Yiğit AKIN, Sacit Nuri GÖRGEL, Osman KÖSE, Esra Meltem KOÇ, Yüksel YILMAZ, Serkan ÖZCAN, Enis Mert YORULMAZ

Lokalize Prostat Kanserli Hastalarda Aktif Kriterler Mevcut Kriterler Uygun mu?

Amaç: Gleason skorlama sistemindeki parametreleri, aktif sürveyansa (AS) uygun düşük riskli prostat kanserli hastalarda (PCa) belirlemeyi hedefledik.Materyal ve Metod: 2007-2017 yılları arasında PCa nedeniyle radikal prostatektomi yapılan 153 hastanın tıbbi kayıtlarını geriye dönük olarak inceledik. Biyopsi ile cerrahi Gleason skoru arasında potansiyel yükselme öngören parametreler değerlendirildi. Tüm hastalarda D’Amico risk sınıflamasına göre düşük riskli klinik PCa vardı. Yaş, vücut kitle indeksi (VKİ), Prostat Spesifik Antijen yoğunluğu (PSAD) ve sigara içme durumu gibi demografik ve klinik parametreler değerlendirildi. Kaydedilen parametrelerin, yükseltme için Gleason skorlama sistemi üzerindeki etkilerini inceledik. Tüm patoloji materyalleri deneyimli bir patoloji kliniği tarafından değerlendirildi. Anlamlı p, p <0.05 olarak kabul edildi.Bulgular: Ortanca takip süresi 113,4 ay (1-144 ay) idi. Ortalama yaş 62.9 ± 6.07 idi. Gleason derecelendirme sisteminde yükselme nedenleri aktif sigara içicisi olmak için BMI≥30, PSA yoğunluğu .1.15, Kaplan-Meier ve log-rank testleri analizlerinde sırasıyla 65 yıl (hepsi p <0.05) idi. Tek değişkenli analizler Yaş, VKİI, PSA yoğunluğu >0.15 ve aktif sigara tiryakisi durumlarının istatistiksel olarak anlamlı prognostik faktörler olduğunu gösterdi (sırasıyla; p:0.007, p <0.001, p <0.001, p <0.001). Sonuç: Mevcut Kriterler, PCa düşük riskli PCa hastalarının tümü için yararlı olamamıştır. AS, VKİ yükselmiş olan PCa hastaları için uygun görünmemektedir.

Anahtar Kelimeler:

Aktif izlem, gleason skoru, prostat kanseri, Vücut kitle indeksi

Are current criteria eligible for active surveillance in patients with localized prostate cancer?

Background: We aimed to determine the parameters on the Gleason scoring system to upgrade in patients with the low-risk prostate cancer (PCa) that were suitable for active surveillance (AS).Methods: We retrospectively analyzed medical records of 153 patients who underwent radical prostatectomy because of PCa between 2007 and 2017. Potential predictors of upgrading were evaluated between the biopsy and surgical Gleason score. All patients had clinical low-risk PCa according to D’Amico risk classification. Demographic and clinical parameters including age, body mass index (BMI), Prostate Specific Antigen density (PSAD), and smoking status were evaluated. We examined the effects of recorded parameters on the Gleason scoring system to upgrade. All pathology materials were evaluated by an experienced pathology clinic. Significant p was accepted as p<0.05.Results: Median follow-up period was 113,4 months (range, 1-144 months). Mean age was 62.9± 6.07 years. Causes to upgrade in Gleason grading system were BMI≥30, PSA density≥0.15, to be an active smoker, and age≥ 65 years in Kaplan-Meier and log-rank tests analyses, respectively (all p<0.05). Univariate analyses showed that Age, BMI, PSA density≥0.15 and active smoker statuses were statistically significant prognostic factors (respectively; p:0.007, p<0.001, p<0.001, p<0.001).Conclusion: Current Criteria for AS could not be useful for all PCa low-risk PCa patients. AS does not seem to be appropriate for PCa patients with Elevated BMI.

Keywords:

Active surveillance, Body mass index, Gleason score, Prostate cancer,

PDF

___

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017; 67(1): 7–30.
2. Mahal BA, Cooperberg MR, Aizer AA, Ziehr DR, Hyatt AS, Choueiri TK, et al. Who bears the greatest burden of aggressive treatment of indolent prostate cancer? Am J Med. 2015; 128(6): 609-616.
3. Punnen S, Cowan JE, Chan JM, Carroll PR, Cooperberg MR. Long-term health-related quality of life after primary treatment for localized prostate cancer: results from the CaPSURE registry. Eur Urol. 2015; 68(4): 600-608.
4. Lehto US, Tenhola H, Taari K, Aromaa A. Patients' perceptions of the negative effects following different prostate cancer treatments and the impact on psychological well-being: a nationwide survey. Br J Cancer. 2017; 116(7): 864-873.
5. Loeb S, Bjurlin MA, Nicholson J, Tammela TL, Penson DF, Carter HB, et al. Overdiagnosis and overtreatment of prostate cancer. Eur Urol. 2014; 65(6): 1046-1055.
6. Klotz L. Active surveillance for low-risk prostate cancer. Curr Urol Rep. 2015; 16(4):24.
7. Gözen AS, Akin Y, Ates M, Hruza M, Rassweiler J. Impact of laparoscopic radical prostatectomy on clinical T3 prostate cancer: experience of a single centre with long-term follow-up. BJU Int. 2015; 116(1): 102-108.
8. Xu N, Wu YP, Li XD, Lin MY, Zheng QS, Chen SH et al. Risk of upgrading from prostate biopsy to radical prostatectomy pathology: Is magnetic resonance imaging-guided biopsy more accurate? J Cancer. 2018; 9(19): 3634-3639.
9. Khoddami M, Khademi Y, Kazemi Aghdam M, Soltanghoraee H. Correlation between Gleason Scores in Needle Biopsy and Corresponding Radical Prostatectomy Specimens: A Twelve-Year Review. Iran J Pathol. 2016; 11(2): 120-126.
10. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA; Grading Committee. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016; 40(2): 244-252.
11. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2017; 71(4): 618-629.
12. Kurreck A, Vandergrift LA, Fuss TL, Habbel P, Agar NYR, Cheng LL. Prostate cancer diagnosis and characterization with mass spectrometry imaging. Prostate Cancer Prostatic Dis. 2018; 21(3): 297-305.
13. National Comprehensive Cancer Network (NCCN®) clinical practice guidelines in Oncology. Prostate cancer, version 2. 2017 (https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf). Accessed at December.21.2018
14. da Silva V, Cagiannos I, Lavallée LT, Mallick R, Witiuk K, Cnossen S et al. An assessment of Prostate Cancer Research International: Active Surveillance (PRIAS) criteria for active surveillance of clinically low-risk prostate cancer patients. Can Urol Assoc. J 2017; 11(8): 238-243.
15. Park JW, Koh DH, Jang WS, Cho KS, Ham WS, Rha KH et al. Predictors of adverse pathologic features after radical prostatectomy in low-risk prostate cancer. BMC Cancer. 2018; 18(1): 545.
16. Bosco C, Cozzi G, Kinsella J, Bianchi R, Acher P, Challacombe B et al. Confirmatory biopsy for the assessment of prostate cancer in men considering active surveillance: reference centre experience. Ecancermedicalscience. 2016; 10: 633.
17. Bruinsma SM, Bangma CH, Carroll PR, Leapman MS, Rannikko A, Petrides N, et al; Movember GAP 3 consortium. Active surveillance for prostate cancer: a narrative review of clinical guidelines. Nat Rew Urol. 2016; 13(3): 151-167.
18. Surveillance, Epidemiology, and End Results Program (SEER) of the National Cancer Institute. Fast Stats: An interactive tool for access to SEER cancer statistics. Bethesda, MD: SEER, National Cancer Institute; nd. ( www.seer.cancer.gov/faststats). Accessed December 21, 2018.
19. Sayehmiri K, Azami M, Mohammadi Y, Soleymani A, Tardeh Z. The association between Selenium and Prostate Cancer: a Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev. 2018; 19(6): 1431-1437.
20. Richstone L, Bianco FJ, Shah HH, Kattan MW, Eastham JA, Scardino PT, et al. Radical prostatectomy in men aged > or = 70 years: Effect of age on upgrading, upstaging, and the accuracy of a preoperative nomogram. BJU Int. 2008; 101(5): 541–546.
21. Ketchandji M, Kuo YF, Shahinian VB, Goodwin JS. Cause of death in older men after the diagnosis of prostate cancer. J Am Geriatr Soc. 2009; 57(1): 24-30.
22. Wallner LP, Slezak JM, Loo RK, Bastani R, Jacobsen SJ. Ten-Year Trends in Preventive Service Use Before and After Prostate Cancer Diagnosis: A Comparison with Noncancer Controls. Perm J. 2017; 21.
23. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015; (219): 1-8.
24. Stewart BW, Wild CP. World Cancer Report 2014. IARC, WHO, 2014, p.IX-X.
25. Peng XF, Meng XY, Wei C, Xing ZH, Huang JB, Fang ZF et al. The association between metabolic syndrome and bladder cancer susceptibility and prognosis: an updated comprehensive evidence synthesis of 95 observational studies involving 97,795,299 subjects. Cancer Manag Res. 2018; 10: 6263-6274.
26. Lavalette C, Trétarre B, Rebillard X, Lamy PJ, Cénée S, Menegaux F. Abdominal obesity and prostate cancer risk: epidemiological evidence from the EPICAP study. Oncotarget. 2018; 9(77): 34485-34494.
27. Bhindi B, Kulkarni GS, Finelli A, Alibhai SM, Hamilton RJ, Toi A, et al. Obesity is associated with risk of progression for low-risk prostate can¬cers managed expectantly. Eur Urol. 2014; 66(5): 841-848
28. Washino S, Okochi T, Saito K, Konishi T, Hirai M, Kobayashi Y, et al. Combination of prostate imaging reporting and data system (PI-RADS) score and prostate-specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naïve patients. BJU Int. 2017; 119(2): 225–233.
29. Jin BS, Kang SH, Kim DY, Oh HG, Kim CI, Moon GH, et al. Pathological upgrading in prostate cancer patients eligible for active surveillance: Does prostate-specific antigen density matter? Korean J Urol. 2015; 56(9): 624-629.
30. Grasgruber P, Hrazdira E, Sebera M, Kalina T. Cancer Incidence in Europe: An Ecological Analysis of Nutritional and Other Environmental Factors. Front Oncol. 2018; 8: 151.