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Subject: search.filters.subject.Gleason score

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    Prostate volume effect on Gleason score upgrading in active surveillance appropriate patients
    (PAGEPRESS PUBL, 2019-01-01) Camur, Emre; Coskun, Alper; Kavukoglu, Ovunc; Can, Utku; Kara, Onder; Camur, Arzu Develi; Sarica, Kemal; Narter, Kamil Fehmi
    Introduction: Gleason Score (GS) upgrading rates in the literature are reported to be around 33-45\%. The relationship between prostate volume and GS upgrading should be defined, aiming to reduce upgrading rates in patients with low risk groups who are eligible for active surveillance (AS) or minimally invasive treatment, by varying biopsy cores, or lengths of cores according to prostate volumes. In this regard, the aim of our study was to establish the relationship between prostate volume and GS upgrading. Materials and methods: We retrospectively analyzed the medical records of 78 patients, who were appropriate for AS between 2011-2016 at our hospital. Inclusion criteria were patient age under 65 years, PSA level under 10 ng/ml, GS (3 + 3) or (3 + 4), and 3 or less positive cores, clinical stages <= T2. GS increase in radical prostatectomy specimen was considered as `upgrading' and in addition, score reported by biopsy as 3 + 4 but in surgical specimen as 4 + 3 were also considered as `upgrading'. The effect of prostate volume on Gleason grade upgrading was examined by calculating upgrading rates separately for patients with prostate volume 30 ml or less, those with 30 to 60 ml, and those over 60 ml. Results: As a result of the analysis of the data, upgrading was seen in 35 (44.8\%) of 78 patients included in the study. In the cohort mean prostate volume was 49.8 (+/- 26.3) ml. Twenty-two patients (28.2\%) had prostate volume 30 ml or less, 34 (43.6\%) 30 to 60 ml, and 22 (28.2\%) 60 ml or more. The patients were divided into two groups as those with and without GS upgrading. Between the groups prostate volume and prostate volume range (0-30/31-60/> 60) were not significantly different (p value > 0.05). Conclusions: Gleason grade upgrading causes patients to be classified in a lower risk group than they actually are, and may lead to inappropriate treatment. This condition has a direct effect on the decision of active surveillance. Therefore, it is important to define the factors that can predict GS upgrading in active surveillance appropriate patients. In this study, we found that prostate volume has no significant effect on upgrading in active surveillance appropriate patients.
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    The utility of ADC parameters in the diagnosis of clinically significant prostate cancer by 3.0-Tesla diffusion-weighted magnetic resonance imaging
    (INT SCIENTIFIC INFORMATION INC, 2021-01-01) Kus, Aylin Altan
    Purpose: This study has focused on investigating the relationship between the exponential apparent diffusion coefficient (exp-ADC), selective apparent diffusion coefficient (sel-ADC) values, the ADC ratio (ADCr), and prostate cancer aggressiveness with transrectal ultrasound-guided prostate biopsy in patients with prostate cancer. Material and methods: All patients underwent a multiparametric magnetic resonance imaging (mpMRI) including tri-planar T2-weighted (T2W), dynamic contrast-enhanced (DCE), diffusion-weighted sequences using a 3.0-Tesla MR scanner (Skyra, Siemens Medical Systems, Germany) with a dedicated 18-channel body coil and a spine coil underneath the pelvis, with the patient in the supine position. Exp-ADC, sel-ADC, and ADCr of defined lesions were evaluated using region-of-interest-based measurements. Exp-ADC, sel-ADC, and ADCr were correlated with the Gleason score obtained through transrectal ultrasound-guided biopsy. Results: Patients were divided into 2 groups. Group I is Gleason score >= 3 + 4, group II is Gleason score = 6. Sel-ADC and exp-ADC were statistically significant between 2 groups (0.014 and 0.012, respectively). However, the ADCr difference between nonclinical significant prostate cancer from clinically significant prostate cancer was not significant (p = 0.09). Conclusions: This study is the first to evaluate exp-ADC and sel-ADC values of prostate carcinoma with ADCr. One limitation of this study might be the limited number of patients. Exp-ADC and sel-ADC values in prostate MRI imaging improved the specificity, accuracy, and area under the curve (AUC) for detecting clinically relevant prostate carcinoma. Adding exp-ADC and sel-ADC values to ADCr can be used to increase the diagnostic accuracy of DWI.