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Wang Y, Teramoto Y, Miyamoto H. Cribriform intraductal carcinoma of the prostate may be more aggressive than cribriform conventional/acinar prostatic adenocarcinoma. Pathology 2025; 57:3-9. [PMID: 39592308 DOI: 10.1016/j.pathol.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 08/08/2024] [Accepted: 08/22/2024] [Indexed: 11/28/2024]
Abstract
It remains to be determined if the prognostic value of cribriform morphology (Crib) associated with intraductal carcinoma of the prostate (IDC) is equivalent to that in conventional/acinar prostatic adenocarcinoma (CPA). We herein assessed radical prostatectomy findings and long-term oncologic outcomes in 732 men with Grade Group 2-4 CPA without any Gleason pattern 5. Our cases were divided into four cohorts according to the absence or presence of Crib within CPA and/or IDC: Cohort-1, no Crib (n=347; 47.4%); Cohort-2, Crib only in CPA (n=203; 27.7%); Cohort-3, Crib only in IDC (n=17; 2.3%); and Cohort-4, Crib in both CPA and IDC (n=165; 22.5%). Compared with that in CPA only (Cohort-2), Crib in both CPA and IDC (Cohort-4) was significantly associated with adverse histopathological features, including higher tumour grade/stage and larger tumour volume. Univariate analysis revealed significantly higher risks of postoperative recurrence in patients with Crib in IDC only [Cohort-3; hazard ratio (HR) 2.450, p=0.022] or both CPA and IDC (Cohort-4; HR 2.835, p<0.001) than in those with Crib in CPA only (Cohort-2), whereas the prognosis was analogous between Cohort-3 and Cohort-4 (p=0.913). In a multivariable analysis [Crib in CPA only (Cohort-2) as a reference], Crib in IDC only (Cohort-3; HR 3.821, p=0.002) or both CPA and IDC (Cohort-4; HR 1.905, p=0.004) showed significantly worse recurrence-free survival. Compared with Crib in CPA only, its presence in both CPA and IDC was thus found to be independently associated with a poorer prognosis, suggesting a potentially greater clinical impact of Crib in IDC than in CPA.
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MESH Headings
- Humans
- Male
- Prostatic Neoplasms/pathology
- Prostatic Neoplasms/surgery
- Aged
- Middle Aged
- Prostatectomy
- Prognosis
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Neoplasm Grading
- Carcinoma, Acinar Cell/pathology
- Carcinoma, Acinar Cell/surgery
- Prostate/pathology
- Prostate/surgery
- Neoplasm Recurrence, Local/pathology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Ductal/pathology
- Carcinoma, Ductal/surgery
- Carcinoma, Ductal/mortality
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Affiliation(s)
- Ying Wang
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Yuki Teramoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hiroshi Miyamoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Urology, University of Rochester Medical Center, Rochester, NY, USA; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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2
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Morozov A, Taratkin M, Bazarkin A, Rivas JG, Puliatti S, Checcucci E, Belenchon IR, Kowalewski KF, Shpikina A, Singla N, Teoh JYC, Kozlov V, Rodler S, Piazza P, Fajkovic H, Yakimov M, Abreu AL, Cacciamani GE, Enikeev D. A systematic review and meta-analysis of artificial intelligence diagnostic accuracy in prostate cancer histology identification and grading. Prostate Cancer Prostatic Dis 2023; 26:681-692. [PMID: 37185992 DOI: 10.1038/s41391-023-00673-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Artificial intelligence (AI) is a promising tool in pathology, including cancer diagnosis, subtyping, grading, and prognostic prediction. METHODS The aim of the study is to assess AI application in prostate cancer (PCa) histology. We carried out a systematic literature search in 3 databases. Primary outcome was AI accuracy in differentiating between PCa and benign hyperplasia. Secondary outcomes were AI accuracy in determining Gleason grade and agreement among AI and pathologists. RESULTS Our final sample consists of 24 studies conducted from 2007 to 2021. They aggregate data from roughly 8000 cases of prostate biopsy and 458 cases of radical prostatectomy (RP). Sensitivity for PCa diagnostic exceeded 90% and ranged from 87% to 100%, and specificity varied from 68% to 99%. Overall accuracy ranged from 83.7% to 98.3% with AUC reaching 0.99. The meta-analysis using the Mantel-Haenszel method showed pooled sensitivity of 0.96 with I2 = 80.7% and pooled specificity of 0.95 with I2 = 86.1%. Pooled positive likehood ratio was 15.3 with I2 = 87.3% and negative - was 0.04 with I2 = 78.6%. SROC (symmetric receiver operating characteristics) curve represents AUC = 0.99. For grading the accuracy of AI was lower: sensitivity for Gleason grading ranged from 77% to 87%, and specificity from 82% to 90%. CONCLUSIONS The accuracy of AI for PCa identification and grading is comparable to expert pathologists. This is a promising approach which has several possible clinical applications resulting in expedite and optimize pathology reports. AI introduction into common practice may be limited by difficult and time-consuming convolutional neural network training and tuning.
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Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andrey Bazarkin
- Institute for Clinical Medicine, Sechenov University, Moscow, Russia
| | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Stefano Puliatti
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Ines Rivero Belenchon
- Department of Uro-Nephrology. Virgen del Rocío University Hospital. Seville, "Seville Biomedicine Institute, IBiS/ Virgen del Rocío University Hospital /CSIC/Seville University. Seville", Seville, Spain
| | - Karl-Friedrich Kowalewski
- Department of Urology, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - Anastasia Shpikina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nirmish Singla
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jeremy Y C Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Vasiliy Kozlov
- Department of Public Health and Healthcare, Sechenov University, Moscow, Russia
| | - Severin Rodler
- Department of Urology, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Harun Fajkovic
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Maxim Yakimov
- Pathology department, Rabin Medical Center, Petach Tikwa, Israel
| | - Andre Luis Abreu
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, CA, USA
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, CA, USA
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
- Department of Urology, Medical University of Vienna, Vienna, Austria.
