Sercan YİLMAZ, Bahadır TOPUZ, Can SİCİMLİ, Adem Emrah COĞUPLUGİL, Engin KAYA, Murat ZOR, Selahattin BEDİR

Gleason skoru 3+3 prostat kanseri olan hastalarda radikal prostatektomi sonrası evre ilerlemesinin öngörülmesinde PI-RADS versiyon 2’nin rolü

Amaç: Gleason skoru (GS), prostat kanserinin agresifitesinin öngörülmesinde kullanılan en önemli parametrelerdendir. TRUS prostat biyopsisindeki Gleason skoru ile radikal prostatektomi sonrası belirlenen Gleason skoru arasında uyumsuzluk saptanabilir. Bu çalışmada TRUS-bx sonrası GS 3+3 prostat kanseri olan hastalarda radikal prostatektomi sonrası GS evre ilerlemesini öngörmede mp-MRG özellikleri ve PI-RADS V2’nin önemini araştırmayı amaçladık. Gereç ve Yöntemler: Hastanemizde Ocak 2016 ile Ocak 2020 yılları arasında TRUS-Bx sonrası GS 3+3 prostat kanseri saptanan ve robot yardımlı radikal prostatektomi (RARP) uygulanan hastaların verileri retrospektif olarak incelendi. Hastalar cerrahi sonrası evre ilerlemesi olan (Grup 1) ve olmayan (Grup 2) olmak üzere 2 gruba ayrıldı. Hastaların PSA seviyesi, hasta yaşı, prostat hacmi, PSA dansitesi, mp-MRG’deki indeks lezyon boyutu, PI-RADS versiyon 2 skorları değerlendirildi. Bulgular: Çalışmaya dahil edilen toplam 43 hastanın ortalama yaşı 63.7±7.1 yıl idi. Yirmi beş hastada (%58.1) cerrahi sonrası evre ilerlemesi gözlenmiştir. Final patoloji raporuna göre prostat kanseri evre ilerlemesi gözlenen ve gözlenmeyen hasta grubunda yaş, PSA dansitesi ve PIRADS V2 skoru istatistiksel olarak anlamlı bulundu (p˂0.05). Evre ilerlemesi PI-RADS versiyon 2 skoru 4 olan 8 hasta ve 5 olan 5 hasta olmak üzere toplam 13 hastada gözlendi. mp-MRG indeks lezyon boyutu her iki grup arasında istatistiksel anlamlı fark olmasa da evre ilerlemesi olan grupta daha büyüktü (12.15±4.3 vs 15.69±7.6). mp-MRG’de prostat dışı yayılım gözlenmeyen hiçbir hastada evre ilerlemesi yokken, prostat dışına yayılım rapor edilen sadece 3 hastada evre ilerlemesi rapor edildi. Sonuç: mp-MRG PIRADS v2 skorunun prostat kanseri evre ilerlemesinde önemli olduğunu saptadık.

Anahtar Kelimeler:

Gleason skoru, multiparametrik manyetik rezonans görüntüleme, PI-RADS skoru, prostat kanseri

The role of PI-RADS version 2 in predicting the stage progression after radical prostatectomy in patients with Gleason score 3+3 prostate cancer

Objective: Gleason score (GS) is one of the most important parameters used in predicting the aggressiveness of prostate cancer. A discrepancy may be detected between the Gleason score in the TRUS prostate biopsy and the Gleason score determined after radical prostatectomy. In this study, we aimed to investigate the importance of mp-MRI features and PI-RADS V2 in predicting the progression of GS stage after radical prostatectomy in patients with GS 3+3 prostate cancer after TRUS-bx. Material and Methods: The data of patients who were diagnosed with GS 3+3 prostate cancer after TRUS-Bx and underwent robot-assisted radical prostatectomy between January 2016 and January 2020 were retrospectively analyzed. The patients were divided into 2 groups as with progressive (Group 1) and not (Group 2) after surgery. The PSA level, patient age, prostate volume, PSA density, index lesion size on mp-MRI, PI-RADS version 2 scores of the patients were evaluated. Results: The mean age of 43 patients included in the study was 63.7±7.1 years. Stage progression was observed in 25 patients (58.1%) after surgery. According to the final pathology report, age, PSA density and PIRADS V2 score were found to be statistically significant in the patient group with and without prostate cancer stage progression (p˂0.05). Stage progression was observed in a total of 13 patients, 8 patients with a PI-RADS version 2 score of 4 and 5 patients with a score of 5. Although the mp-MRI index lesion size was not statistically significant between the two groups, it was larger in the group with stage progression (12.15±4.3 vs 15.69±7.6). While there was no stage progression in any of the patients who did not show extra-prostate dissemination in mp-MRI, only 3 patients with extra-prostate spread were reported. Conclusions: We found that the mp-MRI PIRADS v2 score is important in prostate cancer stage progression.

