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Background: Men are more likely to develop prostate lesions like benign prostatic hypertrophy and prostate cancer as they age. Prostate specific antigen (PSA), which is secreted in large quantities above normal levels of 0–4 ng/ml by cells of the prostate gland in benign prostate hypertrophy (BPH) or prostate cancer (Pca), is a biological marker for the diagnosis of prostate cancer; hence, early diagnosis using PSA facilitates disease detection; the higher the level of PSA, the higher the chance of having prostate cancer (Negahdary et al., 2020; Zhang & Sun, 2018). The Gleason scale is used to grade patients with prostate cancer and determine their risk of the disease progressing. Is it possible to predict the Gleason scores of people with prostate cancer based on their PSA levels? The primary goal of the current study was to establish a correlation between the patient's PSA level and the associated Gleason scores at the time of prostate biopsy at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). Methods: The study utilized a cross-sectional retrospective that focused on patient reports with prostate histology who had a PSA between 2017 and 2022 when they requested a biopsy. The majority of the examined histology reports that did not include a PSA level and thus were disregarded. There were 80 sample reports as a result of this exclusion. Results: According to the study, 36 (45%) of the patients whose prostate tissues were examined had prostate cancer. The majority of 24 (66.7%) patients who had PSA values more than 50 ng/ml when they were first diagnosed with prostate cancer were classified as Gleason 7/Group 2 or higher. The study sought to determine whether PSA levels and Gleason scores were correlated. Gleason scores and PSA levels have a statistically significant positive correlation (p = 0.004, r = 0.474). The majority of patients, 55 (65%), who had high PSA values (>4 ng/ml), were between the ages of 60 and 79. These patients were followed by those who were >80 years old at 15 (18.75%) and those who were 50 to 59 years old at 10 (10%). Age and PSA levels were shown to have a statistically significant positive Pearson correlation (r = 0.236, p = 0.035, 95% CI). Conclusions: Gleason scores rise with increasing PSA levels. Age and PSA level have a positive correlation.
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【Objective】 To identify the risk factors of patients of bone metastatic prostate cancer with high tumor load progressed to castration resistant prostate cancer (CRPC), establish a nomogram prediction model and evaluate its consistency and accuracy. 【Methods】 A total of 164 patients diagnosed by puncture and imaging during 2012 and 2022 were included.The general characteristics were analyzed with IBM SPSS software; the variables were screened with Cox regression; the multivariate risk factors with P<0.05 were included in the nomogram prediction model.The consistency and prediction accuracy of the model were evaluated with C-index, receiver operating characteristic (ROC) curve and calibration chart. 【Results】 In univariate analysis, initial prostate-specific antigen (PSA), prostate-specific antigen density (PSAD), Gleason score, T stage, alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were correlated with CRPC (P<0.05).Multivariate analysis showed that initial PSA, Gleason score, T stage, ALP and LDH were independent risk factors of CRPC (P<0.05).Based on the above five risk factors, a nomogram prediction model was constructed.The C-index was 0.801, the area under ROC curve (AUC) of 1-year progression-free survival (PFS) was 0.701 (0.608-0.794), and the AUC of 2-year PFS was 0.857 (0.767-0.947).The calibration chart showed that the prediction probability of the model was in good agreement with the actual probability. 【Conclusion】 Initial PSA, Gleason score, T stage, ALP and LDH are independent risk factors of CRPC.The predictive model may be an effective tool for the initial diagnosis of high tumor load bone metastatic prostate cancer, but more data are needed for internal and external validation.
