Asociación entre el perfil inmunohistoquímico de la neoplasia intraepitelial de alto grado y del adenocarcinoma acinar de próstata / Association of high-grade prostatic intraepithelial neoplasia immunohistochemical profile with acinar adenocarcinoma of the prostate

Resumen Antecedentes: En el mundo, el carcinoma de próstata constituye la segunda causa de cáncer y la quinta causa de muerte por cáncer en hombres. Objetivo: Conocer el perfil inmunohistoquímico de la neoplasia intraepitelial prostática de alto grado y del adenocarcinoma acinar de próstata. Material y métodos: Estudio observacional, analítico, transversal y retrospectivo de especímenes obtenidos por biopsia con aguja cortante y resección de próstata debido a diagnóstico de adenocarcinoma acinar de próstata y neoplasia intraepitelial de alto grado, entre enero de 2015 y diciembre de 2020. Se realizaron microarreglos tisulares y, posteriormente, estudios de inmunohistoquímica para BCL2, EGFR, p53, Her2/neu y Ki67. Se realizó estadística descriptiva para analizar los factores clinicopatológicos; las variables cualitativas se compararon con prueba exacta de Fisher. Resultados: Se estudiaron 23 pacientes, ocho (34 %) con invasión angiolinfática, 14 (60.8 %) con invasión perineural, cinco (21.2 %) con prostatitis y cuatro (17.3 %) con hiperplasia fibroadenomatosa. Se observó expresión de HER2/neu (p = 0.1023), p53 (p = 1) y BCL2 (p = 0.4136). Conclusión: Se identificó mayor expresión de HER2/neu en la neoplasia intraepitelial prostática de alto grado y el adenocarcinoma acinar de próstata.

Abstract Background: Prostate carcinoma is the second leading cause of cancer and the fifth cause of cancer death in men worldwide. Objective: To know high-grade prostatic intraepithelial neoplasia and prostate acinar adenocarcinoma immunohistochemical profiles. Material and methods: Observational, analytical, cross-sectional, retrospective study of specimens obtained by cutting needle biopsy and prostate resection from subjects diagnosed with acinar adenocarcinoma of the prostate and high-grade prostatic intraepithelial neoplasia between January 2015 and December 2020. Tissue microarrays were performed and, subsequently, immunohistochemical studies for BCL2, EGFR, p53, Her2/neu and Ki67. Descriptive statistics were used to analyze clinicopathological factors. Qualitative variables were compared with Fisher's exact test. Results: Twenty-three patients were studied; eight (34%) with angiolymphatic invasion, 14 (60.8%) with perineural invasion, five (21.2%) with prostatitis, and four (17.3%) with fibroadenomatous hyperplasia. HER2/neu (p = 0.1023), p53 (p = 1) and BCL2 expression (p = 0.4136) was observed. Conclusion: HER2/neu increased expression was identified in high-grade prostatic intraepithelial neoplasia and acinar adenocarcinoma of the prostate.

Radical therapy with or without chemotherapy in highly malignant non-metastatic prostate cancer: interim analysis of a prospective non-randomized controlled study / 中华放射肿瘤学杂志

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.

Consistency between modified 12+ X prostate biopsy and systematic biopsy under transrectal interventional ultrasound and Gleason score after prostate cancer surgery / 中国医师杂志

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.

Prognostic significance of mast cells and vascular density in prostatic adenocarcinoma

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.

La intensidad de la captación intraprostática del PSMA como predictor de cáncer de próstata clínicamente significativo / The intensity of PSMA intraprostatic uptake as a predictor of clinically significant prostate cancer