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3
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Pekala KR, Bergengren O, Eastham JA, Carlsson SV. Active surveillance should be considered for select men with Grade Group 2 prostate cancer. BMC Urol 2023; 23:152. [PMID: 37777716 PMCID: PMC10541702 DOI: 10.1186/s12894-023-01314-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/03/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Treatment decisions for localized prostate cancer must balance patient preferences, oncologic risk, and preservation of sexual, urinary and bowel function. While Active Surveillance (AS) is the recommended option for men with Grade Group 1 (Gleason Score 3 + 3 = 6) prostate cancer without other intermediate-risk features, men with Grade Group 2 (Gleason Score 3 + 4 = 7) are typically recommended active treatment. For select patients, AS can be a possible initial management strategy for men with Grade Group 2. Herein, we review current urology guidelines and the urologic literature regarding recommendations and evidence for AS for this patient group. MAIN BODY AS benefits men with prostate cancer by maintaining their current quality of life and avoiding treatment side effects. AS protocols with close follow up always allow for an option to change course and pursue curative treatment. All the major guideline organizations now include Grade Group 2 disease with slightly differing definitions of eligibility based on risk using prostate-specific antigen (PSA) level, Gleason score, clinical stage, and other factors. Selected men with Grade Group 2 on AS have similar rates of deferred treatment and metastasis to men with Grade Group 1 on AS. There is a growing body of evidence from randomized controlled trials, large observational (prospective and retrospective) cohorts that confirm the oncologic safety of AS for these men. While some men will inevitably conclude AS at some point due to clinical reclassification with biopsy or imaging, some men may be able to stay on AS until transition to watchful waiting (WW). Magnetic resonance imaging is an important tool to confirm AS eligibility, to monitor progression and guide prostate biopsy. CONCLUSION AS is a viable initial management option for well-informed and select men with Grade Group 2 prostate cancer, low volume of pattern 4, and no other adverse clinicopathologic findings following a well-defined monitoring protocol. In the modern era of AS, urologists have tools at their disposal to better stage patients at initial diagnosis, risk stratify patients, and gain information on the biologic potential of a patient's prostate cancer.
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Affiliation(s)
- Kelly R Pekala
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, 1133 York Avenue, New York, NY, 10065, USA
| | - Oskar Bergengren
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, 1133 York Avenue, New York, NY, 10065, USA
- Department of Urology, Uppsala University, Uppsala, Sweden
| | - James A Eastham
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, 1133 York Avenue, New York, NY, 10065, USA
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, 1133 York Avenue, New York, NY, 10065, USA.
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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4
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Li X, Zheng C, Xue X, Wu J, Li F, Song D, Li X. Integrated analysis of single-cell and bulk RNA sequencing identifies a signature based on macrophage marker genes involved in prostate cancer prognosis and treatment responsiveness. Funct Integr Genomics 2023; 23:115. [PMID: 37010617 DOI: 10.1007/s10142-023-01037-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
In the tumor microenvironment, tumor-associated macrophages (TAMs) interact with cancer cells and contribute to the progression of solid tumors. Nonetheless, the clinical significance of TAM-related biomarkers in prostate cancer (PCa) is largely unexplored. The present study aimed to construct a macrophage-related signature (MRS) for predicting PCa patient prognosis based on macrophage marker genes. Six cohorts comprising 1056 PCa patients with RNA-Seq and follow-up data were enrolled. Based on macrophage marker genes identified by single-cell RNA-sequencing (scRNA-seq) analysis, univariate analysis, least absolute shrinkage and selection operator (Lasso)-Cox regression, and machine learning procedures were performed to derive a consensus MRS. Receiver operating characteristic curve (ROC), concordance index, and decision curve analyses were used to confirm the predictive capacity of the MRS. The predictive performance of the MRS for recurrence-free survival (RFS) was stable and robust, and the MRS outperformed traditional clinical variables. Furthermore, high-MRS-score patients presented abundant macrophage infiltration and high-expression levels of immune checkpoints (CTLA4, HAVCR2, and CD86). The frequency of mutations was relatively high in the high-MRS-score subgroup. However, the low-MRS-score patients had a better response to immune checkpoint blockade (ICB) and leuprolide-based adjuvant chemotherapy. Notably, abnormal ATF3 expression may be associated with docetaxel and cabazitaxel resistance in PCa cells, T stage, and the Gleason score. In this study, a novel MRS was first developed and validated to accurately predict patient survival outcomes, evaluate immune characteristics, infer therapeutic benefits, and provide an auxiliary tool for personalized therapy.
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Affiliation(s)
- Xiugai Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122, China
| | - Chang Zheng
- Department of Clinical Epidemiology, First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Xiaoxia Xue
- Science Experiment Center, China Medical University, Shenyang, 110122, China
| | - Junying Wu
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122, China
| | - Fei Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122, China
| | - Dan Song
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122, China
| | - Xuelian Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122, China.