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Background:Prostatic lesions account for the major afflictions in the geriatric population worldwide. Prostate specific antigen can be used for screening but histopathology remains the gold standard for differentiating benign and malignant prostatic enlargements and definite diagnosis. Furthermore, a precise pathologic evaluation of the prostatectomy specimen can provide additional prognostic factors including pathological stages and surgical margin status. Methods: A systematic search identified 306 prostatic specimens submitted in the department over a time period of three years (January 2019-December 2021). Relevant clinical data, PSA level and H&E stained sections were examined for microscopic details and diagnosis. Results: Benign Prostate Hypertrophy (BHP) was the most common prostatic lesion and accounted for 83% of all cases. The age range was 49 to 90 years with a peak age group between 6th-7th decade. BPH associated with prostatitis and basal cell hyperplasia was seen in 57.8% and 3.3% cases respectively. A single case of non-specific granulomatous prostatitis was seen. Malignant tumours constituted 15.7% of all prostatic specimen. Adenocarcinoma was the histopathological subtype in all primary tumours. A single case of metastatic deposits from bladder tumour was recorded. Gleason score 7 was the most frequent (38.2.8%) in occurrence. Most adenocarcinomas were moderately differentiated (55.3%). Prostate Intraepithelial neoplasia (pre malignant lesion) was seen in 1.3 % of cases.Conclusion: Benign Prostate lesions occur more frequently when compared to malignant ones. Major proportion of benign lesions was contributed by Benign prostate hypertrophy. A pathologist's awareness of the benign mimics is important for the diagnosis of Prostate carcinoma.
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Background: Black men of African descent have higher risk for developing prostate cancer and present at a younger age with advanced disease and a poorer prognosis. Limited number of studies directly linking serum vitamin D with either prostate cancer prognosis or measures of prostate cancer aggressiveness have been done. The objective of this study is to compare serum 25 hydroxy vitamin D levels in patients with non-aggressive and aggressive prostate cancer using the Gleason score in black Africans in Jos. Methods: A cross sectional study conducted among fifty patients who presented to the urological surgical out-patient clinic of the Jos University Teaching Hospital who had clinical diagnosis of prostate cancer and were scheduled for prostate biopsy. Blood samples for serum 25-hydroxy vitamin D assay was analysed using the enzyme linked immunosorbent assay (ELISA) technique, patients with histologically confirmed prostate cancer were analysed. Data was collected in a proforma, statistical analysis done using statistical package for the social sciences (SPSS)(R) version 23 and t-test was used for comparison with a p value <0.05 considered significant. Results: Fifty patients were studied whose age ranged from 50-89 years. The mean level of serum 25-hydroxy vitamin D was 37.90 ng/ml±17.92. The mean serum 25-hydroxy vitamin D of patients with non-aggressive disease (GS?6) and aggressive disease (GS?7) was 48.44±17.09 and 34.57±17.08 respectively with a p value of 0.018. Conclusions: This study showed that black African prostate cancer patients with high grade tumors (Gleason score ?7) had significantly lower 25-hydroxy vitamin D levels compared to those with low grade tumors (Gleason score <7).
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Foamy gland carcinoma (FGC) is a distinct histological variant of prostatic acinar adenocarcinomas. It was first described by Epstein and Nelson in 1996. It is characterized by abundant xanthomatous cytoplasm, pyknotic nuclei, and intermediate Gleason grade. However, FGC with a high Gleason grade exists. FGC is found admixed with conventional acinar adenocarcinoma in 17 to 22% of needle biopsies and 13 to 22% of radical prostatectomy specimens and only rarely found in pure form. We report six cases of pure foamy gland carcinoma of prostate. The mean age in our study was 62.83 years and 5 out of the 6 cases presented with an elevated serum PSA level. Histopathological examination of our cases showed tumor cells with abundant foamy cytoplasm and low nucleo-cytoplasmic ratio. This deceptively benign-looking morphology can mimic nonneoplastic prostatic glands, Cowper’s gland, mucinous metaplasia, and xanthomatous prostatitis and hence often pose diagnostic challenges, especially in core needle biopsies. PNI was detected in two of our cases. PSA and AMACR staining was positive in all our cases (100%). p63 Staining was negative in all four cases where it was performed. Three, two, and one of our cases had a Gleason score of 7, 8, and 6 respectively. The prognosis depends on the Gleason score and the presence or absence of PNI or extraprostatic extension. Three of the cases presented with bony metastasis. We report this case series in view of the rarity and also to raise awareness of this entity which is often missed on small biopsies.
