DOCSLIB.ORG

Prostate Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prostate Cancer Guidelines on Prostate Cancer A. Heidenreich (chairman), M. Bolla, S. Joniau, T.H. van der Kwast, V. Matveev, M.D. Mason, N. Mottet, H-P. Schmid, T. Wiegel, F. Zattoni © European Association of Urology 2009 TABLE OF CONTENTS PAGE 1 BACKGROUND 7 1.1 Reference 7 2. BACKGROUND 8 2.1 References 8 3. CLASSIFICATION 8 3.1 Gleason score 9 3.2 References 9 4. RISK FACTORS 9 4.1 References 10 5. SCREENING AND EARLY DETECTION 10 5.1 References 11 6. DIAGNOSIS 13 6.1 Digital rectal examination (DRE) 13 6.2 Prostate specific antigen (PSA) 13 6.2.1 Free/total PSA ratio (f/t PSA) 13 6.2.2 PSA velocity (PSAV), PSA doubling time (PSADT) 14 6.2.3 PCA3 marker 14 6.3 Transrectal ultrasonography (TRUS) 14 6.4 Prostate biopsy 14 6.4.1 Baseline biopsy 14 6.4.2 Repeat biopsy 14 6.4.3 Saturation biopsy 14 6.4.4 Sampling sites and number of cores 14 6.4.5 Diagnostic transurethral resection of the prostate (TURP) 15 6.4.6 Seminal vesicle biopsy 15 6.4.7 Transition zone biopsy 15 6.4.8 Antibiotics 15 6.4.9 Local anaesthesia 15 6.4.10 Fine-needle aspiration biopsy 15 6.4.11 Complications 15 6.5 Pathology of prostate needle biopsies 15 6.5.1 Grossing and processing 15 6.5.2 Microscopy and reporting 16 6.6 Pathohistology of radical prostatectomy (RP) specimens 17 6.6.1 Processing of the RP specimen 17 6.6.2 RP specimen report 17 6.6.2.1 Gleason score 18 6.6.2.2 Interpreting the Gleason score 18 6.6.2.3 Definition of extraprostatic extension 18 6.6.3 Prostate cancer volume 19 6.6.4 Surginal margin status 19 6.6.5 Other factors 19 6.7 References 19 7. STAGING 24 7.1 T-staging 24 7.2 N-staging 26 7.3 M-staging 27 7.4 Guidelines for the staging of prostate cancer (PCa) 28 7.5 References 28 2 UPDATE MARCH 2009 8. TREATMENT: DEFERRED TREATMENT (WATCHFUL WAITING [WW] / ACTIVE MONITORING 33 8.1 Introduction 33 8.1.1 Definition 33 8.2 Deferred treatment of localised PCa (stage T1-T2, Nx-N0, M0) 34 8.2.1 Watchful waiting (WW) 34 8.2.2 Active surveillance 36 8.3 Deferred treatment for locally advanced PCa (stage T3-T4, Nx-N0, M0) 37 8.4 Deferred treatment for metastatic PCa (stage M1) 38 8.5 Summary of deferred treatment 38 8.5.1 Indications 38 8.5.2 Options 38 8.6 References 39 9. TREATMENT: RADICAL PROSTATECTOMY 42 9.1 Introduction 42 9.2 Low-risk localised PCa: cT1-T2a AND Gleason score 2-6 and PSA < 10 43 9.2.1 Stage T1a-T1b PCa 43 9.2.2 Stage T1c and T2a PCa 43 9.3 Intermediate-risk localised PCa: cT2b-T2c OR Gleason score = 7 or PSA 10-20 43 9.3.1 Oncological results of RP in low- and intermediate risk PCa 44 9.4 High-risk localised PCa: cT3a OR Gleason score 8-10 or PSA > 20 44 9.4.1 Locally-advanced PCa: cT3a 44 9.4.2 High-grade PCa: Gleason score 8-10 45 9.4.3 PCa with PSA > 20 45 9.5 Very high-risk localised PCa: cT3b-T4 N0 or any T, N1 46 9.5.1 cT3b-T4 N0 46 9.5.2 Any T, N1 