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5
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Lyu F, Li Y, Yan Z, He Q, Cheng L, Zhang P, Liu B, Liu C, Song Y, Xing Y. Identification of ISG15 and ZFP36 as novel hypoxia- and immune-related gene signatures contributing to a new perspective for the treatment of prostate cancer by bioinformatics and experimental verification. J Transl Med 2022; 20:202. [PMID: 35538543 PMCID: PMC9092714 DOI: 10.1186/s12967-022-03398-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background Prostatic cancer (PCa) is one of the most common malignant tumors in men worldwide. Emerging evidence indicates significance of hypoxia and immunity in PCa invasion and metastasis. This study aimed to develop a hypoxia- and immune-related gene risk signature and explore the molecular mechanisms to formulate a better prognostic tool for PCa patients. Methods The hypoxia and immune scores of all PCa patients in The Cancer Genome Atlas (TCGA) dataset were calculated via the maximally selected rank statistics method and the ESTIMATE algorithm. From common genes identified overlapping hypoxia- and immune-related differentially expressed genes (DE-HRGs and DE-IRGs), a hypoxia- and immune-related gene risk signature was developed utilizing univariate and multivariate Cox regression analyses, and validated in the Memorial Sloan Kettering Cancer Centre (MSKCC) database. The immune cell infiltration level of PCa samples were evaluated with ssGSEA algorithm. Differential expression of prognostic genes was evidenced by immunohistochemistry and western blot (WB) in paired PCa samples. Expression levels of these genes and their variations under regular and hypoxic conditions were examined in cell lines. The functional effects of the prognostic gene on PCa cells were examined by wound healing and transwell assays. Results A hypoxia- and immune-related gene risk signature constructed by ISG15 and ZFP36 displays significant predictive potency, with higher risk score representing worse survival. A nomogram based on independent prognostic factors including the risk score and Gleason score exhibited excellent clinical value in the survival prediction of PCa. Infiltration levels of eosinophils, neutrophils, Tcm, Tem, TFH, Th1 cells, and Th17 cells were significantly lower in the high-risk group. Conversely, aDC, pDC, T helper cells, and Tregs were significantly higher. Additionally, the two prognostic genes were closely correlated with the tumor-infiltrating immune cell subset in PCa progression. RT-qPCR and WB presented higher and lower expression of ISG15 and ZFP36 in PCa cells, respectively. They were correspondingly increased and decreased in PCa cells under hypoxic conditions. Wound healing and transwell assays showed that over-expression of ISG15 promoted the migration and invasion of PCa cells. Conclusion Our study identified a novel hypoxia- and immune-related gene signature, contributing a new perspective to the treatment of PCa Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03398-4.
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Affiliation(s)
- Fang Lyu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yunxue Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhecheng Yan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qingliu He
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lulin Cheng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Pu Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bing Liu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chunyu Liu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yarong Song
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Yifei Xing
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Surintrspanont J, Zhou M. Prostate Pathology: What is New in the 2022 WHO Classification of Urinary and Male Genital Tumors? Pathologica 2022; 115:41-56. [PMID: 36645399 DOI: 10.32074/1591-951x-822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 01/17/2023] Open
Abstract
In 2022, after a six-year interval, the International Agency for Research on Cancer (IARC) has published the 5th edition of the WHO Classification of Urinary and Male Genital Tumors, which provides a comprehensive update on tumor classification of the genitourinary system. This review article focuses on prostate carcinoma and underscores changes in the prostate chapter as well as those made across the entire series of the 5th edition of WHO Blue Books. Although no major alterations were made to this chapter, some of the most notable updates include restructure of contents and introduction of a new format; standardization of mitotic counts, genomic nomenclatures, and units of length; refined definition for the terms "variant", "subtype", and "histologic pattern"; reclassification of prostatic intraepithelial neoplasia (PIN)-like adenocarcinoma as a subtype of prostatic acinar adenocarcinoma; and recognition of treatment-related neuroendocrine prostatic carcinoma as a distinct tumor type. Evolving and unsettled issues related to grading of intraductal carcinoma of the prostate and reporting of tertiary Gleason pattern, the definition and prognostic significance of cribriform growth pattern, and molecular pathology of prostate cancer will also be covered in this review.
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Affiliation(s)
- Jerasit Surintrspanont
- Department of Pathology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.,Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
| | - Ming Zhou
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
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7
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Numbere N, Teramoto Y, Gurung PMS, Wang Y, Yang Z, Miyamoto H. The Clinical Impact of Unilateral Versus Bilateral Invasion Into the Seminal Vesicle in Patients With Prostate Cancer Undergoing Radical Prostatectomy. Arch Pathol Lab Med 2021; 146:855-861. [PMID: 34752605 DOI: 10.5858/arpa.2021-0265-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT.— Seminal vesicle involvement by prostate cancer has generally been considered as a key prognosticator. OBJECTIVE.— To assess the clinical significance of unilateral (Uni) versus bilateral (Bil) seminal vesicle invasion (SVI). DESIGN.— We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients showing Uni-SVI (n = 139) versus Bil-SVI (n = 109). RESULTS.— Tumor grade was significantly higher in Bil-SVI cases than in Uni-SVI cases. Additionally, Bil-SVI was significantly associated with a higher incidence of lymphovascular invasion, lymph node metastasis, or positive surgical margin, and larger estimated tumor volume. When the histopathologic features at SVI foci were compared, Grade Group (GG) 3-5/4-5/5 and cribriform morphology were significantly more often seen in Bil-SVI. Outcome analysis revealed that patients with Bil-SVI had a significantly higher risk of disease progression (P < .001) than patients with Uni-SVI. Significantly worse progression-free survival in patients with Bil-SVI was also observed in all subgroups examined, including those with no immediate adjuvant therapy (IAT) (n = 139; P = .01), IAT (n = 109; P = .001), pN0 disease (n = 153; P = .002), or pN1 disease (n = 93; P = .006). In multivariate analysis, Bil-SVI (versus Uni-SVI) showed significance for progression in the entire (hazard ratio [HR] = 1.83, P = .01), IAT (HR = 2.90, P = .006), and pN0 (HR = 2.05, P = .01) cohorts. Meanwhile, tumor grade at SVI (eg, GG4, GG5), as an independent predictor, was significantly associated with patient outcomes. CONCLUSIONS.— Bil-SVI was found to be strongly associated with worse histopathologic features on radical prostatectomy and poorer prognosis. Pathologists may thus need to report Uni-SVI versus Bil-SVI, along with other histopathologic findings, such as Gleason score, at SVI in prostatectomy specimens.