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Objective:To explore the consistency between modified 12+ X prostate biopsy under transrectal interventional ultrasound and postoperative Gleason score in prostate cancer patients.Methods:A retrospective study was conducted on 312 patients diagnosed with prostate cancer and underwent radical resection at Zhongshan People′s Hospital from January 2020 to December 2022. All patients underwent modified 12+ X prostate biopsy and prostate system biopsy under transrectal interventional ultrasound before surgery. Using the Gleason score of postoperative pathological specimens as the " gold standard", the detection rates of prostate cancer and clinically significant prostate cancer using modified 12+ X prostate biopsy and prostate system biopsy under transrectal interventional ultrasound were compared, and the consistency between the two methods alone or in combination and postoperative Gleason score was compared.Results:Among 312 patients, the positive detection rate of the improved 12+ X puncture biopsy combined with the system puncture biopsy was significantly higher than that of the individual detection (95.51% vs 80.77% vs 76.92%), with a statistically significant difference ( P<0.05). The improved 12+ X puncture biopsy combined with system puncture biopsy showed a clinically significant higher detection rate of prostate cancer in positive patients compared to the two tests alone (94.63% vs 77.78% vs 80.00%), with a statistically significant difference ( P<0.05). There was no statistically significant difference in the detection rate of clinically significant prostate cancer among patients who missed diagnosis, either alone or in combination with biopsy ( P>0.05). The upgrade rate of Gleason score after prostate improvement 12+ X puncture biopsy (25.00%) was significantly lower than that of prostate system puncture (44.17%), which was significantly higher than combined puncture biopsy (11.74%), with a statistically significant difference ( P<0.05). After 312 patients received combined puncture biopsy, urinary retention was found in 14 cases (4.49%), hematuria in 30 cases (9.62%), fever in 28 cases (8.97%), and blood in stool in 18 cases (5.77%). After symptomatic treatment, they basically improved within 3 days after puncture. Conclusions:The combination of modified 12+ X prostate biopsy with systematic biopsy under transrectal interventional ultrasound can improve the detection rate of prostate cancer, and has good consistency with the postoperative Gleason score of prostate cancer patients, which has good clinical application value.
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Objective:To compare the efficacy and safety of standard treatment with or without adjuvant chemotherapy in patients with highly malignant non-metastatic prostate cancer.Methods:In this prospective non-randomized controlled study, consecutive non-metastatic prostate cancer patients with pathologically proven Gleason score of 9-10 or Gleason score of 5 admitted to Peking University First Hospital were enrolled. Four to six cycles of chemotherapy using docetaxel ± carboplatin regimen were added or not after standard radical therapy. The primary end point was 5-year event-free survival (EFS), and the secondary end points were distant metastasis-free survival (MFS), overall survival (OS), and treatment-related adverse events. The survival curve was drawn by Kaplan-Meier method. The differences between two groups were analyzed by log-rank test.Results:A total of 176 patients were consecutively enrolled from November 2019 to January 2022 of which 138 patients received only standard radical therapy (control group), and 38 patients received adjuvant chemotherapy after standard radical therapy (chemotherapy group). The median follow-up time was 13.4 (2.0-34.0) months. All patients survived. The 30-month EFS rates in the chemotherapy and control groups were 100% and 85.6%, respectively ( P=0.064). There were no events in the chemotherapy group, while there were 12 cases of events in the control group, including 6 cases of biochemical recurrence and 6 cases of imaging progression. The 30-month MFS rates in two groups were 100% and 91.9%, respectively ( P=0.205). After the 1 vs. 2 propensity score matching, the EFS and MFS rates in two groups were 100% vs. 85.7% ( P=0.056), and 100% vs. 92.2% ( P=0.209), respectively. The incidence rates of grade 2 and above urinary toxicity in the chemotherapy and control groups were 2.6% and 7.2% ( P=0.354), respectively. The incidence rates of grade 2 and above rectal toxicity were 5.3% and 5.1% ( P=0.711), respectively. Grade 3 and above chemotherapy-related toxicity in the chemotherapy group were leukopenia (31.6%), thrombocytopenia (2.6%) and alopecia (13.2%). Conclusion:The addition of adjuvant chemotherapy after standard radical therapy tends to improve the overall EFS of patients with highly malignant prostate cancer, and the adverse effects are tolerable, which should be confirmed by long-term follow-up results.