Keywords:

gleason score, multi-parametric magnetic resonance imaging, PI-RADS score, prostate cancer,

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1. Epstein JI. An update of the Gleason grading system. J Urol 2010; 183:433-40.
2. Lilja H, Ulmert D, Vickers AJ. Prostate-specific antigen and prostate cancer: prediction, detection and monitoring. Nat Rev Cancer. 2008;8:268–278.
3. Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320–1328.
4. Huang GJ, Sadetsky N, Penson DF. Health related quality of life for men treated for localized prostate cancer with long-term followup. J Urol. 2010;183:2206–2212.
5. Dall’Era MA, Albertsen PC, Bangma C, et al. Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol. 2012;62:976–983.
6. Vargas HA, Akin O, Afaq A, et al. Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol. 2012;188:1732–1738.
7. Ganz PA, et. al. NIH State-of-the-Science Statement: Role of active surveillance in the management of men with localized prostate cancer. NIH Consensus State Science Statements 2011 Dec 5-7; 28(1):1-27.
8. Stephenson, A.J., M.W. Kattan, J.A. Eastham, F.J. Bianco, Jr., O. Yossepowitch, A.J. Vickers, E.A. Klein, D.P. Wood, and P.T. Scardino, Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol, 27(26): p. 4300-5. 2009.
9. Eggener, S.E., P.T. Scardino, P.C. Walsh, M. Han, A.W. Partin, B.J. Trock, Z. Feng, D.P. Wood, J.A. Eastham, O. Yossepowitch, D.M. Rabah, M.W. Kattan, C. Yu, E.A. Klein, and A.J. Stephenson, Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol, 185(3): p. 869-75. 2011.
10. Epstein, J.I., Z. Feng, B.J. Trock, and P.M. Pierorazio, Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol, 61(5): p. 1019-24. 2012.
11. Schroder FH, Hugosson J, Roobol MJ et al: Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360: 1320.
12. United States Preventive Services Task Force: Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008; 149: 185.
13. Porten SP, Whitson JM, Cowan JE et al: Changes in prostate cancer grade on serial biopsy in men undergoing active surveillance. J Clin Oncol 2011; 29: 2795.
14. Klotz L, Zhang L, Lam A et al: Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 2010; 28: 126.
15. Thompson J, Lawrentschuk N, Frydenberg M et al: The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Int, suppl., 2013; 112: 6.
16. Somford DM, Hambrock T, Hulsbergen-van de Kaa CA, et al. Initial experience with identifying high-grade prostate cancer using diffusion-weighted MR imaging (DWI) in patients with a Gleason score
17. Lee DH, Koo KC, Lee SH, et al. Tumor lesion diameter on diffusion weighted magnetic resonance imaging could help predict insignificant prostate cancer in patients eligible for active surveillance: preliminary analysis. J Urol. 2013;190:1213–1217.
18. Park BH, Jeon HG, Choo SH, et al. Role of multiparametric 3.0- Tesla magnetic resonance imaging in patients with prostate cancer eligible for active surveillance. BJU Int. 2014;113:864–870.
19. Yim JH, Kim CK, Kim J-H. Clinically insignificant prostate cancer suitable for active surveillance according to Prostate Cancer Research International: active surveillance criteria: utility of PIRADS v2. J Magn Reson Imaging. 2018;47:1072–1079.
20. Cooperberg MR, Lubeck DP, Mehta SS, Carroll PR, CaPSURE. Time trends in clinical risk stratification for prostate cancer: implications for outcomes (data from CaPSURE) [published erratum appears in J Urol 2004;171:811]. J Urol 2003; 170:S21-5, discussion S6-7.
21. D’Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998; 280:969-74.
22. Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 2005; 293:2095-101.
23. Dinh KT, Mahal BA, Ziehr DR, et al. Incidence and Predictors of Upgrading and Up Staging among 10,000 Contemporary Patients with Low Risk Prostate Cancer. J Urol. 2015;194(2):343-349.
24. Suardi N, Gallina A, Capitanio U et al: Ageadjusted validation of the most stringent criteria for active surveillance in low-risk prostate cancer patients. Cancer 2012; 118: 973.
25. Song SH, Pak S, Park S, et al. Predictors of unfavorable disease after radical prostatectomy in patients at low risk by D'Amico criteria: role of multiparametric magnetic resonance imaging. J Urol. 2014;192(2):402-408. doi:10.1016/j.juro.2014.02.2568.
26. Moussa AS, Li J, Soriano M, Klein EA, Dong F, Jones JS. Prostate biopsy clinical and pathological variables that predict significant grading changes in patients with intermediate and high grade prostate cancer. BJU Int 2009; 103:43-8.
27. Davies JD, Aghazadeh MA, Phillips S, et al. Prostate size as a predictor of Gleason score upgrading in patients with low risk prostate cancer. J Urol 2011;186:2221-7.
28. Park SY, Jung DC, Oh YT, et al. Prostate cancer: PI-RADS version 2 helps preoperatively predict clinically significant cancers. Radiology 2016; 280:108-16.
29. Zhai L, Fan Y, Sun S, et al. PI-RADS v2 and periprostatic fat measured on multiparametric magnetic resonance imaging can predict upgrading in radical prostatectomy pathology amongst patients with biopsy Gleason score 3 + 3 prostate cancer. Scand J Urol. 2018;52(5-6):333-339.
30. Song W, Bang SH, Jeon HG, et al. Role of PI-RADS Version 2 for Prediction of Upgrading in Biopsy-Proven Prostate Cancer With Gleason Score 6. Clin Genitourin Cancer. 2018;16(4):281-287.