46 9.5.2.1 Indication and extent of extended pelvic lymph node dissection (eLND) 46 9.5.2.2 Therapeutic role of eLND 47 9.5.2.3 Morbidity 47 9.5.2.4 Summary of eLND 47 9.6 Summary of RP in high-risk localised disease 47 9.7 Neoadjuvant hormonal therapy and RP 47 9.7.1 Summary of neoadjuvant and adjuvant hormonal treatment and RP 48 9.8 Complications and functional outcome 48 9.9 Summary of indications for nerve-sparing surgery 48 9.10 Guidelines and recommendations for RP 49 9.11 References 49 10. TREATMENT: DEFINITIVE RADIATION THERAPY 56 10.1 Introduction 56 10.2 Technical aspects: three dimensional conformal radiotherapy and intensity modulated external beam radiotherapy 56 10.3 Localised prostate cancer T1-2c N0, M0 56 10.3.1 T1a-T2a, N0, M0 and Gleason score ≤ 6 and PSA < 10 ng/mL (low-risk group) 56 10.3.2 T2b or PSA 10-20 ng/mL, or Gleason score 7 (intermediate-risk group) 57 10.3.3 T2c or Gleason score > 7 or PSA > 20 ng/mL (high-risk group) 57 10.3.4 Prophylactic irradiation of pelvic lymph nodes in high-risk localised prostate cancer 57 10.4 Innovative techniques 58 10.4.1 Intensity modulated radiotherapy 58 10.4.2 Proton beam and carbon ion beam therapy 58 10.5 Transperineal brachytherapy 59 10.6 Late toxicity 60 10.7 Immediate post-operative external irradiation for pathological tumour stage T3 N0 M0 61 10.8 Locally advanced prostate cancer: T3-4 N0, M0 62 10.8.1 Neoadjuvant and concomitant hormonal therapy 62 10.8.2 Concomitant and long-term adjuvant hormonal therapy 62 10.8.3 Long-term adjuvant hormonal therapy 63 10.8.4 Neoadjuvant, concomitant and long-term adjuvant hormonal therapy 63 UPDATE MARCH 2009 3 10.8.5 Short-term or long-term adjuvant hormonal treatment 63 10.8.6 Dose escalation with hormonal therapy 63 10.9 Very high-risk prostate cancer: c or pN1 M0 63 10.10 Summary of definitive radiation therapy 64 10.11 References 64 11. EXPERIMENTAL LOCAL TREATMENT OF PROSTATE CANCER 70 11.1 Background 70 11.2 Cryosurgery of the prostate (CSAP) 70 11.2.1 Indication for CSAP 71 11.2.2 Results of modern cryosurgery for PCa 71 11.2.3 Complications of CSAP for primary treatment of PCa 71 11.2.4 Summary of CSAP 72 11.3 High-intensity focused ultrasound (HIFU) of the prostate 72 11.3.1 Results of HIFU in PCa 72 11.3.2 Complications of HIFU 73 11.4 Radiofrequency interstitial tumour ablation (RITA) 73 11.5 Summary of experimental therapeutic options to treat clinically localized PCa 73 11.6 References 73 12. HORMONAL THERAPY 74 12.1 Introduction 74 12.2 Basics of hormonal control of the prostate 75 12.3 Different types of hormonal therapy 75 12.3.1 Testosterone-lowering therapy (castration) 75 12.3.1.1 Bilateral orchiectomy 75 12.3.1.2 Oestrogens 75 12.3.1.3 LHRH agonists 76 12.3.1.4 LHRH antagonists 77 12.3.2 Anti-androgens 78 12.3.2.1 Steroidal anti-androgens 78 Cyproterone acetate (CPA) 78 Megestrol acetate and medroxyprogesterone