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Context: Though mast cells infiltrate solid tumors, the exact role of mast cells in tumor biology is controversial. Mast cell density (MCD) may vary depending on its location in the tumor and tumor vascularity. MCD may influence the tumor aggressiveness. Aims: This study evaluates MCD and tumor vascularity in different histopathological grades of adenocarcinoma prostate. Settings and Design: Descriptive study with purposive sampling. Methods and Material: The subjects of study were 42 adenocarcinoma patients. 20 cases were of intermediate grade (Gleason score 2–7) and 22 were of high-grade (Gleason score 8-10). Histological diagnosis was made by examining sections stained with hematoxylin and eosin. Additional sections from the same block were stained for mast cells using Giemsa stains as per standard protocol. Mast cell count was done in minimum six random high-power microscopy fields in four different regions- intratumoral, peritumoral, stromal and perivascular regions. Statistical Analysis Used: SSPS software version 13.0. Descriptive statistics, Student's t test and ANOVA test. Results: In high-grade adenocarcinoma, mast cell counts were higher in perilesional, stromal and perivascular regions, whereas it was lower in intralesional areas as compared to the intermediate grade. However, statistical significance was observed only for the perivascular region. There was significantly higher number of blood vessels in high-grade adenocarcinoma as compared to intermediate grade adenocarcinoma. Conclusions: In this study, perilesional mast cells and vascularity increased with increased severity of adenocarcinoma. These findings suggest a possible influence of mast cells on the tumor microenvironment such as vessel density and aggressiveness of tumor. However, further studies are required to substantiate results of this study.
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Objective:To investigate the value of prostate biopsy guided by transrectal real-time ultrasonic elastography (TRTE) combined with peak strain index (PSI) in the diagnosis of prostate cancer and the correlation with TRTE score and pathological Gleason score.Methods:A total of 80 patients with suspected prostate cancer who underwent TRTE in the First Affiliated Hospital of Hebei North University from January 2019 to December 2019 were selected. The PSI for suspicious lesions was measured, and targeted puncture biopsy guided by TRTE combined with PSI was performed on the patients, and then followed by systematic puncture biopsy. The outcomes of targeted biopsy and systematic biopsy were analyzed. Taking pathological biopsy results as the gold standard, the detection rates of prostate cancer and benign prostate lesions detected by both biopsies methods were compared; the prostate volume, serum prostate specific antigen (PSA) level and PSI were compared between patients with prostate cancer and benign prostatic lesions. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to determine the best cut-off value of PSI in the diagnosis of prostate cancer. The values of conventional ultrasound versus TRTE combined with PSI in the diagnosis of prostate cancer were assessed. The positive rate of biopsy puncture points under the guidance of TRTE combined with PSI was compared with that of systematic biopsy. The correlation between TRTE score and pathological Gleason score of prostate malignant lesions was analyzed.Results:Among 80 patients, 45 patients (56.25%) were diagnosed as prostate cancer by prostate puncture biopsy, and 35 patients (43.75%) were benign prostate lesions. Among 45 patients with prostate cancer, 42 cases (93.33%) of prostate cancer were detected by using TRTE combined with PSI-guided targeted puncture biopsy, and 38 cases (84.44%) of prostate cancer were detected by using systematic puncture biopsy; there was no significant difference in the detection rate of prostate cancer by both biopsies methods ( χ2 = 1.80, P = 0.180). The level of serum PSA and PSI value in the prostate cancer group were higher than those in the benign prostate lesion group, and the difference was statistically significant ( t value was 65.28 and 14.93, all P < 0.05). The clinical value of PSI value in the diagnosis of prostate cancer was analyzed by using ROC curve. The results showed that the AUC was 0.857 (95% CI 0.772-0.941), and the optimal cut-off value of PSI was 5.68; PSI ≥ 5.68 was treated as the malignant cancer and PSI < 5.68 was treated as the benign cancer. The sensitivity, specificity and accuracy of TRTE combined with PSI in the diagnosis of prostate cancer were 91.11%, 94.29%, and 92.50%, respectively, which were higher than those of conventional ultrasound (73.33%, 68.57% and 71.25%), and the differences were statistically significant (all P < 0.05). A total of 89 suspected lesions were detected in 80 patients through TRTE combined with PSI, and each suspected lesion was detected by using 2-needle targeted puncture biopsy. There were 178 needles in total including 88 needles of prostate cancer and the positive rate of puncture points was 49.44% (88/178); there were 800 needles in total detected by using 10-needle systematic puncture biopsy including 203 needles of prostate cancer and the positive rate of puncture points was 25.38% (203/800); the positive rate of puncture points guided by TRTE combined with PSI puncture biopsy was higher than that by systematic puncture biopsy, and the difference was statistically significant ( χ2 = 40.337, P < 0.05). For prostate malignant lesions, the Spearman correlation analysis showed that TRTE score was positively correlated with pathological Gleason score ( r = 0.618, P < 0.05). Conclusion:TRTE combined with PSI-guided targeted puncture biopsy plays an important role in the diagnosis of prostate cancer, and it can effectively improve the positive rate of puncture points.
