Effect of preoperative PI-RADS assessment on pathological outcomes in patients who underwent radical prostatectomy
Qianyu PengLili XuGumuyang ZhangDaming ZhangJiahui ZhangXiaoxiao ZhangXin BaiLi ChenZhengyu JinHao Sun
0
Citation
28
Reference
10
Related Paper
Abstract:
Abstract Objective To assess the effect of preoperative MRI with standardized Prostate Imaging–Reporting and Data System (PI-RADS) assessment on pathological outcomes in prostate cancer (PCa) patients who underwent radical prostatectomy (RP). Patients and methods This retrospective cohort study included patients who had undergone prostate MRI and subsequent RP for PCa between January 2017 and December 2022. The patients were divided into the PI-RADS group and the non-PI-RADS group according to evaluation scheme of presurgery MRI. The preoperative characteristics and postoperative outcomes were retrieved and analyzed. The pathological outcomes included pathological T stage (pT2 vs. pT3–4) and positive surgical margins (PSMs). Patients were further stratified according to statistically significant preoperative variables to assess the difference in pathological outcomes. A propensity score matching based on the above preoperative characteristics was additionally performed. Results A total of 380 patients were included in this study, with 201 patients in the PI-RADS group and 179 in the non-PI-RADS group. The two groups had similar preoperative characteristics, except for clinical T stage (cT). As for pathological outcomes, the PI-RADS group showed a significantly lower percentage of pT3–4 (21.4% vs. 48.0%, p < 0.001), a lower percentage of PSMs (31.3% vs. 40.9%, p = 0.055), and a higher concordance between the cT and pT (79.1% vs. 64.8%, p = 0.003). The PI-RADS group also showed a lower proportion of pT3–4 (p < 0.001) in the cT1–2 subgroup and the cohort after propensity score matching. The PSM rate of cT3 patients was reduced by 39.2% in the PI-RADS group but without statistical significance (p = 0.089). Conclusions Preoperative MRI with standardized PI-RADS assessment could benefit the decision-making of patients by reducing the rate of pathologically confirmed non-organ-confined PCa after RP and slightly reducing the PSM rate compared with non-PI-RADS assessment.Keywords:
Concordance
Pathological staging
Concordance
Medication Reconciliation
Cite
Citations (0)
Data for pathological staging of radical prostatectomy specimens reported in the Section of Histopathology of a large tertiary care hospital in Pakistan were compared with sextant biopsy findings to determine whether clinically localized disease is actually localized pathologically.A study was conducted of radical prostatectomy specimens reported in the Section of Histopathology from Jan 2001 to July 2008, with cases staged according to the pathologic TNM staging system. Other variables such as amount of tumor in prostatectomy specimens and lobes affected were also determined.Out of 65 cases, 83.3% were clinical stage TIc. 29.2% were pT3a, 24.6% were pT3b and 3.1% were pT4. Therefore, in the majority of cases, disease was not localized to the prostate and perineurial invasion was seen in all. Comparison with biopsy results showed Gleason's grade to be altered in 20% cases.The large majority of prostatic carcinomas in Pakistan are advanced cancers with pathologic stage more advanced than evident on clinical staging. On average, tumors involved 35-40% of the prostate with a particular preponderance in posterior lobes.
Histopathology
Pathological staging
Prostatic adenocarcinoma
Cite
Citations (2)
Although some scholars suggest that racial/ethnic concordance between physicians and patients will do much to eliminate disparities in medical care, the evidence for concordance effects is mixed. Using nationally representative data with an oversample of blacks and Latinos, this study examines a variety of topics, including beliefs about and preferences for concordance, the effects of concordance on patient experiences, and interactions between expectations and experiences. The results point to the limited effects of concordance in general but illuminate for whom concordance matters most. The results encourage more nuanced and contingent theories. They suggest that racial/ethnic concordance holds little salience in the minds of most black and Latino patients and that discordance has little effect. Nevertheless, there is some evidence that concordance has a positive effect among those who prefer concordance-thus the apparent effects of concordance might reflect the effects of patient choice more than concordance per se. The conclusion sketches policy implications, including the merits of promoting concordance among targeted groups of patients, even in the absence of overall effects on disparities.