Resumen Introducción: La tomografía por emisión de positrones (PET) con antígeno de membrana específico de próstata (PSMA) mejora la estadificación del cáncer de próstata. Además, la intensidad de captación intraprostática del PSMA puede predecir resultados oncológicos clínicamente relevantes. Nuestro objetivo fue evaluar si la intensidad de captación de PSMA se asocia con el cáncer de próstata clínicamente significativo y poder conocer qué valor de captación de PSMA discrimina mejor esta relación. Métodos: Se realizó un estudio de cohorte de 40 pacientes con cáncer de próstata comprobado por biopsia previo a la realización de radioterapia externa. Se evaluó correlación entre intensidad de captación del PSMA intraprostático y los resulta dos patológicos adversos en la biopsia prostática. Se estudió qué valor de captación de PSMA discrimina mejor el cáncer de próstata clínicamente significativo utilizando curvas ROC. Resultados: El 40% de los pacientes tuvieron un cáncer de próstata clínicamente significativo, el maximum standardized uptake value (SUV max) tuvo una media de 11.5 (DE ± 7). La muestra arrojó un coeficiente de correlación Spearman de 0.4 (p = 0.007). El área bajo la curva (AUC) fue de 0.73, mostrando el punto de corte un SUV max ≥ 9.5, sensibilidad 0.81 y especificidad 0.71 en la detección de cáncer de próstata clínicamente significativo. Conclusión: la intensidad de captación del PSMA intraprostático puede ser una nueva herramienta diagnóstica en la detección del cáncer de próstata clínicamente significativo. Una intensidad de captación ≥ 9.5 tuvo una buena correlación con el cáncer de próstata clínicamente significativo.

Abstract Introduction: Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) improves prostate cancer staging. Furthermore, the intensity of intraprostatic uptake of PSMA can predict clinically relevant oncologic outcomes. The objective of this study is to evaluate whether the intensity of PSMA uptake is associated with clinically significant prostate cancer and to determine which value of PSMA uptake best dis criminates this relationship. Methods: A cohort study of 40 patients with biopsy-proven prostate cancer prior to external radiotherapy was conducted. The correlation between intraprostatic PSMA uptake intensity and adverse pathological findings in prostate biopsy was evaluated. Which PSMA uptake value better discriminates clinically significant prostate cancer was assessed using ROC curves. Results: Forty percent of the patients had a clinically significant prostate cancer and the maximum standardized uptake value (SUV max) had a mean of 11.5 (SD ± 7). The sample showed a Spearman correlation coefficient of 0.4 (p = 0.007). The area under the curve (AUC) was 0.73 and a SUV max ≥ 9.5 showed a sensitivity of 0.81 and a specificity of 0.71 in the detection of clinically significant prostate cancer. Conclusion: Intraprostatic PSMA uptake intensity can be a new diagnostic tool in the detection of clinically significant prostate cancer. An uptake intensity equal or greater than 9.5 is correlated with clinically significant prostate cancer.

The value of PCPT-RC high risk probability combined with Gleason score for predicting the risk of metastasis in newly diagnosed prostate cancer / 西安交通大学学报(医学版)

【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.

Value of prostate biopsy guided by transrectal real-time ultrasonic elastography combined with peak strain index in the diagnosis of prostate cancer / 肿瘤研究与临床

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.

Risk factors for Gleason score changes between biopsy pathology and radical prostatectomy specimen / 中华泌尿外科杂志

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.

Diagnosis value of multiparametric magnetic resonance imaging in prostate cancer and its relationship with clinicopathological grade / 中国医师进修杂志

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.

Prognostic value of ECOG performance status and Gleason score in the survival of castration-resistant prostate cancer: a systematic review / 亚洲男科学杂志(英文版)

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.

A novel screening strategy for clinically significant prostate cancer in elderly men over 75 years of age / 亚洲男科学杂志(英文版)

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

A grading dilemma; Gleason scoring system: Are we sufficiently compatible? A multi center study

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.

The relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopahtological characteristics in patients treated with radical prostatectomy / 中华泌尿外科杂志

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.

The relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopahtological characteristics in patients treated with radical prostatectomy / 中华泌尿外科杂志

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.

