patients suitable for AS (age ≤75yrs, PSA ≤15 ng/ml, Gleason ≤6, clinical stage T1-2a, ≤50% cores positive, ≤10mm cancer in a single core (similar to Royal Marsden criteria) and fit enough for radical therapy) were followed prospectively. Results: Between May 2006 and June 2010, 101 men on AS underwent restaging template biopsy after a median interval of 12 months (1-57) from diagnosis. At diagnosis the median age was 68 years (51-75) and median PSA was 6.5 ng/ ml (0.9-15). 34% of men had more significant prostate cancer (increase in grade or volume) on restaging template biopsy. 44% of these men had disease predominantly in the anterior part of the gland, an area often undersampled by transrectal biopsies. PSA velocity and PSA doubling time did not correlate with upgraded / upstaged tumours. In total, 33% of men stopped AS and had radical treatment. Conclusions: Around a third of men had more significant prostate cancer on transperineal template biopsies, which for most led to a change of management from AS to active treatment. PSA seems to be a poor indicator in AS.
The PCA3 score accurately predicts tumor volume and might help in selecting prostate cancer patients for active surveillance
Ploussard G., Durand X., Xylinas E., Moutereau S., Radulescu C., Forgue A., Terry S., Allory Y., Loric S., Salomon L., Vacherot F., De La Taille A. INSERM U955, Team 7, Dept. of Urology, CHU Mondor, Creteil, France p=0.947
perineural invasion (-)
Correlation of biopsy Gleason score and Gleason score of the corresponding radical prostatectomy specimen in patients who met the inclusion criteria for active surveillance
Skradski V., Bektic J., Horninger W. Universitätsklinik Innsbruck, Dept. of Urology, Innsbruck, Austria
1008
capsular invasion (-)
1006
p=0.923
Introduction & Objectives: The optimal selection of active surveillance (AS) prostate cancer (PCa) patients is currently being debated. To assess the impact of urinary PCA3 score as AS criterion instead of and in addition to the current criteria. Materials & Methods: We studied prospectively 106 consecutive low-risk PCa (PSA £10 ng/ml, clinical stage T1c-T2a and biopsy Gleason score 6) patients who underwent a PCA3 urine test before radical prostatectomy (RP). Performance of AS criteria (biopsy criteria, PCA3 score, PSA density and MRI findings) was tested in predicting 4 prognostic pathologic findings in RP specimens as follows: (i) pT3pT4 disease; (ii) overall unfavourable disease (OUD) defined by a pT3-4 disease and/or a pathological primary Gleason pattern 4; (iii) tumor volume <0.5 cm3; (iv) insignificant PCa.
Eur Urol Suppl 2011;10(2):313
Predictability of PSA doubling time for unfavorable pathology at radical prostatectomy: Results from a prospective Japanese active surveillance cohort
Sugimoto M.1, Shiraishi T.2, Tsunemori H.1, Saito Y.3, Kamoto T.4, Kakehi Y.1 1 Kagawa University, Dept. of Urology, Kagawa, Japan, 2Mie University, Dept. of Pathologic Oncology, Mie, Japan, 3Shizuoka Cancer Center, Dept. of Urology, Shizuoka, Japan, 4Miyazaki University, Dept. of Urology, Miyazaki, Japan Introduction & Objectives: The objective of this study is to investigate relationship between PSA doubling time (PSADT) during active surveillance (AS) and pathological findings at radical prostatectomy. Materials & Methods: This is a multi-center prospective one-arm observational study. Seven cancer center hospitals and six university hospitals in Japan participated in this study. 184 patients with biopsy proven prostate cancer that met the following criteria were enrolled into the present study between January 2000 and December 2003. The selection criteria included (1) stage T1cN0M0, (2) age 50–80, (3) serum prostate specific antigen (PSA) <20 ng/ml, (4) one or two positive cores per 6–12 systematic biopsy cores, (5) Gleason score <6, and (6) maximum cancer involvement in positive core <50%, while (4), (5), (6) were confirmed by a central pathologist (TS). Candidate patients were encouraged to choose AS and 165 patients consequently started AS. Triggers to start curable treatment were PSADT of 2 years or shorter or pathological progression at 1-year re-biopsy. Until March 2010, 37 patients underwent radical prostatectomy for various reasons during active surveillance program. Elapsed time to operation was 3-65 months (median 15 months). Radical prostatectomy (RP) was carried out due to on-protocol triggers in 21 patients. Patients were stratified according to PSADT (cut-off: 2 years or 3 years), and compared them with pathological findings in prostatectomy specimens between each groups. PSADT was assessed based on all PSA measurements prior to RP. Results: Of 37 patients, PSADT in 8 patients showed 2 years or less and 12 patients showed 3 years or less. Pathological parameters including Gleason score, lymphatic invasion, venous invasion, capsular invasion and perineural infiltration were compared between shorter and longer PSADT cohorts, but failed to find any significant difference (Table). Conclusions: PSADT during AS did not adequately predict pathological outcomes of RP following AS. Results of the present study indicate significance of repeat biopsy during AS. PSADT < 2yrs
>2yrs
< 3yrs
>3yrs
(n=8)
(n=29)
(n=12)
(n=25)
pathological Gleason score 6 or less
3
10
4
9
3+4
4
10
6
8
4+3
0
7
8 or more
1
2
1
6
p=0.459
1
2
10
17
p=0.296
2