Concordance
Salience (neuroscience)
Cite
Citations (53)
Concordance
Prostate biopsy
Cite
Citations (7)
Cite
Citations (0)
Concordance
Cite
Citations (0)
Local treatment following radical prostatectomy used in prostate cancer patients with risk factors of recurrence or with biochemical recurrence and/or local recurrence consists of adjuvant and salvage radiotherapy. The postprostatectomy biochemical failure, according to some studies based on ten years of follow-up, is estimated at one-third of patients. It remains challenging to extract those patients who may benefit from implementing radiotherapy while minimizing the risk of overtreatment. Adjuvant radiotherapy is considered in a situation of the absence of biochemical recurrence with the presence of high-risk features in pathological staging defined as positive surgical margins (R1), extraprostatic extension (pT3a), or seminal vesicle invasion (pT3b) and Gleason score 8-10. Failure rate after RP is found approximately in 50% of men diagnosed with adverse pathologic features. It is recommended to implement adjuvant radiotherapy in case of very aggressive form of prostate cancer (pT3b, Gleason 8-10) without awaiting biochemical recurrence. However, salvage radiotherapy represents a therapeutic option for patients experiencing biochemical recurrence in case of no distant metastasis. Monitoring of serum PSA levels in each individual is crucial in deciding whether salvage radiotherapy is needed. The effectiveness of treatment increases along with early initiation of radiation therapy. Current guidelines developed by NCCN and EAU regard conversion of PSA from undetectable to detectable level as a sign of cancers’ recurrence. In addition, prostate-specific membrane antigen (PSMA) PET should be used as a part of modern imaging diagnostics for a precise determination of disease extent.
Biochemical recurrence
Adjuvant radiotherapy
Pathological staging
Salvage therapy
Cite
Citations (0)
The difficulty in predicting indolent prostate cancer leads to the use of different inclusion criteria in an active surveillance (AS) program. This chapter presents the pathology findings of radical prostatectomy (RP) in patients whose disease meet criteria for AS, as well as of those who are operated during AS.Two independent Medline searches were conducted, both of them with a double objective: pathological findingsin radical prostatectomy specimens of patients who could have been included in AS and pathological features of patients operated after an AS period. The following terms were used for the research: "prostaticneoplasm", "radical prostatectomy" and "active surveillance": "radical prostatectomy", "after", "following" and "active surveillance". Pathological findings in radical prostatectomy specimens, down staging and downgrading rates were recorded. Active surveillance length and reason for surgery was included when it was available.Depending on different AS inclusion criteria, clinical downgrading rate (pathological Gleason > 6) varied between 12.1 and 61% and clinical downstaging between 0-26%. Pathological Gleason score =8 was reported in 0-7.8% and there were anecdotal findings of seminal vesicle invasion or positive nodes. Overall, unfavorable pathology (Gleason ≥ 7 or stage ≥ pT3)was detected in 13.1-42.4%, based on different definitions. The criteria at John Hopkins were the strictest and had the lowest clinical downgrading and downstaging. On the other hand, the Memorial Sloan Kettering Cancer Center(MSKCC) criteria had the highest risk of unfavorable pathology but had the highest recruitment capacity. Indolent tumor was observed in 70-82.2% according to the current definition. The average duration in AS prior to surgery was 15-37 months. pT3 stage was seen in 7.7-36.7%, Gleason score 3+4 in 18.6-42.9%, Gleason score 4+3 in 1.4-31.8%, Gleason score >7 in 0-10.3%, positive margins in 3-40.9%. Seminal vesicle invasion rate was extremely low (0-2.9%) as well as positive nodes (0-4.5%).Although there is a low risk of clinical downstaging and downgrading between patients who have being included in AS, it remains feasible. The probability of predicting an indolent tumor depends greatly on the quality of the prostate biopsy and/or the confirmatory biopsy. On the other hand, most patients who progress in an AS program can have a high probability of cure. We are still in the early stages of AS management in order to be able to predict the biological behavior and the cure rate of radical prostatectomy in patients after a long AS period.