acetate 78 12.3.2.2 Non-steroidal anti-androgens 78 Nilutamide 79 Flutamide 79 Bicalutamide 79 12.3.3 Combination therapies 81 12.3.3.1 Complete androgen blockade 81 12.3.3.2 Minimal androgen blockade (or peripheral androgen blockade) 81 12.3.3.3 Intermittent vs continuous androgen deprivation therapy 81 12.3.3.4 Immediate vs deferred ADT 83 12.4 Indications for hormonal therapy 84 12.5 Contraindications for various therapies 84 12.6 Outcome 85 12.7 Side-effects, QoL and cost of hormonal therapy 85 12.7.1 Side-effects 85 12.7.2 Quality of Life (QoL) 86 12.7.3 Cost-effectiveness of hormonal therapy options 87 12.8 Summary of hormonal therapy 87 12.9 References 88 13. SUMMARY OF GUIDELINES ON PRIMARY TREATMENT OF PCa 98 14 FOLLOW-UP: AFTER PRIMARY TREATMENT WITH CURATIVE INTENT 99 14.1 Definition 99 14.2 Why follow-up? 99 14.3 How to follow-up? 99 14.3.1 PSA monitoring 99 14.3.2 Definition of PSA progression 99 4 UPDATE MARCH 2009 14.3.3 PSA monitoring after radical prostatectomy 100 14.3.4 PSA monitoring after radiation therapy 100 14.3.5 Digital rectal examination (DRE) 100 14.3.6 Transrectal ultrasonography (TRUS) and biopsy 100 14.3.7 Bone scintigraphy 100 14.3.8 Computed tomography (CT) and magnetic resonance imaging (MRI) 100 14.4 When to follow-up? 101 14.5 Guidelines for follow-up after treatment with curative intent 101 14.6 References 101 15. FOLLOW-UP AFTER HORMONAL TREATMENT 103 15.1 Introduction 103 15.2 Purpose of follow-up 103 15.3 Methods of follow-up 103 15.3.1 Prostate-specific antigen monitoring 103 15.3.2 Creatinine, haemoglobin and liver function monitoring 103 15.3.3 Bone scan, ultrasound and chest X-ray 104 15.4 When to follow-up 104 15.4.1 Stage M0 patients 104 15.4.2 Stage M1 patients 104 15.4.3 Hormone-refractory patients 104 15.5 Guidelines for follow-up after hormonal treatment 104 15.6 References 105 16. TREATMENT OF BIOCHEMICAL FAILURE AFTER TRATMENT WITH CURATIVE INTENT 106 16.1 Background 106 16.2 Definitions 106 16.2.1 Definition of treatment failure 106 16.2.2 Definition of recurrence 106 16.3 Local or systemic relapse 106 16.3.1 Definition of local and systemic failure 107 16.4 Evaluation of PSA progression 108 16.5 Diagnostic procedures in patients with PSA relapse 109 16.6 Treatment of PSA-only recurrences 109 16.6.1 Radiation therapy for PSA-only recurrence after radical prostatectomy (RP) 109 16.6.2 Hormonal therapy 110 16.6.3 Observation 111 16.6.4 Management of PSA relapse after radical prostatectomy 111 16.7 Management of PSA failures after radiation therapy 111 16.7.1 Salvage cryosurgical ablation of the prostate (CSAP) for radiation failures 112 16.7.2 Salvage brachytherapy for radiation failures 112 16.7.3 Observation 112 16.7.4 Management of PSA-relapse after radiation therapy 113 16.8 Guidelines for second-line therapy after treatment with curative intent 113 16.9 References 113 17.