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Affiliation(s)
- Numbereye Numbere
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Wang, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Yuki Teramoto
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Wang, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York.,James P. Wilmot Cancer Institute (Teramoto, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Pratik M S Gurung
- The Department of Urology (Gurung, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Ying Wang
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Wang, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Zhiming Yang
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Wang, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Hiroshi Miyamoto
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Wang, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York.,James P. Wilmot Cancer Institute (Teramoto, Miyamoto), University of Rochester Medical Center, Rochester, New York.,The Department of Urology (Gurung, Miyamoto), University of Rochester Medical Center, Rochester, New York
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8
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Cyll K, Kleppe A, Kalsnes J, Vlatkovic L, Pradhan M, Kildal W, Tobin KAR, Reine TM, Wæhre H, Brennhovd B, Askautrud HA, Skaaheim Haug E, Hveem TS, Danielsen HE. PTEN and DNA Ploidy Status by Machine Learning in Prostate Cancer. Cancers (Basel) 2021; 13:cancers13174291. [PMID: 34503100 PMCID: PMC8428363 DOI: 10.3390/cancers13174291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Molecular tissue-based prognostic biomarkers are anticipated to complement the current risk stratification systems in prostate cancer, but their manual assessment is subjective and time-consuming. Objective assessment of such biomarkers by machine learning-based methods could advance their adoption in a clinical workflow. PTEN and DNA ploidy status are well-studied biomarkers, which can provide clinically relevant information in prostate cancer at a low cost. Using a cohort of 253 patients who received radical prostatectomy, we developed a novel, fully-automated PTEN scoring in immunohistochemically-stained tissue slides, which could be used to assess PTEN status in a reliable and reproducible manner. In an independent validation cohort of 259 patients, automatically assessed PTEN status was significantly associated with time to biochemical recurrence after radical prostatectomy, and the combination of PTEN and DNA ploidy status further improved risk stratification. These results demonstrate the utility of machine learning in biomarker assessment. Abstract Machine learning (ML) is expected to improve biomarker assessment. Using convolution neural networks, we developed a fully-automated method for assessing PTEN protein status in immunohistochemically-stained slides using a radical prostatectomy (RP) cohort (n = 253). It was validated according to a predefined protocol in an independent RP cohort (n = 259), alone and by measuring its prognostic value in combination with DNA ploidy status determined by ML-based image cytometry. In the primary analysis, automatically assessed dichotomized PTEN status was associated with time to biochemical recurrence (TTBCR) (hazard ratio (HR) = 3.32, 95% CI 2.05 to 5.38). Patients with both non-diploid tumors and PTEN-low had an HR of 4.63 (95% CI 2.50 to 8.57), while patients with one of these characteristics had an HR of 1.94 (95% CI 1.15 to 3.30), compared to patients with diploid tumors and PTEN-high, in univariable analysis of TTBCR in the validation cohort. Automatic PTEN scoring was strongly predictive of the PTEN status assessed by human experts (area under the curve 0.987 (95% CI 0.968 to 0.994)). This suggests that PTEN status can be accurately assessed using ML, and that the combined marker of automatically assessed PTEN and DNA ploidy status may provide an objective supplement to the existing risk stratification factors in prostate cancer.
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Affiliation(s)
- Karolina Cyll
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Andreas Kleppe
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
- Department of Informatics, University of Oslo, NO-0316 Oslo, Norway
| | - Joakim Kalsnes
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Ljiljana Vlatkovic
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Manohar Pradhan
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Wanja Kildal
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Kari Anne R. Tobin
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Trine M. Reine
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Håkon Wæhre
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Bjørn Brennhovd
- Department of Urology, Oslo University Hospital, NO-0424 Oslo, Norway;
| | - Hanne A. Askautrud
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Erik Skaaheim Haug
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
- Department of Urology, Vestfold Hospital Trust, NO-3103 Tønsberg, Norway
| | - Tarjei S. Hveem
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
| | - Håvard E. Danielsen
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, NO-0424 Oslo, Norway; (K.C.); (A.K.); (J.K.); (L.V.); (M.P.); (W.K.); (K.A.R.T.); (T.M.R.); (H.W.); (H.A.A.); (E.S.H.); (T.S.H.)
- Department of Informatics, University of Oslo, NO-0316 Oslo, Norway
- Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford OX3 9DU, UK
- Correspondence: ; Tel.: +47-22-78-23-20
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9
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Hollemans E, Verhoef EI, Bangma CH, Rietbergen J, Roobol MJ, Helleman J, van Leenders GJLH. Clinical outcome comparison of Grade Group 1 and Grade Group 2 prostate cancer with and without cribriform architecture at the time of radical prostatectomy. Histopathology 2021; 76:755-762. [PMID: 31944367 PMCID: PMC7216977 DOI: 10.1111/his.14064] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/08/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Abstract
Aims Invasive cribriform and intraductal carcinoma are associated with aggressive disease in Grade Group 2 (GG2) prostate cancer patients. However, the characteristics and clinical outcome of patients with GG2 prostate cancer without cribriform architecture (GG2−) as compared with those with Grade Group 1 (GG1) prostate cancer are unknown. The aim of this study was to investigate the clinical and pathological characteristics of GG1 and GG2− prostate cancer in radical prostatectomy specimens. Methods and results We reviewed 835 radical prostatectomy specimens for Grade Group, pT stage, surgical margin status, and the presence of cribriform architecture. Biochemical recurrence‐free survival and metastasis were used as clinical outcomes. GG1 prostate cancer was seen in 207 patients, and GG2 prostate cancer was seen in 420 patients, of whom 228 (54%) showed cribriform architecture (GG2+) and 192 (46%) did not. GG2− patients had higher prostate‐specific antigen levels (9.4 ng/ml versus 7.0 ng/ml; P < 0.001), more often had extraprostatic extension (36% versus 11%; P < 0.001) and had more positive surgical margins (27% versus 17%; P = 0.01) than GG1 patients. GG2− patients had shorter biochemical recurrence‐free survival (hazard ratio 2.7, 95% confidence interval 1.4–4.9; P = 0.002) than GG1 patients. Lymph node and distant metastasis were observed neither in GG2− nor in GG1 patients, but occurred in 22 of 228 (10%) GG2+ patients. Conclusion In conclusion, patients with GG2− prostate cancer at radical prostatectomy have more advanced disease and shorter biochemical recurrence‐free survival than those with GG1 prostate cancer, but both groups have a very low risk of developing metastasis.
