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Cancer Epidemiology
Published in Trevor F. Cox, Medical Statistics for Cancer Studies, 2022
The mean ages of the Caucasian and Asian men were 62.5 and 68.5 years respectively. We need to assess the affect of age on the probability of having prostate cancer. Table 7.32 shows the number of men without cancer, the number of men with cancer and the number of men with cancer, whose Gleason score (GS) was seven or above, for each 10-year age group from 21 to 90. (The Gleason score ranges from 0 to 10, based on the appearance of cancer cells.)
Radionuclide-based Diagnosis and Therapy of Prostate Cancer
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Sven-Erik Strand, Mohamed Altai, Joanna Strand, David Ulmert
The results from tissue-sample analysis (biopsy) and imaging are then compiled into a tumour staging system, the TNM system. The system describes tumour invasiveness to surrounding tissue (T), spread to lymph nodes (N), and distant metastases (M). The T staging includes the following categories: T1 (incidental – PSA detected, and PCa not palpable by digital rectal examination); T2 (confined within the prostate gland, palpable); T3 (extending through the prostate capsule); and T4 (invading neighbouring organs) [5]. Further, the biopsy samples are scored according to the Gleason score grading system – the tumour is graded 1–5 according to the aggressiveness of the disease, with 1 being high differentiated cells and 5 being low differentiated cells. The overall Gleason score is calculated by adding the score of the most common grade and the highest grade seen in the biopsy samples. PSA levels, Gleason score, and tumour stage are the principal clinical parameters used to determine the likelihood of local or distant recurrent disease. PCa spreads mostly through lymphatic vessels, with pelvic nodes being the primary and most frequent site of metastases.
Molecular Mediator of Prostate Cancer Progression and Its Implication in Therapy
Published in Surinder K. Batra, Moorthy P. Ponnusamy, Gene Regulation and Therapeutics for Cancer, 2021
Samikshan Dutta, Navatha Shree Sharma, Ridwan Islam, Kaustubh Datta
Clinical staging is based mainly on histopathological evaluation of biopsy specimen (Gleason score), TNM classification, PSA level and imaging study. On the other hand, during or after surgery, this clinical staging often changes due to the up or down gradation on pathological staging. Histologic grades such as Gleason scoring remains an important prognostic factor in PCa [28, 29]. A high Gleason score predicts rapid progression of the disease and thereby indicates the requirement of a severe treatment regimen. However, the Gleason score does not provide information on the type of treatment strategy to be used on a specific patient leading to over or non-optimum treatment. Patients with low Gleason score usually have indolent, low risk cancer [30–32]. Unfortunately, as previously mentioned, cancer in some patients do progress and becomes a lethal disease. Because of the fear of having aggressive disease, patients with low Gleason grades are often treated with radical therapy leading to morbidity and poor quality of life [33, 34]. The risk stratification strategy for localized PCa patients is therefore utmost necessary, with an underlying objective to identify and categorize patient groups who can be benefited from aggressive treatments versus those with indolent tumors who can be good candidates for either active surveillance or with no or limited intervention. However, the challenges remain in the identification of molecular subtypes that drive differential prognoses in localized PCa.
Can a prostate biopsy be safely deferred on PI-RADS 1,2 or 3 lesions seen on pre-biopsy mp-MRI?
Published in Arab Journal of Urology, 2023
Rickaz Abdul Raheem, Ahsen Razzaq, Victoria Beraud, Richard Menzies-Wilson, Rakan Odeh, Imoh Ibiok, Prashant Mulawkar, Henry Andrews, Iqbal Anjum, Khaled Hosny, Tom Leslie
Analyses of other characteristics between clinically insignificant (Gleason score 3 + 3) and significant cancers (Gleason score ≥3 + 4) demonstrated important findings. Among the diagnosed cancer cases the average percentage of cancer in the biopsy specimens was 13.8%. On separate analysis, only 3.2% of cancer was found when clinically insignificant cancer was diagnosed whereas, for clinically significant cancer, 20.1% of mean percentage cancer was identified. Similarly, maximum cancer core length was greater when a clinically significant cancer was diagnosed (6.5 mm) compared to clinically insignificant cancer (2.5 mm). Interestingly, a higher percentage of positive cores was noted from the total number of biopsied cores in clinically significant cancer (37.9%) compared to the clinically insignificant group (12%). Therefore, it can be concluded that an increased volume of cancer is harboured with a higher Gleason score. This finding is clinically important in managing patients since the amount of tumour found in the biopsy has been found to influence overall survival [22].
Tissue N-linked glycosylation as potential prognostic biomarker for biochemical recurrence-free survival
Published in Biomarkers, 2021
Tijl Vermassen, Arne Van Den Broeck, Nicolaas Lumen, Nico Callewaert, Sylvie Rottey, Joris Delanghe
As expected, several clinical characteristics showed prognostic properties or BCR. T stage, Gleason score, EAU risk groups for BCR and positive surgical margins were all prognosticators for BCR-free survival following RALP. These findings are (partly) in line with other research. Van den Broeck et al. (2019) reviewed the prognostic effect of several biomarkers on PCa outcome. There is a clear consensus regarding the negative prognostic value of increasing Gleason scores for oncological outcomes (Van den Broeck et al.2019). Logically, high Gleason scores in our study were also associated with shorter BCR-free survival. T stage on the other hand causes some controversy for its prognostic use. This as only 7/13, 4/12, and 2/6 studies illustrated a significant association for distant metastases, PCa specific survival and overall mortality; respectively. A comparable association was found in our study for BCR-free survival.
Robust treatment planning of dose painting for prostate cancer based on ADC-to-Gleason score mappings – what is the potential to increase the tumor control probability?
Published in Acta Oncologica, 2021
Eric Grönlund, Erik Almhagen, Silvia Johansson, Erik Traneus, Tufve Nyholm, Camilla Thellenberg, Anders Ahnesjö
One of the most predictive factors for prostate cancer prognosis is the Gleason score determined from biopsy samples of prostate tissue. It has been shown that increasing Gleason scores correlate with an increased risk for biochemical recurrences after both RT and prostatectomy [12–15]. Ghobadi et al. [16] hypothesized that Gleason scores could be used to characterize patient specific dose-responses through implementing Gleason scores as a parameter in the linear-quadratic model. In their modeling study, they found that the prostate dose could be differentiated by 10 Gy with an equal TCP as for uniform dose treatments. Furthermore, increasing Gleason scores are shown to correlate with decreasing apparent diffusion coefficient (ADC) data acquired from diffusion weighted MR imaging [17–23]. Similar to Ghobadi et al. [16], we hypothesized in our earlier study [24] that Gleason scores could be used to predict differentiated dose-responses and thus used to maximize the TCP with the average dose constrained to that for conventional uniform dose treatments. The underlying Gleason driven dose-response functions were derived from a learning set of pre-RT Gleason scores and post-RT outcomes from 122 high-risk patients treated with a uniform dose of 91.6 Gy EQD2. The endpoint for TCP was freedom from biochemical recurrences (BCR) 5-years post-RT.