Pathological staging
Surgical pathology
Cite
Citations (4)
The pathological stage of the tumor is the most influential prognostic factor for progression after radical prostatectomy. However, as many as 50% of men undergoing radical prostatectomy are found to have extraprostatic disease in the pathological specimen. Accurate identification of the risks of disease extension and of disease recurrence prior to radical prostatectomy would thus be useful in counseling men presenting with clinically localized prostate cancer. Nomograms may help patients and physicians make more informed treatment decisions based on the probability of pathological stage. Partin and co-workers popularized the use of a pretreatment nomogram based on PSA (prostate specific antigen), clinical stage (TNM stage) and biopsy Gleason score to predict the pathological stage of localized prostate cancer. However, it may not be directly applicable to Japanese males, and the interpretation and comparison of data sets should be done with caution and careful consideration. Although attempts have been made to establish a nomogram for Japanese patients, been tried, it is still based on the data for a small number of patients. More data from a greater number of patients and validation analysis are essential. Recently, artificial neural networks (ANN) have been shown to be effective in predicting pathologic stage in men with clinically localized prostate cancer. The use of ANNs is a relatively new concept and the data is based on Western people; thus, the data analysis for Japanese patients is necessary. The present paper mainly outlines the usefulness and problems for the preoperative prediction of the pathological stage in prostate cancer by nomograms and artificial neural networks.
Nomogram
Pathological staging
T-stage
Cite
Citations (0)
Objective To evaluate the clinical significance of combining clinical parameter staging and magnetic resonance imaging (MRI) staging for prostate cancer before radical prostatectomy. Methods The data of 53 patients with organ confined prostate cancer were reviewed to assess the accuracy of combining clinical parameter staging and MRI staging in correlation with pathological staging results after radical prostatectomy. Results Of the 53 prostate cancer cases,20 were of stage T 2 preoperatively,but 5 (25%) of the 20 were pathologically diagnosed as stage T 3 after prostatectomy when serum PSA16.3 ng/ml plus biopsy Gleason score6.Twenty of the 53 prostate cancer cases were of stage T 2,but 6 (30%) of the 20 were pathologically diagnosed as T 3 after prostatectomy when serum PSA16.3 ng/ml plus the percentage of positive prostate biopsies34%-50%.Thirty three of the 53 cases were of stage T 3 clinically,10 of the 33 were pathologically diagnosed as T 2 after prostatectomy in combining clinical parameter staging.In MRI staging,31 of the 48 prostate cancer cases were of T 2.Of the 31 cases,14 (42.4%) were of T 3 and 1 (3.2%) was of T 2N 1 pathologically after prostatectomy.Of the 17 cases who were of T 3 with MRI,2 (11.8%) were of pathological T 2 and 1 (5.9%) of pathological T 3N 1.The clinical parameter staging (ie,serum PSA plus biopsy Gleason score or the percentage of positive biopsies) and MRI staging had more correlation with pathological staging results ( r=0.449,P =0.001),and could predict pathological staging results (χ 2=10.739, P = 0.001 ),but there was no significant difference among these 3 staging methods (χ 2=0.305, P = 0.859 ).The predicting rate of the 3 methods for staging organ confined prostate cancer (PPV) were 75%(15/20),70% (14/20) and 54.8% (17/31),respectively,and for non organ confined prostate cancer (NPV) were 69.7 %(23/33), 69.7 %(23/33) and 88.2%(15/17),respectively. Conclusions All these methods can predict pathological staging results.The combined clinical parameter staging methods are more specific and accurate than the MRI staging method for predicting pathological staging results in organ confined prostate cancer,while the MRI staging is more accurate for predicting non organ confined prostate cancer before radical prostatectomy.
Pathological staging
T-stage
Cite
Citations (0)