Load more

Recommended publications
  • Gleason Grading and Prognostic Factors in Carcinoma of the Prostate
    Modern Pathology (2004) 17, 292–306 & 2004 USCAP, Inc All rights reserved 0893-3952/04 $25.00 www.modernpathology.org Gleason grading and prognostic factors in carcinoma of the prostate Peter A Humphrey Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA Gleason grade of adenocarcinoma of the prostate is an established prognostic indicator that has stood the test of time. The Gleason grading method was devised in the 1960s and 1970s by Dr Donald F Gleason and members of the Veterans Administration Cooperative Urological Research Group. This grading system is based entirely on the histologic pattern of arrangement of carcinoma cells in H&E-stained sections. Five basic grade patterns are used to generate a histologic score, which can range from 2 to 10. These patterns are illustrated in a standard drawing that can be employed as a guide for recognition of the specific Gleason grades. Increasing Gleason grade is directly related to a number of histopathologic end points, including tumor size, margin status, and pathologic stage. Indeed, models have been developed that allow for pretreatment prediction of pathologic stage based upon needle biopsy Gleason grade, total serum prostate-specific antigen level, and clinical stage. Gleason grade has been linked to a number of clinical end points, including clinical stage, progression to metastatic disease, and survival. Gleason grade is often incorporated into nomograms used to predict response to a specific therapy, such as radiotherapy or surgery. Needle biopsy Gleason grade is routinely used to plan patient management and is also often one of the criteria for eligibility for clinical trials testing new therapies.
    [Show full text]
  • The Role of Lymphadenectomy in Prostate Cancer Patients
    Acta Clin Croat (Suppl. 1) 2019; 58:24-35 Professional paper doi: 10.20471/acc.2019.58.s2.05 THE ROLE OF LYMPHADENECTOMY IN PROSTATE CANCER PATIENTS Dean Markić1,2, Romano Oguić1,2, Kristian Krpina1, Ivan Vukelić1, Gordana Đorđević3,4, Iva Žuža5 and Josip Španjol1,2 1Department of Urology, University Hospital Rijeka, Rijeka, Croatia; 2Department of Urology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia; 3Department of Pathology, University Hospital Rijeka, Rijeka, Croatia; 4Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia; 5Department of Radiology, University Hospital Rijeka, Rijeka, Croatia SUMMARY – Prostate cancer is one of the most important men’s health issues in developed countries. For patients with prostate cancer a preoperative staging of the disease must be made. In- volvement of lymph nodes could be assessed using imaging methods (CT or/and MRI), however, newer methods also exist (PET/CT, PSMA PET/CT). For some patients during radical prostatec- tomy a pelvic lymphadenectomy is recommended. Pelvic lymphadenectomy is indicated in intermedi- ate- and high-risk group patients and with increased probability of lymph node invasion. The most used prediction tools for preoperative assessment of lymph nodes are Briganti and MSKCC nomo- grams and Partin tables. Pelvic lymphadenectomy can include different lymph nodes group, but extended lymphadenectomy is the recommended procedure. In 1-20% of patients, the lymph node invasion is present. Pelvic lymphadenectomy is primarily a diagnostic and staging method, and in minority of patients with positive lymph nodes it can be a curative method, too. In other patients with positive lymph nodes adjuvant therapy (radiotherapy and androgen deprivation therapy) can be beneficial.
    [Show full text]
  • Automated Gleason Scoring and Tumor Quantification in Prostate
    cancers Article Automated Gleason Scoring and Tumor Quantification in Prostate Core Needle Biopsy Images Using Deep Neural Networks and Its Comparison with Pathologist-Based Assessment 1,2, 3, 1,4, 5 5 Han Suk Ryu y, Min-Sun Jin y , Jeong Hwan Park y, Sanghun Lee , Joonyoung Cho , Sangjun Oh 5, Tae-Yeong Kwak 5 , Junwoo Isaac Woo 5, Yechan Mun 5, Sun Woo Kim 5, Soohyun Hwang 6, Su-Jin Shin 7 and Hyeyoon Chang 5,* 1 Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea; [email protected] (H.S.R.); [email protected] (J.H.P.) 2 Department of Pathology, Seoul National University Hospital, Seoul 03080, Korea 3 Department of Pathology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do 14647, Korea; [email protected] 4 Department of Pathology, SMG-SNU Boramae Medical Center, Seoul 07061, Korea 5 Deep Bio Inc., 1201 HanWha BizMetro, 242, Digital-ro, Guro-gu, Seoul 08394, Korea; [email protected] (S.L.); [email protected] (J.C.); [email protected] (S.O.); [email protected] (T.-Y.K.); [email protected] (J.I.W.); [email protected] (Y.M.); [email protected] (S.W.K.) 6 Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; [email protected] 7 Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; [email protected] * Correspondence: [email protected]; Tel.: +82-70-7703-4746; Fax: +82-2-2621-2223 These authors contributed equally to this paper.