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Affiliation(s)
- Eva Hollemans
- Department of Pathology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Esther I Verhoef
- Department of Pathology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - John Rietbergen
- Department of Urology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Jozien Helleman
- Department of Urology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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10
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Xiao GQ, Sherrod AE. Are we ready to include invasive cribriform and intraductal carcinoma into the prostate cancer grade grouping system? Transl Androl Urol 2020; 9:2292-2295. [PMID: 33209697 PMCID: PMC7658155 DOI: 10.21037/tau-20-845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Guang-Qian Xiao
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Andy E Sherrod
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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11
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van Leenders GJLH, Verhoef EI, Hollemans E. Prostate cancer growth patterns beyond the Gleason score: entering a new era of comprehensive tumour grading. Histopathology 2020; 77:850-861. [PMID: 32683729 PMCID: PMC7756302 DOI: 10.1111/his.14214] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/18/2022]
Abstract
The Gleason grading system is one of the most important factors in clinical decision‐making for prostate cancer patients, and is entirely based on the classification of tumour growth patterns. In recent years it has become clear that some individual growth patterns themselves have independent prognostic value, and could be used for better personalised risk stratification. In this review we summarise recent literature on the clinicopathological value and molecular characteristics of individual prostate cancer growth patterns, and show how these, most particularly cribriform architecture, could alter treatment decisions for prostate cancer patients.
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Affiliation(s)
| | - Esther I Verhoef
- Department of Pathology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Eva Hollemans
- Department of Pathology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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12
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Xiao GQ, Nguyen E, Unger PD, Sherrod AE. Comparative expression of immunohistochemical biomarkers in cribriform and pattern 4 non-cribriform prostatic adenocarcinoma. Exp Mol Pathol 2020; 114:104400. [DOI: 10.1016/j.yexmp.2020.104400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022]
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13
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Gao J, Zhang Q, Fu Y, Wang W, Zhang C, Kan Y, Huang H, Li D, Shi J, Guo H, Zhang B. Combined clinical characteristics and multiparametric MRI parameters for prediction of cribriform morphology in intermediate-risk prostate cancer patients. Urol Oncol 2020; 38:216-224. [DOI: 10.1016/j.urolonc.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/20/2019] [Accepted: 09/04/2019] [Indexed: 12/30/2022]
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14
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Haffner MC, Salles DC, Gao G, Epstein JI. Gleason pattern 4 with cribriform morphology on biopsy is associated with adverse clinicopathological findings in a prospective radical prostatectomy cohort. Hum Pathol 2020; 98:74-80. [PMID: 32119879 DOI: 10.1016/j.humpath.2020.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Abstract
The prognostic significance of the Gleason grading system has been well established. However, individual Gleason patterns comprise heterogeneous morphologies which might add additional prognostic information. Recent evidence suggests that Gleason pattern 4 with cribriform growth pattern is associated with an adverse prognosis. To determine the association between cribriform pattern on biopsies and pathological findings on subsequent prostatectomies, we evaluated the presence of cribriform architecture in a prospective cohort of 367 men from 2014 to 2018 treated at a single institution. Cribriform architecture was present in 63.5% of all biopsies and was correlated with the overall extent of Gleason pattern 4. In addition, cribriform morphology on biopsy showed a statistically significant association with higher Gleason grade and increased pathological stage and nodal metastasis. In a subset analysis of cases with Grade Group 2 (Gleason score 3 + 4, n = 208), these associations did not reach statistical significance, but the presence of cribriform growth in this subgroup showed a trend toward increased upgrading to Grade Group 5 (Gleason score 9/10) (1 [0.5%] vs. 5 [2.4%], P = 0.06). This large prospective study comparing biopsy and prostatectomy finding of cribriform architecture demonstrates that cribriform pattern 4 is associated with adverse prognostic features and highlights the relevance for recognizing specific morphologies with distinct biological and clinical features.
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Affiliation(s)
- Michael C Haffner
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Daniela C Salles
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Guofeng Gao
- Department of Pathology, University of California Davis Health System, Sacramento, CA 92093, USA
| | - Jonathan I Epstein
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
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15
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Carlsson S, Benfante N, Alvim R, Sjoberg DD, Vickers A, Reuter VE, Fine SW, Vargas HA, Wiseman M, Mamoor M, Ehdaie B, Laudone V, Scardino P, Eastham J, Touijer K. Risk of Metastasis in Men with Grade Group 2 Prostate Cancer Managed with Active Surveillance at a Tertiary Cancer Center. J Urol 2020; 203:1117-1121. [PMID: 31909690 DOI: 10.1097/ju.0000000000000742] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE We studied the risk of metastatic prostate cancer development in men with Grade Group 2 disease managed with active surveillance at Memorial Sloan Kettering Cancer Center. MATERIALS AND METHODS A total of 219 men with Grade Group 2 prostate cancer had disease managed with active surveillance between 2000 and 2017. Biopsy was performed every 2 to 3 years, or upon changes in magnetic resonance imaging, prostate specific antigen level or digital rectal examination. The primary outcome was development of distant metastasis. The Kaplan-Meier method was used to estimate treatment-free survival. RESULTS Median age at diagnosis was 67 years (IQR 61-72), median prostate specific antigen was 5 ng/ml (IQR 4-7) and most patients (69%) had nonpalpable disease. During followup 64 men received treatment, including radical prostatectomy in 36 (56%), radiotherapy in 20 (31%), hormone therapy in 3 (5%) and focal therapy in 5 (8%). Of the 36 patients who underwent radical prostatectomy 32 (89%) had Grade Group 2 disease on pathology and 4 (11%) had Grade Group 3 disease. Treatment-free survival was 61% (95% CI 52-70) at 5 years and 49% (95% CI 37-60) at 10 years. Three men experienced biochemical recurrence, no men had distant metastasis and no men died of prostate cancer during the followup. Median followup was 3.1 years (IQR 1.9-4.9). CONCLUSIONS Active surveillance appears to be a safe initial management strategy in the short term for carefully selected and closely monitored men with Grade Group 2 prostate cancer treated at a tertiary cancer center. Definitive conclusions await further followup.
