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How well does the Gleason score predict prostate cancer death?: A 20-year followup of a population based cohort in Sweden
Örebro University, Department of Clinical Medicine.
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2006 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 175, no 4, p. 1337-1340Article in journal (Refereed) Published
Abstract [en]

Purpose

Adenocarcinoma of the prostate is the most common cancer among men in Western countries. Although the prognostic heterogeneity of prostate cancer is enormous, clinically insignificant aggressive prostate cancers cannot be reliably distinguished. Therefore, identifying prognostic factors is increasingly important, notably among men diagnosed with localized prostate cancer, because many of them may not require aggressive treatment.

Materials and Methods

We analyzed a population based cohort of 253 men with early stage (T1a-b, Nx, M0) initially untreated prostate cancer diagnosed between 1977 and 1991, before PSA screening was available. Tissue samples were available for 240 patients diagnosed with transurethral resection. During complete followup through September 2003, standardized criteria were used to classify histopathological characteristics, progression and causes of death.

Results

Higher Gleason grade, higher nuclear grade and larger tumor volume were independent predictors of death in prostate cancer with monotonous and statistically significant trends (p <0.05). In contrast, the level of Ki-67 – strongly correlated to Gleason score – was not an independent predictor of prostate cancer death. Given a Gleason score of 7 or greater, the probability of dying of prostate cancer was 29%. The corresponding predictive value for Gleason score 8 or greater was 48%.

Conclusions

Although a high Gleason score is a determinant of prostate cancer death, its PPV is relatively low. Thus, further efforts in finding other or complementary indicators of prostate cancer outcome are needed.

Place, publisher, year, edition, pages
Baltimore: Williams and Wilkins Co. , 2006. Vol. 175, no 4, p. 1337-1340
National Category
Medical and Health Sciences Surgery Urology and Nephrology
Research subject
Surgery esp. Urology Specific
Identifiers
URN: urn:nbn:se:oru:diva-5067DOI: 10.1016/S0022-5347(05)00734-2OAI: oai:DiVA.org:oru-5067DiVA, id: diva2:139666
Available from: 2009-01-26 Created: 2009-01-26 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Natural history and prognostic factors in localized prostate cancer
Open this publication in new window or tab >>Natural history and prognostic factors in localized prostate cancer
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The natural history of localized prostate cancer is not fully understood. In most patients the tumor will never progress to a lethal disease, while a subset of patients will ultimately die of the disease. Efficient tools to separate indolent from lethal disease is currently lacking which means that many patients will be offered treatment without any benefit, but still be at risk of experiencing treatment related side effects.

The aims of these studies were to get more insight into the natural history of untreated localized prostate cancer, to assess the prognostic value of established clinical parameters such as Gleason score, nuclear grade and tumor volume and, moreover, some new prognostic markers Ki-67, AMACR and MUC-1. We also aimed to study time trends in the detection of incidental tumors in Sweden.

Patients with localized disease (n=223) and no initial treatment were followed for 21 years. Most patients had a favorable outcome. However, a subset of patients developed lethal disease even beyond 15 years of follow-up and these patients define the group that may benefit most from treatment with curative intent. Patients with poorly differentiated tumors experienced a 9 time higher risk of dying in prostate cancer.

The studies on prognostic markers are based on a cohort of patients (n=253) with incidental prostate cancer detected by transurethral resection for presumed benign hyperplasia. All patients were left without initial treatment. Gleason grade, nuclear grade and tumor volume turned all out to be independent prognostic factors. MUC-1, AMACR and Ki-67 also carried prognostic information. However, after adjustment for Gleason grade, nuclear grade and tumor volume only MUC-1 and AMACR remained as statistically significant prognostic factors. When tested for sensitivity and specificity they all failed and, consequently, they seem to be of less value in daily practice for cancelling an individual patient regarding the choice of treatment.

Time trends in incidental prostate tumors in Sweden were analyzed in a cohort of patients with prostate tumors detected by transurethral resection (TUR-P). Through linkage of the national registration number (NRN) with several registers, e.g. the Swedish Cancer Registry, the National Inpatient registry and the Cause of Death Registry we identified, during the period 1970 through 2003, in total 23288 patients with incidental prostate cancer, who constituted the study group. As comparison group we choose all patients diagnosed with prostate cancer between 1970-2003 excluding those with incidental cancer, in total 112204 patients. Our result confirms earlier findings that there has been a dramatic change over time in incidence of incidental prostate cancers in Sweden, which parallels the introduction of prostate specific antigen. We also found that the cumulative incidence of prostate cancer death is high in the incidental group, opposing earlier findings that incidental tumours are a non-lethal disease.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 78
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 15
Keywords
Prostate Cancer, Natural History, Ki-67, Survival, Prognostic factor, Tumor grade, TUR-P, Incidental, Tumor volume, MUC-1, AMACR
National Category
Urology and Nephrology Surgery
Research subject
Surgery esp. Urology Specific
Identifiers
urn:nbn:se:oru:diva-2109 (URN)978-91-7668-592-1 (ISBN)
Public defence
2008-05-16, Bohmanssonsalen, Hus-B USÖ, Södra Grev Rosengatan, Örebro, 08:30
Opponent
Supervisors
Available from: 2008-04-25 Created: 2008-04-25 Last updated: 2017-10-18Bibliographically approved

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