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dc.contributor.advisorStephen Freedland (Duke University)
dc.contributor.authorMithal, Prabhakar
dc.contributor.authorHoward, Lauren E.
dc.contributor.authorAronson, William J.
dc.contributor.authorKane, Christopher J.
dc.contributor.authorCooperberg, Matthew R.
dc.contributor.authorTerris, Martha K.
dc.contributor.authorAmling, Christopher L.
dc.contributor.authorFreedland, Stephen J.
dc.date2022-08-11T08:10:55.000
dc.date.accessioned2022-08-23T17:24:48Z
dc.date.available2022-08-23T17:24:48Z
dc.date.issued2015-04-01
dc.date.submitted2016-03-28
dc.identifier.citationInt J Urol. 2015 Apr;22(4):362-6. doi: 10.1111/iju.12704. Epub 2015 Feb 24. <a href="http://dx.doi.org/10.1111/iju.12704">Link to article on publisher's site</a>
dc.identifier.issn0919-8172 (Linking)
dc.identifier.doi10.1111/iju.12704
dc.identifier.pmid25728968
dc.identifier.urihttp://hdl.handle.net/20.500.14038/49270
dc.description<p>Prabhakar Mithal participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.</p>
dc.description.abstractOBJECTIVES: To assess the ability of preoperative prostate-specific antigen level, Gleason score and stage to predict prostate cancer outcomes beyond biochemical recurrence, specifically castration-resistant prostate cancer, metastases and prostate cancer-specific mortality in radical prostatectomy patients. METHODS: We carried out a retrospective study of 2735 men in the Shared Equal Access Regional Cancer Hospital database treated by radical prostatectomy from 1988 to 2011 with data available on pathological stage, grade and preoperative prostate-specific antigen. We used Cox hazards analyses to examine the predictive accuracy (c-index) of the preoperative prostate-specific antigen (log-transformed), path Gleason score ( < /= 7, 3 + 4, 4 + 3 and 8-10) and path stage grouping (pT2 negative margins; pT2 positive margins; pT3a negative margins; pT3a positive margins; pT3b; vs positive nodes) to predict biochemical recurrence, castration-resistant prostate cancer, metastases and prostate cancer-specific mortality. RESULTS: Median follow up was 8.7 years, during which, 937 (34%) had biochemical recurrence, 108 (4%) castration-resistant prostate cancer, 127 (5%) metastases and 68 (2%) prostate cancer-specific mortality. For the outcomes of biochemical recurrence, castration-resistant prostate cancer, metastases and prostate cancer-specific mortality, the c-indices were, respectively: prostate-specific antigen 0.65, 0.66, 0.64 and 0.69; Gleason score 0.66, 0.83, 0.76 and 0.85; and pathological stage group 0.69, 0.76, 0.72 and 0.80. CONCLUSIONS: Gleason score can predict with very high accuracy prostate cancer-specific mortality in patients undergoing radical prostatectomy. Thus, Gleason score should be given more weight in nomograms to predict prostate cancer-specific mortality. Furthermore, men with a high Gleason score should be given special consideration for adjuvant treatment or referral to clinical trials because of a higher risk of prostate cancer-specific mortality.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=25728968&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1111/iju.12704
dc.subjectAged
dc.subjectDatabases, Factual
dc.subjectFollow-Up Studies
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectNeoplasm Grading
dc.subjectNeoplasm Metastasis
dc.subjectNeoplasm Recurrence, Local
dc.subjectNeoplasm Staging
dc.subjectPredictive Value of Tests
dc.subjectProportional Hazards Models
dc.subjectProstate-Specific Antigen
dc.subjectProstatectomy
dc.subjectProstatic Neoplasms
dc.subjectProstatic Neoplasms, Castration-Resistant
dc.subjectRetrospective Studies
dc.subjectTreatment Outcome
dc.subjectdisease progression
dc.subjectmortality
dc.subjectprostatectomy
dc.subjectprostatic neoplasms
dc.subjectrisk factors
dc.subjectHealth Services Research
dc.subjectNeoplasms
dc.subjectUrology
dc.titleProstate-specific antigen level, stage or Gleason score: which is best for predicting outcomes after radical prostatectomy, and does it vary by the outcome being measured? Results from Shared Equal Access Regional Cancer Hospital database
dc.typeJournal Article
dc.source.journaltitleInternational journal of urology : official journal of the Japanese Urological Association
dc.source.volume22
dc.source.issue4
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/ssp/213
dc.identifier.contextkey8390985
html.description.abstract<p>OBJECTIVES: To assess the ability of preoperative prostate-specific antigen level, Gleason score and stage to predict prostate cancer outcomes beyond biochemical recurrence, specifically castration-resistant prostate cancer, metastases and prostate cancer-specific mortality in radical prostatectomy patients.</p> <p>METHODS: We carried out a retrospective study of 2735 men in the Shared Equal Access Regional Cancer Hospital database treated by radical prostatectomy from 1988 to 2011 with data available on pathological stage, grade and preoperative prostate-specific antigen. We used Cox hazards analyses to examine the predictive accuracy (c-index) of the preoperative prostate-specific antigen (log-transformed), path Gleason score ( < /= 7, 3 + 4, 4 + 3 and 8-10) and path stage grouping (pT2 negative margins; pT2 positive margins; pT3a negative margins; pT3a positive margins; pT3b; vs positive nodes) to predict biochemical recurrence, castration-resistant prostate cancer, metastases and prostate cancer-specific mortality.</p> <p>RESULTS: Median follow up was 8.7 years, during which, 937 (34%) had biochemical recurrence, 108 (4%) castration-resistant prostate cancer, 127 (5%) metastases and 68 (2%) prostate cancer-specific mortality. For the outcomes of biochemical recurrence, castration-resistant prostate cancer, metastases and prostate cancer-specific mortality, the c-indices were, respectively: prostate-specific antigen 0.65, 0.66, 0.64 and 0.69; Gleason score 0.66, 0.83, 0.76 and 0.85; and pathological stage group 0.69, 0.76, 0.72 and 0.80.</p> <p>CONCLUSIONS: Gleason score can predict with very high accuracy prostate cancer-specific mortality in patients undergoing radical prostatectomy. Thus, Gleason score should be given more weight in nomograms to predict prostate cancer-specific mortality. Furthermore, men with a high Gleason score should be given special consideration for adjuvant treatment or referral to clinical trials because of a higher risk of prostate cancer-specific mortality.</p>
dc.identifier.submissionpathssp/213
dc.contributor.departmentSenior Scholars Program
dc.contributor.departmentSchool of Medicine
dc.source.pages362-6


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