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Affiliation(s)
- Sigrid Carlsson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.,Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ricardo Alvim
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Michal Wiseman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maha Mamoor
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vincent Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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16
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Kim KH, Ku JY, Lee CH, Park WY, Ha HK. Cribriform Pattern at the Surgical Margin is Highly Predictive of Biochemical Recurrence in Patients Undergoing Radical Prostatectomy. KOSIN MEDICAL JOURNAL 2019. [DOI: 10.7180/kmj.2019.34.2.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives We investigated the relationship between cribriform patterns and biochemical recurrence in patients with positive surgical margins after radical prostatectomy. Methods This study was based on radical prostatectomy specimens obtained from 817 patients (165 with margin-positive status) collected at a single center between 2010 and 2016. We retrospectively analyzed and compared body mass index, preoperative prostate-specific antigen, Gleason score, operative methods, postoperative Gleason score, pathological T-stage, tumor percentage involvement, lymphatic and perineural invasion, prostate-specific antigen nadir, location and length of the positive margin, cribriform pattern status, and Gleason grade at the surgical margin in terms of their association with biochemical recurrence. Risk factors for biochemical recurrence were also investigated. Results 21% (31/146) of surgical margin-positive patients had a cribriform pattern. Nadir prostate-specific antigen, perineural invasion and biochemical recurrence rates were significantly higher in cribriform pattern present group than absent group (P = 0.031, 0.043 and 0.045, respectively). According to the Cox regression model, postoperative Gleason score, tumor percentage involvement, location and length of the positive margin, and the presence of a cribriform pattern at the surgical margin were significant predictive factors of biochemical recurrence (P = 0.022, < 0.001, 0.015, 0.001, and 0.022, respectively). Moreover, the biochemical recurrence risk was approximately 3-fold higher in patients with a cribriform pattern at the surgical margin than in those without (HR: 3.41, 95% CI 1.20-9.70, P = 0.022). Conclusions A cribriform pattern at the surgical margin is a significant predictor of biochemical recurrence in patients who undergo radical prostatectomy.
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17
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Mithal P, Truong M, Quarrier S, Lu D, Hollenberg G, Weinberg E, Miyamoto H, Frye T. Cribriform pattern and perineural invasion on MR/US fusion biopsy predict failure of selection criteria for prostatic hemigland ablation. Urol Oncol 2019; 38:38.e1-38.e8. [PMID: 31753604 DOI: 10.1016/j.urolonc.2019.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/20/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess clinicopathologic factors on MR/US fusion biopsy that might predict failure of theoretical selection criteria for prostatic hemigland ablation (HA). SUBJECTS AND METHODS A retrospectively maintained single institution multiparametric MRI database (n = 1667) was queried to identify 355 patients who underwent MR/US fusion biopsy, including both targeted biopsy and concurrent systematic biopsy from December 1, 2014 to June 1, 2018. Clinical, pathological, and imaging variables were assessed on fusion biopsy (Table 1) to determine who met theoretical selection criteria for HA, defined as unilateral intermediate-risk prostate cancer per NCCN criteria (Grade Group [GG] 2 or 3 with prostate-specific antigen <20) and no evidence of extraprostatic extension (EPE) on multiparametric MRI. Predictors of selection criteria failure were then assessed in patients who also underwent radical prostatectomy (RP). Failure of the theoretical HA selection criteria was defined as presence of GG ≧ 2 on the contralateral (untreated) side, or the presence of high-risk disease (any GG ≧ 4 or EPE) in the RP specimen. RESULTS Of the 355 patients who underwent fusion biopsy, 84 patients met the theoretical selection criteria for HA. Of those patients eligible, 54 underwent RP, 37 (68.5%) of which represented unsuccessful HA selection criteria. Patients no longer met HA selection criteria on the basis of upgrading alone in 6/54 (11.1%), EPE alone in 9/54 (16.7%), bilateral GG 2 or 3 in 16/54 (29.6%) or combined EPE and bilateral GG 2 or 3 in 6/54 (11.1%) cases. In the HA selection failures due to upgrading, three also had EPE, one of whom also had missed contralateral GG ≧ 2 disease. The only factor independently associated with HA failure was any presence of cribriform pattern (HR 7.01, P = 0.021). Perineural invasion on systematic biopsyalso appeared to improve the performance of our multivariable model (HR 5.33, P = 0.052), though it was not statistically significant when using a cutoff of <0.05. Accuracy for predicting successful HA was 0.32 and improved to 0.74 if PNI or cribriform were excluded and 0.84 if both were excluded. CONCLUSIONS In a retrospective analysis of RP patients who underwent preoperative MRI/US fusion biopsy, current selection criteria for prostatic HA based on NCCN intermediate-risk stratification failed to accurately identify appropriate candidates in 68.5% of patients. Cribriform pattern and PNI detected on biopsy reduced the failure of hemigland selection criteria to 43%. These criteria should be routinely reported on biopsy pathology and taken into consideration when selecting patients for HA in prospective clinical trials.
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Affiliation(s)
- Prabhakar Mithal
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Matthew Truong
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Scott Quarrier
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Diane Lu
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Gary Hollenberg
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Eric Weinberg
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Hiroshi Miyamoto
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Thomas Frye
- University of Rochester Medical Center, Department of Urology, Rochester, NY.