Comparison of Old Gleason Score with Modified Gleason Score and Correlation of Needle Biopsy of Prostate with PSA

Introduction: The prostate gland is a secondary sex, exocrineorgan that is an integral part of the human male reproductivesystem. There are three main diseases of the prostate:prostatitis, benign prostatic hyperplasia, and prostate cancer.The new grading system for prostate cancer has obviousbenefits that is: it has more accurate grade stratification thanthe current Gleason system. PSA is serine protease producedby ductal and acinar epithelial cells of normal, hyperplastic,and malignant tissue of the prostate. To study morphologicfeatures of the benign and malignant lesions of prostate,histopathological correlation of benign and malignant lesionsof prostate with serum PSA level, compare new Gleasongrading system with old Gleason grading system.Material and Methods: All the needle biopsies and TURPspecimens submitted to the histopathology laboratory,Department of Pathology, Government medical college, Kotaduring the period from January 2014 to june 2016. We receivedtotal 445 prostate biopsies and TURP specimen from January2014 to June 2016 at our department of pathology, Govt.Medical College, Kota and were examined with haematoxylinand eosin and compare new gleason grading system with oldgleason grading system.Results: On histopathological examination of total 441cases, the majority of cases 323 (73.24%) were benign, 109(24.72%) cases were malignant and 9 (2.04%) cases were pureinflammatory lesions.Conclusion: We observed continuous and significant risingtrend of prostate malignancy from year 2014 to june 2016.Prostatic carcinoma is the malignant neoplasm of aging menmaximum number of prostatic carcinoma were found in agegroup 61-70 yr. Majority (14 cases; 12.84%) of carcinomaprostate cases were found to be associated with PSA level>100.0 ng/ml. In present study majority of cases had Gleasonscore 6 (48%) followed by Gleason score 7 (29%), Gleasonscore 8 (13%), Gleason score 5 (4%), Gleason score 9 (3%)and least one cases in Gleason score 2, 4 and PIN.

New perspectives in modified Gleason’s grading for prostatic cancer and its comparison with original Gleason’s

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.

Prognostic utility of epidermal growth factor receptor (EGFR) expression in prostatic acinar adenocarcinoma

Background: Epidermal growth factor receptor (EGFR) is potential prognostic biomarker expressed in many human cancers. Prognostic significance of EGFR immunohistochemical expression has not been established in prostatic acinar adenocarcinoma, therefore we aimed to evaluate the frequency of expression of EGFR in prostatic adenocarcinoma and its association with other prognostic parameters. Methods: The study included 123 cases of biopsy proven prostatic acinar adenocarcinoma treated at Liaquat National hospital, Karachi from January 2013 till December 2017. Paraffin blocks of all cases were retrieved; sections were cut and stained with haematoxylin and eosin. Pathologic characteristics including tumor quantification, WHO grade group, gleason score, perineural and lymphovascular invasion were evaluated. EGFR immunohistochemistry (IHC) was performed on all tissue blocks. Results: Mean age of the patients included in the study was 69.05±8.68years. High gleason scores i.e. 8 & 9 were noted in 22% (27 cases) and 22.8% (28 cases) respectively. Similarly, 22.8% (28 cases) showed WHO grade group 5. 52.8% (65 cases) had > 50% tissue involvement by carcinoma and perineural invasion was seen in 37.4% (46 cases). Positive EGFR expression was noted in 18.7% (23 cases), while 81.3% (100 cases) showed negative EGFR expression. Significant association of EGFR expression was noted with gleason score (p-value = < 0.001), WHO grade (p = < 0.001), tumor quantification (p =0.007) and perineural invasion (p = < 0.001). Moreover, significant association of EGFR expression was also seen with disease recurrence and Her2neu over expression. Patients with low gleason scores (score 6 and 7) and lower grade group (1, 2 & 3) were less likely to have positive EGFR expression as compared to patients with high gleason score (score 9) and higher grade group (5). Similarly, patients with perineural invasion were more likely to have positive EGFR expression. Conclusion: We found a relatively low EGFR expression in our patients with prostatic adenocarcinoma; however, its association with poor prognostic parameters like high gleason score, higher grade group, perineural invasion, higher tissue involvement by cancer and disease recurrence signifies its importance as a prognostic parameter in prostatic acinar adenocarcinoma (AU)