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【Objective】 To investigate the value of prostate cancer prevention trial risk calculator （PCPT-RC） combined with biopsy Gleason score for predicting the risk of metastasis in newly diagnosed prostate cancer patients. 【Methods】 We retrospectively collected the data of 74 patients with newly diagnosed prostate cancer confirmed by biopsy from April 2019 to August 2021， concurrent with 18F-PSMA-1007 PET/CT whole body imaging in the same period. Based on this， a binary logistic regression model was established to obtain the high risk probability of PCPT. We calculated the receiver operating characteristic curve （ROC） was drawn and the area under the curve， Yuden index， sensitivity， specificity， positive predictive value and negative predictive value. We compared the predictive value of the prostate cancer prevention trial risk calculator and Gleason score alone or in combination in predicting the risk of prostate cancer metastasis. 【Results】 Based on the PSMA PET/CT results， 74 patients were divided into non-metastatic group （46/74） and metastatic group （28/74）. PCPT high risk probability ［41.14% （16%-67%）］ vs. ［30.89% （5%-65%）］， Gleason score ［8.5（6-10） score］ vs. ［7.7（6-9） score］， tPSA ［26.24（5.70-42.32） ng/mL］ vs. ［19.58（2.47-49.35） ng/mL］， and fPSA ［3.94（0.82-12.00） ng/mL］ vs. ［2.33（0.35-10.20） ng/mL］ were significantly higher in metastatic group than in non-metastatic group. Binary Logistic regression analysis showed that Gleason score and PCPT low risk probability may be independent predictors of prostate cancer metastasis. PCPT low risk probability alone did not predict the risk of prostate cancer metastasis （P=0.172）. The predictive accuracy of Gleason score and high probability of PCPT in predicting prostate cancer metastasis were 0.715 and 0.679， respectively， and the accuracy of the combined prediction was 0.809. 【Conclusion】 PCPT-RC combined with Gleason score is valuable for predicting the metastasis risk of newly diagnosed prostate cancer patients， which has certain guiding significance for clinical individualized treatment.
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Gleason grading system is a critical factor for assessing the risk, making treatment decision and evaluating prognosis for patients with prostate cancer. However, it has been reported that concordance rates of Gleason score between biopsy pathology and radical prostatectomy specimen were only39%-63%, whilst postsurgical upgrade and downgrade rates were 30%-55% and 7%-20% respectively. This situation brings difficulties in performing clinical practice. This literature aimed to review relevant and updated studies in literature to summarize the concordance rate and independent predictive factors of Gleason score change from following several aspects: patient clinical characteristics, biopsy-related factors, accuracy of pathologic assignment and interpretation of pathology reports. This review also investigated how the factors influenced the Gleason score change and clinical decision-making. There were many factors influencing the Gleason score change which were roughly consistent with risk factors of prostate cancer, however, some factors were controversial. In order to provide precise evaluation of risk stratification and optimal individualized treatment, it is essential to consider the risk factors which are correlated with Gleason score change.
