Changes in prostate cancer grade on serial biopsy in men undergoing active surveillance.
PURPOSE Active surveillance is now considered a viable treatment option for men with low-risk prostate cancer. However, little is known regarding changes in Gleason grade on serial biopsies over an extended period of time. PATIENTS AND METHODS Men diagnosed with prostate cancer between 1998 and 2009...
| Published in: | Journal of Clinical Oncology Vol. 29; no. 20; pp. 2795 - 2801 |
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| Main Authors: | , , , , , , , , |
| Format: | research Journal Article |
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American Society of Clinical Oncology
7/10/2011
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104654425&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104654425 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0732183X 20D jtl: Journal of Clinical Oncology issn: 0732183X maglogo: N pubinfo: dt: 7/10/2011 vid: 29 iid: 20 pid: 26892 pub: American Society of Clinical Oncology place: Alexandria, Virginia artinfo: ui: 104654425 2011205848 10.1200/JCO.2010.33.0134 NLM21632511 104654425 ppf: 2795 ppct: 6 formats: tig: atl: Changes in prostate cancer grade on serial biopsy in men undergoing active surveillance. aug: au: Porten SP Whitson JM Cowan JE Cooperberg MR Shinohara K Perez N Greene KL Meng MV Carroll PR affil: Department of Urology, University of California, San Francisco, 1600 Divisadero St, Box 1695, San Francisco, CA 94143-1695; sporten@urology.ucsf.edu. sug: subj: Observational Methods Methods Prostatic Neoplasms Pathology Adult Aged Aged, 80 and Over Biopsy Clinical Assessment Tools Disease Progression Life Table Method Male Middle Age Neoplasm Staging Prognosis Prospective Studies Prostate-Specific Antigen Blood Prostatic Neoplasms Therapy Human Adult: 19-44 years Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Male ab: PURPOSE Active surveillance is now considered a viable treatment option for men with low-risk prostate cancer. However, little is known regarding changes in Gleason grade on serial biopsies over an extended period of time. PATIENTS AND METHODS Men diagnosed with prostate cancer between 1998 and 2009 who elected active surveillance as initial treatment, with 6 or more months of follow-up and a minimum of six cores at biopsy, were included in analysis. Upgrading and downgrading were defined as an increase or decrease in primary or secondary Gleason score. Means and frequency tables were used to describe patient characteristics, and treatment-free survival rates were determined by life-table product limit estimates. Results Three hundred seventy-seven men met inclusion criteria. Mean age at diagnosis was 61.9 years. Fifty-three percent of men had prostate-specific antigen of 6 ng/mL or less, and 94% had Gleason score of 6 or less. A majority of men were cT1 (62%), had less than 33% of biopsy cores involved (80%), and were low risk (77%) at diagnosis. Median number of cores taken at diagnostic biopsy was 13, mean time to follow-up was 18.5 months, and 29% of men had three or more repeat biopsies. Overall, 34% (129 men) were found to have an increase in Gleason grade. The majority of men who experienced an upgrade (81%) did so by their second repeat biopsy. CONCLUSION A proportion of men experience an upgrade in Gleason score while undergoing active surveillance. Men who experience early upgrading likely represent initial sampling error, whereas later upgrading may reflect tumor dedifferentiation. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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