PMID- 27367469
OWN - NLM
STAT- MEDLINE
DCOM- 20170630
LR  - 20220310
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 119
IP  - 5
DP  - 2017 May
TI  - Primary Gleason pattern upgrading in contemporary patients with D'Amico low-risk 
      prostate cancer: implications for future biomarkers and imaging modalities.
PG  - 692-699
LID - 10.1111/bju.13570 [doi]
AB  - OBJECTIVE: To retrospectively assess the rate of high-grade primary Gleason 
      upgrading (HGPGU) to primary Gleason pattern 4 or 5 in a contemporary cohort of 
      patients with D'Amico low-risk prostate cancer including those who fulfilled 
      Prostate Cancer Research International Active Surveillance (PRIAS) criteria, and 
      to develop a tool for HGPGU prediction. HGPGU is a contraindication in most 
      active surveillance (AS) and focal therapy protocols. PATIENTS AND METHODS: In 
      all, 10 616 patients with localised prostate cancer were treated at a high-volume 
      European tertiary care centre from 2010 to 2015 with radical prostatectomy. 
      Analyses were restricted to 1 819 patients with D'Amico low-risk prostate cancer 
      (17.1%) with prostate-specific antigen (PSA) levels of <10.0 ng/mL, cT1c-cT2a and 
      Gleason score </=6, and were repeated within 772 of the men (7.3%) who fulfilled 
      the PRIAS criteria for AS (PSA level of </=10 ng/mL, T1c-T2, Gleason score </=6, PSA 
      density (PSAD) of <0.2 ng/mL(2) , </=2 positive cores). Uni- and multivariable 
      logistic regression models were fitted, testing predictors of HGPGU. The final 
      logistic regression model was based on the most informative variables. RESULTS: 
      There was HGPGU in 88 (4.8%) patients with D'Amico low-risk prostate cancer and 
      in 32 (4.1%) of the subgroup who were PRIAS eligible. Multivariable analysis 
      predicting HGPGU for the patients with D'Amico low-risk yielded three independent 
      predictors: age, PSAD, and clinical tumour stage (P = 0.008, P = 0.005 and P = 
      0.021, respectively). Within the same patients, the model using all vs the most 
      informative variables resulted in area under the curves (AUCs) of 69.2% and 
      68.3%, respectively. Multivariable analysis of those who were PRIAS eligible, 
      yielded age and number of positive cores as independent predictors of HGPGU (P = 
      0.002 and P = 0.049, respectively; AUC 64.9%). CONCLUSIONS: The low accuracy 
      (invariably <70%) for HGPGU prediction in both patients with D'Amico low-risk 
      prostate cancer and PRIAS eligibility indicates that these variables have poor 
      predictive ability in contemporary patients. Despite HGPGU being a rare 
      phenomenon, it may have life threatening implications and consequently 
      alternatives such as biomarkers, genetic markers, or imaging modalities at 
      re-biopsy are needed.
CI  - (c) 2016 The Authors BJU International (c) 2016 BJU International Published by John 
      Wiley & Sons Ltd.
FAU - Leyh-Bannurah, Sami-Ramzi
AU  - Leyh-Bannurah SR
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
AD  - Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
FAU - Abou-Haidar, Hiba
AU  - Abou-Haidar H
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
AD  - Department of Urology, University of Montreal Health Center, Montreal, QC, 
      Canada.
FAU - Dell'Oglio, Paolo
AU  - Dell'Oglio P
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
AD  - Department of Urology and Division of Experimental Oncology, URI, Urological 
      Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Schiffmann, Jonas
AU  - Schiffmann J
AD  - Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
FAU - Tian, Zhe
AU  - Tian Z
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
AD  - Department of Epidemiology, Biostatistics and Occupational Health, McGill 
      University, Montreal, QC, Canada.
FAU - Heinzer, Hans
AU  - Heinzer H
AD  - Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
FAU - Huland, Hartwig
AU  - Huland H
AD  - Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
FAU - Graefen, Markus
AU  - Graefen M
AD  - Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
FAU - Budaus, Lars
AU  - Budaus L
AD  - Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
FAU - Karakiewicz, Pierre I
AU  - Karakiewicz PI
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health 
      Center, Montreal, QC, Canada.
AD  - Department of Urology, University of Montreal Health Center, Montreal, QC, 
      Canada.
LA  - eng
PT  - Journal Article
DEP - 20160805
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
RN  - 0 (Biomarkers, Tumor)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Biomarkers, Tumor
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Grading
MH  - Predictive Value of Tests
MH  - Prostatic Neoplasms/diagnostic imaging/*pathology/therapy
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Watchful Waiting
OTO - NOTNLM
OT  - PRIAS
OT  - active surveillance
OT  - genetic markers
OT  - multiparametric MRI
OT  - nomogram
EDAT- 2016/07/02 06:00
MHDA- 2017/07/01 06:00
CRDT- 2016/07/02 06:00
PHST- 2016/07/02 06:00 [pubmed]
PHST- 2017/07/01 06:00 [medline]
PHST- 2016/07/02 06:00 [entrez]
AID - 10.1111/bju.13570 [doi]
PST - ppublish
SO  - BJU Int. 2017 May;119(5):692-699. doi: 10.1111/bju.13570. Epub 2016 Aug 5.