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Objective:To analyze the diagnosis value of multiparametric magnetic resonance imaging (mpMRI) in prostate cancer, and its relationship with clinicopathological grade.Methods:The clinical data of 50 patients with prostate cancer and 50 patients with benign prostatic hyperplasia from January to May 2019 in Qinhuangdao Second Hospital were retrospectively analyzed. All patients were examined by mpMRI, and the results were assessed by 2 radiologists according to the prostate imaging reporting and data system version 2 (PI-RADS 2). The mpMRI results were compared with Gleason score (GS). The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of mpMRI for prostate cancer.Results:For single sequence of mpMRI, when the cut-off value of DWI sequence was higher than 2 scores, the area under the curve (AUC) in diagnosis of prostate cancer was 0.951, and the sensitivity and specificity were 94.00% and 88.00%, respectively; when the cut-off value of T 2WI sequence was higher than 3 scores, the AUC in diagnosis of prostate cancer was 0.920, and the sensitivity and specificity were 80.00% and 96.00%, respectively; when DEE was positive, the AUC in diagnosis of prostate cancer was 0.810, and the sensitivity and specificity were 94.00% and 68.00%, respectively; when the 3 indexes were combined to diagnose prostate cancer, the AUC was 0.960, and the sensitivity and specificity were 90.00% and 96.00%, respectively. The ADC in patients with GS pathology graded low-risk, intermediate-risk and high-risk prostate cancer was (0.95 ± 0.11), (0.75 ± 0.12) and (0.61 ± 0.13) × 10 -3 mm 2/s, and the maximum tumor diameter was (1.27 ± 0.45), (2.17 ± 0.54) and (2.86 ± 0.63) cm. With the increase of the GS pathological grade, the ADC decreased, the maximum tumor diameter increased, and there were statistical differences ( F = 20.519 and 20.396, P<0.01). Spearman correlation analysis result showed that GS had negative correlation with ADC ( r = - 0.765, P<0.01), and positive correlation with the maximum tumor diameter ( r = 0.413, P<0.01). Conclusions:The diagnostic efficiency of mpMRI PI-RADS 2 for prostate cancer is relatively higher. ADC is negatively correlated with GS pathological grade, and the maximum tumor diameter is positively correlated with GS pathological grade, which provides a basis for preoperative diagnosis of prostate cancer.
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A standard modality for prostate cancer detection in men 75 years and older has not been established. A simple screening method for elderly patients is needed to avoid unnecessary biopsies and to effectively diagnose prostate cancer. A retrospective study was conducted on elderly patients who had prostate biopsy at Kanazawa University Hospital (Kanazawa, Japan) between 2000 and 2017. Of the 2251 patients who underwent prostate biopsy, 254 had clinically significant prostate cancer (CSPC) with a Gleason score (GS) of≥7 and 273 had a GS of <7 or no malignancy. In this study, patients aged 75 years or older were classified as elderly patients. GS ≥ 7 was characterized by a prostate-specific antigen (PSA) of the maximum area under the curve of 12 ng ml
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Eastern Cooperative Oncology Group (ECOG) performance status and Gleason score are commonly investigated factors for overall survival (OS) in men with castration-resistant prostate cancer (CRPC). However, there is a lack of consistency regarding their prognostic or predictive value for OS. Therefore, we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories. A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019. The data from 8247 patients in 34 studies, including clinical trials and real-world data, were included in our meta-analysis. Of these, twenty studies reported multivariate results and were included in our main analysis. CRPC patients with higher ECOG performance statuses (≥ 2) had a significantly increased mortality risk than those with lower ECOG performance statuses (<2), hazard ratio (HR): 2.10, 95% confidence interval (CI): 1.68-2.62, and P < 0.001. The synthesized HR of OS stratified by Gleason score was 1.01, with a 95% CI of 0.62-1.67 (Gleason score ≥ 8 vs <8). Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy (docetaxel and cabazitaxel) and androgen-targeting therapy (abiraterone acetate and enzalutamide) or for patients with different chemotherapy histories. ECOG performance status was identified as a significant prognostic factor in CRPC patients, while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.
