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- Carlsson, S., et al.
(författare)
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The value of a first MRI and targeted biopsies after several years of active surveillance for low-risk prostate cancer - results from the SAMS trial
- 2020
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 54:4, s. 318-322
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess the value of a first MRI examination and image-fusion-guided biopsies in men with low-risk prostate cancer who have been on active surveillance (AS) for several years with no signs of progression. Patients and Methods All 45 participants from two centers who had not previously had an MRI were included. They had been on AS for T1c Gleason score 6 prostate cancer for 2.6 to 6.7 years and had 2 to 5 sets of systematic biopsies with a total of 1640 cores. All underwent a bi-parametric MRI, PI-RADS >= 3 lesions were targeted with image-fusion-guided biopsies. Primary outcome measure: detection of Gleason score >= 7 cancer. Results Twenty-five of the 45 men (56%) had a total of 30 suspicious MRI lesions. The lesion with the highest score was a PI-RADS 3 in 18, a PI-RADS 4 in 5 and PI-RADS 5 in 3 men. Targeted biopsies from the 30 lesions detected Gleason score 7 cancer in 6 men. Of these six cancers, four were located in the apical and one in the anterior/apical part of the prostate. A Gleason score 7 cancer was detected in 3 of 5 men with PSA density >0.15 ng/ml/cm(3). Conclusions Even after several years of AS with stable PSA values and many sets of systematic biopsies, a first MRI and targeted biopsies lead to the detection of Gleason score 7 (ISUP 2 and ISUP 3) cancer in a significant proportion of men, particularly among those with a high PSA density.
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| 2. |
- Jaderling, F., et al.
(författare)
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Accurate prediction tools in prostate cancer require consistent assessment of included variables
- 2016
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Ingår i: Scandinavian Journal of Urology. - : Informa UK Limited. - 2168-1805 .- 2168-1813. ; 50:4, s. 260-266
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to create a preoperative prediction model predicting extraprostatic tumour growth in men with clinically organ-confined disease from a prospectively collected Swedish cohort. Materials and methods: The study used data from 3386 men in the prospective multi-centre Laparoscopic Prostatectomy Robot Open (LAPPRO) trial, with 14 participating urological departments. External validation was performed using a cohort of 634 men from the largest study centre with patients who underwent surgery before and after the inclusion period of the LAPPRO study. External validation of the updated Partin table was used for comparison. The prediction models were created by multivariable logistic regression. Nomogram prediction performance, internal, internal-external and external validation are presented as the area under the receiver operating characteristic curve (AUC). Results: The nomogram reached a prediction performance with an AUC of 0.741, with internal and external validation of 0.738 and 0.698, respectively. Internal-external validation showed great divergence between centres, with AUCs ranging from 0.476 to 0.892, indicating inconsistencies in pathological staging or one or more of the included variables in the regression model. When including centre as a variable in the multivariable model it was significantly associated with the outcome of pT3 (p<0.001). AUC for external validation of the Partin table was 0.694. Conclusions: Accurate prediction tools in prostate cancer require consistent assessment of included variables, and local validation is needed before the use of such tools in clinical practice.
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