    [Show full text]
  • Grading Evolution and Contemporary Prognostic Biomarkers of Clinically Significant Prostate Cancer
    cancers Review Grading Evolution and Contemporary Prognostic Biomarkers of Clinically Significant Prostate Cancer Konrad Sopyllo 1, Andrew M. Erickson 2 and Tuomas Mirtti 1,3,* 1 Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; konrad.sopyllo@helsinki.fi 2 Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK; [email protected] 3 Department of Pathology, HUS Diagnostic Centre, Helsinki University Hospital, 00029 Helsinki, Finland * Correspondence: tuomas.mirtti@helsinki.fi Simple Summary: Prostate cancer treatment decisions are based on clinical stage and histological diagnosis, including Gleason grading assessed by a pathologist, in biopsies. Prior to staging and grading, serum or blood prostate-specific antigen (PSA) levels are measured and often trigger diagnostic examinations. However, PSA is best suited as a marker of cancer relapse after initial treatment. In this review, we first narratively describe the evolution of histological grading, the current status of Gleason pattern-based diagnostics and glance into future methodology of risk assessment by histological examination. In the second part, we systematically review the biomarkers that have been shown, independent from clinical characteristics, to correlate with clinically relevant end-points, i.e., occurrence of metastases, disease-specific mortality and overall survival after initial treatment of localized prostate cancer. Abstract: Gleason grading remains the strongest prognostic parameter in localized prostate ade- nocarcinoma. We have here outlined the evolution and contemporary practices in pathological evaluation of prostate tissue samples for Gleason score and Grade group. The state of more observer- Citation: Sopyllo, K.; Erickson, A.M.; Mirtti, T. Grading Evolution and independent grading methods with the aid of artificial intelligence is also reviewed.
    [Show full text]
  • Prostate Cancer Early Detection, Diagnosis, and Staging Finding Prostate Cancer Early
    cancer.org | 1.800.227.2345 Prostate Cancer Early Detection, Diagnosis, and Staging Finding Prostate Cancer Early Catching cancer early often allows for more treatment options. Some early cancers may have signs and symptoms that can be noticed, but that is not always the case. ● Can Prostate Cancer Be Found Early? ● Screening Tests for Prostate Cancer ● American Cancer Society Recommendations for Prostate Cancer Early Detection ● Insurance Coverage for Prostate Cancer Screening Diagnosis and Planning Treatment After a cancer diagnosis, staging provides important information about the extent of cancer in the body and anticipated response to treatment. ● Signs and Symptoms of Prostate Cancer ● Tests to Diagnose and Stage Prostate Cancer ● Prostate Pathology ● Prostate Cancer Stages and Other Ways to Assess Risk ● Survival Rates for Prostate Cancer ● Questions To Ask About Prostate Cancer 1 ____________________________________________________________________________________American Cancer Society cancer.org | 1.800.227.2345 Can Prostate Cancer Be Found Early? Screening is testing to find cancer in people before they have symptoms. For some types of cancer, screening can help find cancers at an early stage, when they are likely to be easier to treat. Prostate cancer can often be found early by testing for prostate-specific antigen (PSA) levels in a man’s blood. Another way to find prostate cancer is the digital rectal exam (DRE). For a DRE, the doctor puts a gloved, lubricated finger into the rectum to feel the prostate gland. These tests and the actual process of screening are described in more detail in Screening Tests for Prostate Cancer. If the results of either of these tests is abnormal, further testing (such as a prostate biopsy) is often done to see if a man has cancer.