Correlation of ADC value and Gleason score, Ki-67, P53 proteins expression in prostate cancer / 中国医学影像技术

Objective: To explore the correlation of DWI ADC value and Gleason score, Ki-67, P53 proteins expression in prostate cancer, respectively. Methods Totally 59 patients with prostate cancer who had pathological data were enrolled and underwent DWI examination. The pathological samples were stained with Ki-67, P53 using immunohistochemistry staining. Then Gleason score was used to evaluate the degree of differentiation of tumor cells and stroma, and the patients were divided into well-differentiated group (8 scores, n=19). The differences of ADC value and the correlation with Ki-67 and P53 were analyzed. Results: The ADC value of prostate cancer was (0.98±0.19)×10-3 mm2/s in all 59 patients, while in well-differentiated group, moderately-differentiated group and poorly-differentiated group was (1.14±0.17)×10-3 mm2/s, (1.05±0.17)×10-3 mm2/s and (0.88±0.24)×10-3 mm2/s, respectively, and the differences were significant in total and each pairwise comparison (all P<0.05). ADC value of prostate cancer was negatively correlated with Gleason score (rs=-0.611, P=0.019), the expression of Ki-67 (rs=-0.491, P=0.016) and P53 protein (rs=-0.511, P=0.021), respectively. Conclusion: ADC value of prostate cancer is negatively correlated with Gleason score and Ki-67, P53 proteins expression. ADC value can be used to preliminarily and noninvasively predict the malignancy degree of tumor cells, the degree of cell differentiation and proliferation in prostate neoplasm.

Gleason scores in prostate needle biopsy and prostatectomy specimens in prostatic adenocarcinoma: A correlation study

@#Introduction: Gleason scoring (GS) categorised prostatic adenocarcinoma into five prognostic grade groups (PGGs); associated with different prognosis and treatment. This study aims to correlate between Gleason scores of needle biopsies with the corresponding total prostatectomy specimens, and to assess the relationship between the percentage of Gleason 4 tumour pattern (GP4) within Gleason score 7 (GS7) needle biopsy groups with the pathological staging. Materials and Methods: Seventy-eight specimens of needle prostate biopsy and its subsequent radical prostatectomy were retrospectively studied. The GSs of the needle biopsy were compared with the corresponding prostatectomy specimens. The percentage of GP4 in GS7 needle biopsy groups was calculated and correlated with the pathological staging. Results: More than half (60%) of GS 6 needle biopsy cases (PGG 1) were upgraded in the prostatectomy specimen, while the majority (80%) of the GS7 needle biopsy groups (PGG 2 and 3) remain unchanged. Cohen’s Kappa shows fair agreement in the Gleason scoring between needle biopsies and prostatectomy specimens, K = 0.324 (95% CI, 6.94 to 7.29), p <0.0005 and in the percentage of GP4 in GS7 needle biopsy groups and their corresponding radical prostatectomy specimens, K = 0.399 (95% CI 34.2 – 49.2), p<0.0005. A significant relationship was seen between the percentage of GP4 in GS7 needle biopsy with the pT and pN stage of its radical prostatectomy (p = 0.008 and p=0.001 respectively). Conclusion: A higher percentage of GP4 in GS7 tumour is associated with worse tumour behaviour, therefore it is crucial for clinicians to realise this in deciding the optimal treatment.

Contemporary grading of prostate cancer: 2017 update for pathologists and clinicians / 亚洲男科学杂志(英文版)

The Gleason grading system for prostate cancer (PCA) was developed in the 1960s by DF Gleason. Due to changes in PCA detection and treatment, the application of the Gleason grading system has changed considerably in pathology routine practice. Two consensus conferences were held in 2005 and in 2014 to update PCA Gleason grading. This review provides a summary of the changes in the grading of PCA from the original Gleason grading system to the prognostic grade grouping, as well as a discussion of the clinical significance of the percentage of Gleason patterns 4 and 5.