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Objective: Gleason scoring is the grading system which strongly predicts the prognosis of prostate cancer. However, even being one of the most commonly used systems, the presence of different interobserver agreement rates push the uropathologists update the definitons of the Gleason patterns. In this study, we aimed to determine the interobserver agreement variability among 7 general pathologists, and one expert uropathologist from 6 different centers. Methods: A set of 50 Hematoxylin & Eosin stained slides from 41 patients diagnosed as prostate cancer were revised by 8 different pathologists. The pathologists were also grouped according to having their residency at the same institute or working at the same center. All pathologists' and the subgroups' Gleason scores were then compared for interobserver variability by Fleiss' and Cohen's kappa tests using R v3.2.4. Results: There were about 8 pathologists from 6 different centers revised all the slides. One of them was an expert uropathologist with experience of 18 years. Among 7 general pathologists 4 had surgical pathology experience for over 5 years whilst 3 had under 5 years. The Fleiss' kappa was found as 0.54 for primary Gleason pattern, and 0.44 for total Gleason score (moderate agreement). The Fleiss' kappa was 0.45 for grade grouping system. Conclusion: Assigning a Gleason score for a patient can be problematic because of different interobserver agreement rates among pathologists even though the patterns were accepted as well-defined.
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Objective To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.Methods The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed.31 patients with a mean age (63.1 ± 4.9) and baseline PSA (72.71 ± 173.15) ng/ml were enrolled.Their BMI mean (24.6 ± 3.0) kg/m2.Baseline testosterone of 14 patients was (4.72 ± 1.64) ng/ml.Based on the Gleason scores related ISUP classification,all patients were classified into grade one in 5 cases,grade 2in 7 cases,grade 3 in 4 cases,grade 4 in 10 cases and grade 5 in 5 cases.The clinical classification included 6 cases in T2a stage,2 cases in T2b stage,17 cases in T2c stage,1 case in T3a stage,4 cases in T3b stage and 1 case in T4 stage.SUVmax was accessed by two independent professional nuclear medicine physicians.SUVmax was 12.49 ± 9.38.SPSS 16.0 software was used to do statistic analysis.Results The post-operative pathological results showed the surgical margin positive in 19 cases,negative in 12 cases,vascular positive in 5 cases,negative in 20 case,positive nerve invasion in 20 cases and negative in 11 cases.2 patients were low risk,7 patients were medium risk and 22 patients were high risk according to D'Amico classification.Based on the basis of PSA(≤ 10 or ＞ 10) and Gleason score (≤6 or ＞ 6),6 patients were in group with low PSA and low Gleason score,5 patients were low PSA and high Gleason score,9 patients were high PSA and low Gleason score,11 patients were high PSA and high Gleason score.SUVmax had a significant positive relationship with pathological ISUP (r =0.434,P =0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli (14.78 ± 10.68 vs.8.17 ± 2.81,P =0.005).No significant correlation was found between SUVmax and baseline PSA,testosterone,pathologic T stage,surgical margin,nerve invasion,pelvic lymph node status as well as risk stratification.SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P =0.033) and the sensitivity was 88.9％.The specificity was 77.3％ when SUVmax ≥ 11.34.SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01 ± 5.40 vs.4.98 ± 2.11,P =0.007).Conclusions SUVmax measured on preoperative 68 Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.
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Objective@#To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.@*Methods@#The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m2. Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T2a stage, 2 cases in T2b stage, 17 cases in T2c stage, 1 case in T3a stage, 4 cases in T3b stage and 1 case in T4 stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis.@*Results@#The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007).@*Conclusions@#SUVmax measured on preoperative 68Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.