    [Show full text]
  • Histologic Carcinoma of the Prostate in Autopsies: Frequency, Origin, Extension, Grading and Terminology Athanase Billis, Carlos A.F
    Clinical Urology Brazilian Journal of Urology Vol. 28 (3): 197-206, May - June, 2002 Official Journal of the Brazilian Society of Urology HISTOLOGIC CARCINOMA OF THE PROSTATE IN AUTOPSIES: FREQUENCY, ORIGIN, EXTENSION, GRADING AND TERMINOLOGY ATHANASE BILLIS, CARLOS A.F. SOUZA, HELENICE PIOVESAN Department of Anatomic Pathology, School of Medicine, State University of Campinas (UNICAMP), Campinas, SP, and Pathology Division, School of Medicine, São Francisco University (USF), Bragança Paulista, SP, Brazil ABSTRACT Objective: To study the prostate carcinoma incidentally found in autopsies. Material and Methods: The prostates from 150 autopsied men over 40 years of age were dissected in transitional and peripheral zones. The microscopic examination included presence or absence of adenocarcinoma, neoplastic extension, evaluated by the number of fragments, and histologic grading, according to the Gleason system. Results: The frequency was 36.66%, being significantly higher in older patients with no predilection to color. From a total of 55 carcinomas, 56.36% were found in both transitional and peripheral zones, 25.45% only in transitional zone and 18.18% only in peripheral zone. All neoplasias found only in the transitional zone or only in the peripheral zone were not extense and had low grade. When found in both zones, the carcinoma was not very extense and had low grade in the transitional zone, but it was extense and with high grade in the peripheral zone. In 14.54%, 80% and 5.45% of the carcinomas, the Gleason score was 2 - 4, 5 - 6 and 7, respectively. Gleason score 2 - 4 was significantly more frequent in younger patients and score 7 in older patients.
    [Show full text]
  • MR Imaging of Early Prostate Cancer
    PROSTATE CANCER: LATEST IN IMAGING TESTS AND STAGING CLASSIFICATION Jin Wei Kwek MBBS, FRCR(UK), FAMS Senior Consultant, Div of Oncologic Imaging, Dy Director, Div of Cancer Education Adj Asst Prof, Duke-NUS Medical School Prostate Cancer: Imaging Test SCOPE • Diagnosis of prostate cancer, staging classification and risk assessment • Imaging tests and applications. Prostate Cancer - Diagnosis Diagnosis of Prostate Cancer Trans-Rectal US guided Biopsy • High specificity but Low sensitivity (FN up to 30%) Cancer at Apex • May miss aggressive cancer and detect insignificant cancer Anterior • Missed Cancers: Apex, Lateral Cancer and Anterior cancers • Potential role for imaging in Lateral Cancer detecting clinically significant tumour and guiding biopsy Parker C et al Ann Oncol 2015 Patel AR et al Urol 2004 Prostate Cancer: Imaging Tests TNM Staging Classification • Majority new diagnosed cT1c – non palpable • T2 Tumour confined within the prostate1 • T2a Tumour involves one half of one lobe or less • T2b Tumour involves more than half of one lobe, but not both lobes • T2c Tumour involves both lobes • T3 Tumour extends through the prostatic capsule2 • T3a Extracapsular extension (unilateral or bilateral) including microscopic bladder neck involvement • T3b Seminal vesicle(s) invasion • T4 Tumour is fixed or invades adjacent structures other than seminal vesicles: external sphincter, rectum, levator muscles, and/or pelvic wall Prostate Cancer: Imaging Test TNM Staging Classification N-Regional Lymph Nodes (Below common iliac bifurcation) • NX Regional lymph nodes cannot be assessed • N0 No regional lymph node metastasis • N1 Regional lymph node metastasis M-Distant Metastasis • M1a Non-regional lymph node(s) • M1b Bone(s) • M1c Other site(s) Prostate Cancer: Imaging Test AJCC 8th Edition Changes Ref: CA Cancer J Clin 2017;67:245-253 Prostate Cancer: Imaging Test AJCC 8th Ed: Radiological Considerations 1) T Stage: MRI most useful for demarcation of extent of primary tumour and extraprostatic extension .