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18
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Hollemans E, Verhoef EI, Bangma CH, Schoots I, Rietbergen J, Helleman J, Roobol MJ, van Leenders GJLH. Concordance of cribriform architecture in matched prostate cancer biopsy and radical prostatectomy specimens. Histopathology 2019; 75:338-345. [PMID: 31045262 PMCID: PMC6851781 DOI: 10.1111/his.13893] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/29/2019] [Indexed: 01/12/2023]
Abstract
Aims Invasive cribriform and/or intraductal carcinoma have been identified as independent adverse parameters for prostate cancer outcome. Little is known on biopsy undersampling of cribriform architecture. Our aim was to determine the extent of cribriform architecture undersampling and to find predictive factors for identifying false cribriform‐negative cases. Methods and results We reviewed 186 matched prostate biopsies and radical prostatectomy specimens. Of 97 biopsy grade group 2 (Gleason score 3 + 4 = 7) patients, 22 (23%) had true cribriform‐negative (TN), 39 (40%) false‐negative (FN) and 36 (37%) true‐positive (TP) biopsies. Patients with FN biopsies had higher, although not statistically significant (P = 0.06), median PSA levels than patients with TP biopsies (12 versus 8 ng/ml). A PI‐RADS 5 lesion was present in nine of 16 (54%) FN and three of 11 (27%) TN biopsies (P = 0.05). Positive biopsy rate (P = 0.47), percentage Gleason pattern 4 (P = 0.55) and glomeruloid architecture (P = 1.0) were not different. Logistic regression identified PSA as an independent predictor (odds ratio = 3.5; 95% confidence interval = 1.2–9.4, P = 0.02) for cribriform architecture on radical prostatectomy, but not PI‐RADS score. The FN rate for large cribriform architecture at radical prostatectomy was 27%, which was lower than for any cribriform architecture (P = 0.01). During follow‐up (median 27 months), biochemical recurrence‐free survival of patients with TP biopsies was significantly shorter than that of those with FN biopsies (P = 0.03). Conclusion In conclusion, 40% of grade group 2 prostate cancer biopsies were FN for cribriform architecture. These patients had higher PSA levels and more frequent PI‐RADS score 5 lesions than men with TN biopsies.
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Affiliation(s)
- Eva Hollemans
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Esther I Verhoef
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ivo Schoots
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - John Rietbergen
- Department of Urology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Jozien Helleman
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Characterization of lung adenocarcinoma with a cribriform component reveals its association with spread through air spaces and poor outcomes. Lung Cancer 2019; 134:238-244. [PMID: 31319987 DOI: 10.1016/j.lungcan.2019.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To further investigate the relationship between the cribriform component and spread through air spaces (STAS), and to unravel the potential pathological mechanism of poor prognoses in lung adenocarcinoma (LUAD) patients with a cribriform component. METHODS We retrospectively reviewed the clinicopathological characteristics of 208 LUADs. The cribriform component was identified by hematoxylin and eosin staining. The identification of STAS referred to our previous study. The relationship between the cribriform component and STAS was determined by using a logistic regression model. The effects of the cribriform component and STAS on prognosis were analyzed using a Cox proportional hazards regression model. RESULTS LUAD patients with a cribriform component had significantly inferior outcomes and increased risk of both locoregional and distant recurrences when compared with those with no cribriform component (p < 0.001). Among 67 patients with a cribriform component presented, 48 (71.6%) cases had STAS. The logistic regression model identified that the cribriform component was an independent risk factor for the presence of STAS (p = 0.044). Subgroup analysis showed that Crib+ (cribriform component present)/STAS+ (spread through air spaces positive) patients had significantly inferior outcomes when compared with Crib+/STAS- (spread through air spaces negative) patients (p < 0.001). Moreover, the multivariate Cox regression analysis further confirmed that STAS was an independent risk factor for a worsening recurrence-free survival (RFS) (p = 0.001) and overall survival (OS) (p < 0.001) in LUAD patients with a cribriform component. CONCLUSIONS Our results indicated that STAS was more frequently observed in LUAD patients with a cribriform component. Moreover, STAS could provide helpful prognostic information in patients with stage I-III LUAD with a cribriform component.
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Tonttila PP, Ahtikoski A, Kuisma M, Pääkkö E, Hirvikoski P, Vaarala MH. Multiparametric MRI prior to radical prostatectomy identifies intraductal and cribriform growth patterns in prostate cancer. BJU Int 2019; 124:992-998. [DOI: 10.1111/bju.14812] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Panu P. Tonttila
- Departments of Urology, Pathology and Radiology, and Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Oulu Finland
| | - Anne Ahtikoski
- Departments of Urology, Pathology and Radiology, and Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Oulu Finland
| | - Mari Kuisma
- Departments of Urology, Pathology and Radiology, and Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Oulu Finland
| | - Eija Pääkkö
- Departments of Urology, Pathology and Radiology, and Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Oulu Finland
| | - Pasi Hirvikoski
- Departments of Urology, Pathology and Radiology, and Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Oulu Finland
| | - Markku H. Vaarala
- Departments of Urology, Pathology and Radiology, and Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Oulu Finland
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Wang X, Qi M, Zhang J, Sun X, Guo H, Pang Y, Zhang Q, Chen X, Zhang R, Liu Z, Liu L, Hao X, Han B. Differential response to neoadjuvant hormonal therapy in prostate cancer: Predictive morphological parameters and molecular markers. Prostate 2019; 79:709-719. [PMID: 30825345 DOI: 10.1002/pros.23777] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The predictive value of the histological parameters and molecular markers for neoadjuvant hormonal therapy (NHT) in prostate cancer (PCa) has not been well established. The aim of this study is to determine pathological variables that can predict differences in response to NHT in PCa. METHODS A total of 85 locally high risk PCa patients with matched preoperative needle biopsies and radical prostatectomy (RP) specimens were included. All patients were treated with NHT for at least 3 months. We quantified the response to NHT using a new proposed pathological grading system. The system classified tumors into five groups (grades 0-4) according to the severity of histological response. We then categorized the PCa patients into drug-sensitive (DS) group (Grades 2-4) and drug-resistant (DR) group (Grades 0-1). Two pathologists assessed each pretreated tumors for presence or absence of nine morphological features. The expression of androgen receptor (AR), ERG, and PTEN were evaluated by immunohistochemistry (IHC) as well. Statistical analysis was performed to identify significant associations between differentially histological response to NHT and morphological features as well as molecular aberrations. We evaluated different prediction models using receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) analysis. RESULTS 73% (n = 62/85) of tumors in our cohort belonged to DS group, whereas 27% (n = 23/85) of tumors were DR. Univariate logistic analysis suggested four pathological variables, cribriform growth pattern, macronucleoli, ductal adenocarcinoma differentiation, and PTEN loss in needle biopsies were significantly associated with DR effect, all with P-value < 0.05. Multivariate logistic regression analysis revealed that the three parameters as significant predictive factors for predicting DR effect. These were macronucleoli (RR = 4.008, P = 0.002), ductal adenocarcinoma differentiation (RR = 11.659, P = 0.009) and PTEN loss expression (RR = 7.275, P = 0.015). The AUC of three integrated indicators model was 0.781. CONCLUSIONS Our study suggested that the presence of tumor cribriform growth pattern, macronucleoli, ductal adenocarcinoma differentiation, and PTEN loss in needle biopsies are of value in predicting tumor response to NHT regimen. Multivariate logistic regression analysis revealed the performance of combined pathological indicators in predicting DR response was better than that of model based on individual factor alone.