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Background: The Gleason score is the most widely accepted histopathological grading system for prostate cancer since decade despite having many deficiency that can potentially impact patient health care. So ISUP agreed on developing a system of prognostic grade groups from I-V. Aim and objective was to study the new perspectives of modified Gleason’s grading and to compare it with original Gleason’s System with focus on the prognostic significance of the modifications.Methods: A retrospective study of 60 patients, who underwent TURP and Sextant biopsy and diagnosed as prostatic carcinoma in our institute were included in this study. Laboratory requisition forms with clinical history, PSA levels and histopathology reports of these patients were reviewed and graded accordingly to the newer gleasons. New Gleason grade includes five distinct Grade Groups based on the modified Gleason score groups. Grade Group 1 = Gleason score ≤6, Grade Group 2 = Gleason score 3 + 4 = 7, Grade Group 3 = Gleason score 4 + 3 = 7, Grade Group 4 = Gleason score 8, Grade Group 5 = Gleason scores 9 and 10 were assigned. The change in the grading system is tabulated and compared separately.Results: Patients age ranged from 55-80 years. The number of cases were 3,12,15,19 and 11 categorized under grade group I, grade group II, grade group III, grade group IV, grade group V cancer respectively according to modified gleason grading.Conclusions: Modified Gleason is a simplified grading system which may reduce over treatment of indolent prostate cancer. New gleasons grading clarifies the clinicians about the dilemma of gleason scores, offering an excellent prognostic stratification of this carcinoma.
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@#【Objectives】 To comparatively analyze the diagnostic performance of transrectal real- time elastography（TRTE）and magnetic resonance diffusion- weighted imaging （DWI）in differentiating benign from malignant prostatic lesions，to evaluate the value of the two methods in guided prostate biopsy，and to investigate the correlation between the two methods and Gleason scores. 【Methods】 A total of 126 patients with suspected prostate cancer underwent prostate biopsy. Preoperative tests of TRTE and DWI were performed in all of the included patients. Combined with pathological results，the diagnostic efficacy of TRTE and DWI for prostate cancer and the effects of prostate biopsy guided by the two methods were compared ，and the relationship between the elastography score and ADC value and Gleason scores were also evaluated.【Results】 The sensitivity，specificity，accuracy of diagnosing prostate cancer by TRTE were 78.8% ，78.3% ，78.6% ，the sensitivity，specificity，accuracy of diagnosing prostate cancer by DWI were 87.9% ，90% ，88.9% ， there was no significant difference of sensitivity and specificity between the two groups（P > 0.05），and the accuracy was statistically different（P < 0.05）. The AUC of elastography score and ADC value were 0.859 and 0.906，the accuracy of the diagnosis of benign and malignant prostate lesions by ADC value method was higher than elastography score ，but there was no statistically significant difference （P > 0.05）. A significant positive correlation was found between elastography score and Gleason scores，while a significant negative correlation was found between ADC value and Gleason scores.【Conclusions】TRTE and DWI is valuable in diagnosis of prostatic lesions. Biopsy guided by the two methods can improve the detection rate of prostate cancer and can provide indicative evidence for tumor differentiation analysis.
ABSTRACT
This study compared the diagnostic efficacy of transrectal ultrasound (TRUS)-guided prostate biopsy (TRBx) and transperineal prostate biopsy (TPBx) in patients with suspected prostate cancer (PCa). We enrolled 2962 men who underwent transrectal (n = 1216) or transperineal (n = 1746) systematic 12-core prostate biopsy. Clinical data including age, prostate-specific antigen (PSA) level, and prostate volume (PV) were recorded. To minimize confounding, we performed propensity score-matching analysis. We measured and compared PCa detection rates between TRBx and TPBx, which were stratified by clinical characteristics and Gleason scores. The effects of clinical characteristics on PCa detection rate were assessed by logistic regression. For all patients, TPBx detected a higher proportion of clinically significant PCa (P < 0.001). Logistic regression analyses illustrated that PV had a smaller impact on PCa detection rate of TPBx compared with TRBx. Propensity score-matching analysis showed that the detection rates in TRBx were higher than those in TPBx for patients aged >- 80 years (80.4% vs 56.5%, P = 0.004) and with PSA level 20.1-100.0 ng ml-1 (80.8% vs 69.1%, P = 0.040). In conclusion, TPBx was associated with a higher detection rate of clinically significant PCa than TRBx was; however, because of the high detection rate at certain ages and PSA levels, biopsy approaches should be optimized according to patents' clinical characteristics.