    [Show full text]
  • Grading of Prostatic Adenocarcinoma: Current State and Prognostic Implications Jennifer Gordetsky1,2 and Jonathan Epstein3,4*
    Gordetsky and Epstein Diagnostic Pathology (2016) 11:25 DOI 10.1186/s13000-016-0478-2 REVIEW Open Access Grading of prostatic adenocarcinoma: current state and prognostic implications Jennifer Gordetsky1,2 and Jonathan Epstein3,4* Abstract Background: Despite significant changes in the clinical and histologic diagnosis of prostate cancer, the Gleason grading system remains one of the most powerful prognostic predictors in prostate cancer. The correct diagnosis and grading of prostate cancer is crucial for a patient’s prognosis and therapeutic options. However, this system has undergone significant revisions and continues to have deficiencies that can potentially impact patient care. Main Body: We describe the current state of grading prostate cancer, focusing on the current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma. We also explore the limitations of the current Gleason grading system and present a validated alternative to the Gleason score. The new grading system initially described in 2013 in a study from Johns Hopkins Hospital and then validated in a multi-institutional study, 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. Conclusion: As this new grading system is simpler and more accurately reflects prostate cancer biology, it is recommended by the World Health Organization (WHO) to be used in conjunction with Gleason grading.
    [Show full text]
  • Gleason Scoring System: Nuances in Interpretation
    Gleason Scoring System: Nuances in Interpretation Jasreman Dhillon, MD Assistant Member Anatomic Pathology, GU Moffitt Cancer Center Gleason Grading System • Created by Donald F. Gleason in 1966 • Based solely on the architectural pattern of the tumor • Tumors are assigned a Gleason score based on sum of the two most common grade patterns • Certain aspects of the original Gleason system are interpreted differently in today’s practice • Remarkable that more than 40 years after it’s inception, it remains one of the most powerful prognostic predictors in prostate cancer • Multiple molecular marker studies in serum and tissue have largely failed to improve upon the prognostic power of this system. Gleason Score 1977 2005 Consensus Conference on Gleason Grading of Prostatic Carcinoma • International Society of Urological Pathology (ISUP) in 2005 – Incorporate changes in the reporting of Gleason score in pathology reports that reflect the changing clinical practices – Obtain consensus on how to grade newly described variants of prostatic ca e.g. mucinous carcinoma, ductal carcinoma, foamy gland carcinoma – Pathologists: • Achieve consensus on Gleason grading • Help pathologists adapt the Gleason grading system to current day practice in a more uniform manner Variations in Reporting • Do all pathologists follow ISUP 2005 recommendations • How different pathologists interpret ISUP 2005 recommendations • ISUP 2005 Committee could not come to consensus in certain areas of reporting Interpretation of 2005 ISUP Recommendations by Pathologists • European
    [Show full text]
  • New Circulating Biomarkers for Prostate Cancer
    Prostate Cancer and Prostatic Diseases (2008) 11, 112–120 & 2008 Nature Publishing Group All rights reserved 1365-7852/08 $30.00 www.nature.com/pcan REVIEW New circulating biomarkers for prostate cancer K Bensalah, Y Lotan, JA Karam and SF Shariat Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA The introduction of prostate-specific antigen (PSA) revolutionized prostate cancer (PCa) screening and ushered the PSA era. However, its use as a screening tool remains controversial and changes in the epidemiology of PCa have strongly limited its prognostic role. Therefore, we need novel approaches to improve our ability to detect PCa and foretell the course of the disease. To improve the specificity of total PSA, several approaches based on PSA derivatives have been investigated such as age-specific values, PSA density (PSAD), PSAD of the transition zone, PSA velocity and assessment of various isoforms of PSA. With recent advances in biotechnology such as high- throughput molecular analyses, many potential blood biomarkers have been identified and are currently under investigation. Given the plethora of candidate PCa biomarkers, we have chosen to discuss a select group of candidate blood-based biomarkers including human glandular kallikrein, early prostate cancer antigens, insulin-like growth factor-I (IGF-I) and its binding proteins (IGFBP- 2 and IGFBP-3), urokinase plasminogen activation system, transforming growth factor-b1, interleukin-6, chromogranin A, prostate secretory protein, prostate-specific membrane antigen, PCa-specific autoantibodies and a-methylacyl-CoA racemase. While these and other markers have shown promise in early phase studies, no single biomarker is likely to have the appropriate degree of certainty to dictate treatment decisions.