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Affiliation(s)
- Xueli Wang
- The Key Laboratory of Experimental Teratology, Ministry of Education and Department of Pathology, Shandong University, School of Basic Medical Sciences, Jinan, China
- Department of Pathology, Binzhou City Central Hospital, Binzhou, China
| | - Mei Qi
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
| | - Jing Zhang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiubin Sun
- Department of Statistics, Shandong University, School of Public Health, Jinan, China
| | - Hongwei Guo
- Department of Pathology, Linyi People's Hospital, Linyi, China
| | - Yu Pang
- Department of Pathology, Taian City Central Hospital, Taian, China
| | - Qian Zhang
- Department of Pathology, Binzhou Medical University, Binzhou, China
| | - Xinyi Chen
- Department of Pathology, Qingdao Central Hospital of Qingdao University Medical College, Qingdao, China
| | - Ruifeng Zhang
- Department of Pathology, Traditional Chinese Medical Hospital of Xintai, Taian, China
| | - Zhiyan Liu
- The Key Laboratory of Experimental Teratology, Ministry of Education and Department of Pathology, Shandong University, School of Basic Medical Sciences, Jinan, China
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
| | - Long Liu
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
| | - Xiaomeng Hao
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
| | - Bo Han
- The Key Laboratory of Experimental Teratology, Ministry of Education and Department of Pathology, Shandong University, School of Basic Medical Sciences, Jinan, China
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
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Gao J, Zhang C, Zhang Q, Fu Y, Zhao X, Chen M, Zhang B, Li D, Shi J, Wang F, Guo H. Diagnostic performance of 68Ga-PSMA PET/CT for identification of aggressive cribriform morphology in prostate cancer with whole-mount sections. Eur J Nucl Med Mol Imaging 2019; 46:1531-1541. [DOI: 10.1007/s00259-019-04320-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/25/2019] [Indexed: 01/22/2023]
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Taylor RA, Fraser M, Rebello RJ, Boutros PC, Murphy DG, Bristow RG, Risbridger GP. The influence of BRCA2 mutation on localized prostate cancer. Nat Rev Urol 2019; 16:281-290. [DOI: 10.1038/s41585-019-0164-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Approaches to urinary detection of prostate cancer. Prostate Cancer Prostatic Dis 2019; 22:362-381. [PMID: 30655600 PMCID: PMC6640078 DOI: 10.1038/s41391-019-0127-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/06/2018] [Accepted: 12/26/2018] [Indexed: 12/11/2022]
Abstract
Background: Prostate cancer is the most common cancer in American men that ranges from low risk states amenable to active surveillance to high risk states that can be lethal especially if untreated. There is a critical need to develop relatively non-invasive and clinically useful methods for screening, detection, prognosis, disease monitoring, and prediction of treatment efficacy. In this review, we focus on important advances as well as future efforts needed to drive clinical innovation in this area of urine biomarker research for prostate cancer detection and prognostication. Methods: We provide a review of current literature on urinary biomarkers for prostate cancer. We evaluate the strengths and limitations of a variety of approaches that vary in sampling strategies and targets measured; discuss reported urine tests for prostate cancer with respect to their technical, analytical, and clinical parameters; and provide our perspectives on critical considerations in approaches to developing a urine-based test for prostate cancer. Results: There has been an extensive history of exploring urine as a source of biomarkers for prostate cancer that has resulted in a variety of urine tests that are in current clinical use. Importantly, at least three tests have demonstrated high sensitivity (~90%) and negative predictive value (~95%) for clinically significant tumors; however, there has not been widespread adoption of these tests. Conclusions: Conceptual and methodological advances in the field will help to drive the development of novel urinary tests that in turn may lead to a shift in the clinical paradigm for prostate cancer diagnosis and management.
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Multimodal Radiomic Features for the Predicting Gleason Score of Prostate Cancer. Cancers (Basel) 2018; 10:cancers10080249. [PMID: 30060575 PMCID: PMC6116195 DOI: 10.3390/cancers10080249] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Novel radiomic features are enabling the extraction of biological data from routine sequences of MRI images. This study's purpose was to establish a new model, based on the joint intensity matrix (JIM), to predict the Gleason score (GS) of prostate cancer (PCa) patients. METHODS A retrospective dataset comprised of the diagnostic imaging data of 99 PCa patients was used, extracted from The Cancer Imaging Archive's (TCIA) T2-Weighted (T2-WI) and apparent diffusion coefficient (ADC) images. Radiomic features derived from JIM and the grey level co-occurrence matrix (GLCM) were extracted from the reported tumor locations. The Kruskal-Wallis test and Spearman's rank correlation identified features related to the GS. The Random Forest classifier model was implemented to identify the best performing signature of JIM and GLCM radiomic features to predict for GS. RESULTS Five JIM-derived features: contrast, homogeneity, difference variance, dissimilarity, and inverse difference were independent predictors of GS (p < 0.05). Combined JIM and GLCM analysis provided the best performing area-under-the-curve, with values of 78.40% for GS ≤ 6, 82.35% for GS = 3 + 4, and 64.76% for GS ≥ 4 + 3. CONCLUSION This retrospective study produced a novel predictive model for GS by the incorporation of JIM data from standard diagnostic MRI images.
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