8
3
3
p=0.446
9
22
1
1
11
24
p=0.623
Gleason score 3+4 or less
7
20
4+3 or more
1
9
p=0.326
lymphatic invasion (+)
2
4
(-)
6
25
(+)
1
1
(-)
7
28
p=0.315
venous invasion p=0.316
p=0.585
(+)
2
7
6
22
3
6
p=0.960
9
19
(+)
4
11
4
18
5
10
p=0.538
7
15
Introduction & Objectives: The aim of the study was to investigate the correlation of biopsy Gleason score and Gleason Score of the corresponding radical prostatectomy specimen, in patients who met the inclusion criteria for active surveillance and underwent radical retropubic prostatectomy. Materials & Methods: Consecutive biopsy and prostatectomy specimens from 212 cases of prostate cancer, which were diagnosed by prostatic needle biopsy and underwent consecutive radical prostatectomy, were reviewed retrospectively. We defined arbitrary thresholds as inclusion criteria for active surveillance: PSA<10, Gleason score ≤6 and ≤2 cancer-positive cores in needle biopsy. Results: 88 patients (41,5%) had identical Gleason scores on needle biopsy and prostatectomy specimens. Undergrading of needle biopsy specimen was seen in a total of 90 cases (42,4%) and overgrading was seen in 34 subjects (16,1%). Conclusions: We could show that a main part of patients treated by radical prostatectomy at our institution who would have met the inclusion criteria for active surveillance, had a higher Gleason score than obtained at the needle biopsy, and therefore would not have been destined to be treated in an active surveillance strategy. This should be considered in the preoperative decision process regarding the treatment of patients with localized prostate cancer.
1007
What is the role of transperineal template biopsies in the assessment of men on active surveillance?
Ayres B.E.1, Montgomery B.S.I.1, Barber N.J.1, Pereira N.1, Langley S.E.M.2, Denham P.3, Bott S.R.J.1 1 Frimley Park Hospital, Dept. of Urology, Camberley, United Kingdom, 2Royal Surrey County Hospital, Dept. of Urology, Guildford, United Kingdom, 3Frimley Park Hospital, Dept. of Histopathology, Camberley, United Kingdom Introduction & Objectives: There has been a stage migration in prostate cancer with an increasing incidence of localized disease. Active surveillance (AS) aims to reduce treatment-related morbidity by restricting radical treatment to patients whose cancer becomes more aggressive. The optimal method of surveillance remains unknown. Previously we have found that 16% of men on AS have more significant disease on repeat transrectal biopsies, which is consistent with other published AS cohorts. However, transperineal template biopsies in the diagnostic setting are more accurate than transrectal biopsies and we examined their role in the follow-up of men on AS. Materials & Methods: All patients suitable for AS (age ≤75yrs, PSA ≤15 ng/ml, Gleason ≤6, clinical stage T1-2a, ≤50% cores positive, ≤10mm cancer in a single core (similar to Royal Marsden criteria) and fit enough for radical therapy) were followed prospectively. Results: Between May 2006 and June 2010, 101 men on AS underwent restaging template biopsy after a median interval of 12 months (1-57) from diagnosis. At diagnosis the median age was 68 years (51-75) and median PSA was 6.5 ng/ ml (0.9-15). 34% of men had more significant prostate cancer (increase in grade or volume) on restaging template biopsy. 44% of these men had disease predominantly in the anterior part of the gland, an area often undersampled by transrectal biopsies. PSA velocity and PSA doubling time did not correlate with upgraded / upstaged tumours. In total, 33% of men stopped AS and had radical treatment. Conclusions: Around a third of men had more significant prostate cancer on transperineal template biopsies, which for most led to a change of management from AS to active treatment. PSA seems to be a poor indicator in AS.
The PCA3 score accurately predicts tumor volume and might help in selecting prostate cancer patients for active surveillance
Ploussard G., Durand X., Xylinas E., Moutereau S., Radulescu C., Forgue A., Terry S., Allory Y., Loric S., Salomon L., Vacherot F., De La Taille A. INSERM U955, Team 7, Dept. of Urology, CHU Mondor, Creteil, France p=0.947
perineural invasion (-)
Correlation of biopsy Gleason score and Gleason score of the corresponding radical prostatectomy specimen in patients who met the inclusion criteria for active surveillance
Skradski V., Bektic J., Horninger W. Universitätsklinik Innsbruck, Dept. of Urology, Innsbruck, Austria
1008
capsular invasion (-)
1006
p=0.923
Introduction & Objectives: The optimal selection of active surveillance (AS) prostate cancer (PCa) patients is currently being debated. To assess the impact of urinary PCA3 score as AS criterion instead of and in addition to the current criteria. Materials & Methods: We studied prospectively 106 consecutive low-risk PCa (PSA £10 ng/ml, clinical stage T1c-T2a and biopsy Gleason score 6) patients who underwent a PCA3 urine test before radical prostatectomy (RP). Performance of AS criteria (biopsy criteria, PCA3 score, PSA density and MRI findings) was tested in predicting 4 prognostic pathologic findings in RP specimens as follows: (i) pT3pT4 disease; (ii) overall unfavourable disease (OUD) defined by a pT3-4 disease and/or a pathological primary Gleason pattern 4; (iii) tumor volume <0.5 cm3; (iv) insignificant PCa.
Eur Urol Suppl 2011;10(2):313