    [Show full text]
  • May/June 2012 Topics
    Monthly Journal of Updates and Information MAY/JUNE 2012 WHAT’S NEW: The following information is currently available on the FCDS website. REGISTRATION ONLINE: https://fcds.med.miami.edu/scripts/ FLORIDA ANNUAL CANCER register.pl REPORT: INCIDENCE AND MORTALITY - 2007 You may visit the hotel reservation link FCDS/NAACCR EDITs available on the FCDS registration page Metafile - 12.1B Metafile, (click or copy and paste link listed) or posted 02/06/2012 8:15am, 12.1B Metafile changes, call 1-800-360-4016 and reference the minor changes to Reason The 2012 Florida Cancer Data System group code "FCDS" to get the group rate No Radiation edits. Annual Conference is being held July 26th of $139.00. FCDS/NAACCR th -27 , 2012 at the TradeWinds Island Re- WEBINAR SERIES: sorts in St Pete Beach. The FCRA Annual **Deadline for group rate NAACCR 2011-2012 conference is at the same hotel and pre- reservations is 7/9/2012.** CANCER REGISTRY cedes the FCDS conference. AND SURVEILLANCE WEBINAR SERIES - ICD-10-CM AND CANCER Hotel requires a one-night deposit at SURVEILLANCE, 07/12/2012, TOPICS: reservation time. 48 hours notice for BEING HELD AT 7 NPCR CER & AHRQ Projects cancellation to return your deposit. FLORIDA FACILITIES AND requires registration. Quality Control - Reviews & Exercises For more information contact: Web-based Education & User Bleu Thompson Controlled Facility Profiles Florida Cancer Data System Tumor Consolidation PO Box 016960 (D4-11) Cancer Patient Portal Miami, Florida 33101 [email protected] Unified Case Finding Follow Back 305-243-2635 305-243-4871 (Fax) *Slides/Handouts will be available for printing prior to conference as nothing The Florida Cancer Data System will be distributed at the meeting.* (FCDS) is Florida's statewide, popu- lation-based cancer registry and has been collecting incidence data since 1981.
    [Show full text]
  • Automated Gleason Grading of Prostate Biopsies Using Deep Learning
    Automated Gleason Grading of Prostate Biopsies using Deep Learning Wouter Bulten1,*, Hans Pinckaers1, Hester van Boven2, Robert Vink3, Thomas de Bel1, Bram van Ginneken4, Jeroen van der Laak1, Christina Hulsbergen-van de Kaa3, and Geert Litjens1 1Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pathology, Nijmegen, The Netherlands 2The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital (NKI-AVL), Department of Pathology, Amsterdam, The Netherlands 3Laboratory of Pathology East Netherlands (LabPON), Hengelo, The Netherlands 4Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Radiology & Nuclear Medicine, Nijmegen, The Netherlands *[email protected] ABSTRACT The Gleason score is the most important prognostic marker for prostate cancer patients but suffers from significant inter- observer variability. We developed a fully automated deep learning system to grade prostate biopsies. The system was developed using 5834 biopsies from 1243 patients. A semi-automatic labeling technique was used to circumvent the need for full manual annotation by pathologists. The developed system achieved a high agreement with the reference standard. In a separate observer experiment, the deep learning system outperformed 10 out of 15 pathologists. The system has the potential to improve prostate cancer prognostics by acting as a first or second reader. Introduction With 1.2 million new prostate cancer cases each year1, a high incidence-to-mortality ratio, and risk of overdiagnosis and overtreatment2,3 , there is a strong need for accurate assessment of patient prognosis. Currently, the Gleason score4, assigned by a pathologist after microscopic examination of cancer morphology, is the most powerful prognostic marker for prostate cancer (PCa) patients.
    [Show full text]