Gleason score - Reviews in Urology

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Evaluation and Treatment of Men with Biochemical Prostate-Specific Antigen Recurrence Following Definitive Therapy for Clinically Localized Prostate Cancer

Treatment Update

Charles R Pound Alan W Partin Michael K Brawer

Prostate-specific antigen Gleason score Cryoablation External beam radiation Transrectalultrasound Immunoscintigraphy

Volume 4, Number 3 Point-Counterpoint

Selecting Treatment for High-Risk, Localized Prostate Cancer: The Case for Radiation Therapy

Robert Meier Michael K Brawer

Prostate cancer Radical prostatectomy Gleason score Radiotherapy Brachytherapy Biochemical disease-free outcome

Volume 4, Supplement 2 Supplement

Salvage Cryosurgery--How I Do It

John C Saliken Bryan J Donnelly

Gleason score Transrectal ultrasound Cryoablation Prostatic acid phosphatase Radiation failure

Volume 4, Supplement 2 Supplement

Radiation Therapy Failure in Prostate Cancer Patients: Risk Factors and Methods of Detection

Michael K Brawer

Prostate cancer Prostate-specific antigen Gleason score Transrectal ultrasound Digital rectal examination Biopsy, post-radiation prostate

Volume 5, Number 3 Meeting Reviews

Best of the 2003 AUA Annual Meeting

Highlights from the 2003 Annual Meeting of the American Urological Association, April 26-May 1, 2003

Michael Dobrovits Bob Djavan Arie S Belldegrun Allan J Pantuck Mesut Remzi Matthew B Gretzer Kazumasa Torimoto Dean G Assimos Ellen Shapiro Alan W Partin Michael B Chancellor J Curtis Nickel Jacob Rajfer Claus G Roehrborn Michael K Brawer Randall B Meacham

Prostate cancer Renal cell carcinoma Benign prostatic hyperplasia Depression Bladder cancer Lower urinary tract symptoms Urinary tract infection Prostate-specific antigen Nephrolithiasis Overactive bladder Radical prostatectomy Peyronie’s disease Gleason score Transrectal ultrasound Erectile dysfunction Chronic prostatitis/chronic pelvic pain syndrome Acute urinary retention International Prostate Symptom Score Bacille Calmette-Guérin therapy Chronic Prostatitis Symptom Index MTOPS trial PLESS study Prostate tumor markers SELDI-TOF

Volume 6, Supplement 2 Supplement

Management of Clinically Localized Prostate Cancer

Herbert Lepor

Prostate cancer Prostate-specific antigen Gleason score

Volume 17, Number 4 Original Research

The 4Kscore® Test Reduces Prostate Biopsy Rates in Community and Academic Urology Practices

Jeffrey Schock Randy M Chudler Gregory M Oldford Kenneth M Kernen Badrinath R Konety Danielle Osterhout Stephen M Zappala Jason Hafron Dipen J Parekh

There is significant concern regarding prostate cancer screening because of the potential for overdiagnosis and overtreatment of men who are discovered to have abnormal prostate specific antigen (PSA) levels and/or digital rectal examination (DRE) results. The 4Kscore® Test (OPKO Diagnostics, LLC) is a blood test that utilizes four kallikrein levels plus clinical information in an algorithm to calculate an individual’s percentage risk (< 1% to > 95%) for aggressive prostate cancer (Gleason score ≥ 7) on prostate biopsy. The 4Kscore Test, as a follow-up test after abnormal PSA and/or DRE test results, has been shown to improve the specificity for predicting the risk of aggressive prostate cancer and reduce unnecessary prostate biopsies. A clinical utility study was conducted to assess the influence of the 4Kscore Test on the decision to perform prostate biopsies in men referred to urologists for abnormal PSA and/or DRE results. The study population included 611 patients seen by 35 academic and community urologists in the United States. Urologists ordered the 4Kscore Test as part of their assessment of men referred for abnormal PSA and/or DRE test results. Results for the patients were stratified into low risk (< 7.5%), intermediate risk (7.5%-19.9%), and high risk (≥ 20%) for aggressive prostate cancer. The 4Kscore Test results influenced biopsy decisions in 88.7% of the men. Performing the 4Kscore Test resulted in a 64.6% reduction in prostate biopsies in patients; the actual percentage of cases not proceeding to biopsy were 94.0%, 52.9%, and 19.0% for men who had low-, intermediate-, and high-risk 4Kscore Test results, respectively. A higher 4Kscore Test was associated with greater likelihood of having a prostate biopsy (P < 0.001). Among the 171 patients who had a biopsy, the 4Kscore risk category is strongly associated with biopsy pathology. The 4Kscore Test, as a follow-up test for an abnormal PSA and/or DRE results, significantly influenced the physician and patient shared decision in clinical practice, which led to a reduction in prostate biopsies while increasing the probability of detecting aggressive cancer. [Rev Urol. 2015;17(4):231-240 doi: 10.3909/riu0699] © 2016 MedReviews®, LLC

Prostate cancer Prostate-specific antigen 4Kscore Gleason score Digital rectal examination Biopsy rate Prostate cancer prognosis

Volume 18, Number 4 Review Articles

Frequency of Gleason Score 7 to 10 in 5100 Elderly Prostate Cancer Patients

Cancer Screening Update

Vladimir Ioffe Navin Shah

Men 70 to 80 years of age are known to have an increased incidence of high-grade (Gleason sum score [GSS] 7-10) prostate cancer. We determined the frequency of high-grade prostate cancer among men 70 to 80 years old in our practice. We retrospectively reviewed our 5100 prostate cancer patients who are 70 to 80 years old and who opted for radiation therapy (external radiation, brachytherapy, or combination). Data were gathered on race, prostate-specific antigen value, digital rectal examination (DRE) results, and GSS. Patients were further subdivided by age in two categories, those 70 to 75 years and 76 to 80 years, and also by time period: 2006-2010 and 2011-2015. In patients 70 to 75 years, 1426 patients had a GSS of 6 (41%) and 2042 patients had a GSS of 7 to 10 (59%). In patients 76 to 80 years old, 553 had a GSS of 6 (34%) and 1079 had a GSS of 7 to 10 (66%). In 1432 patients with an abnormal DRE result, the GSS was 6 in 376 (26%) and GSS was 7 to 10 in 1059 (74%). Based on analysis of 5100 prostate cancer patients in our practice, we determined that 61% of patients age 70 to 80 have a high-grade prostate cancer, as do 59% of patients age 70 to 75 years, and 66% of patients between age 76 and 80 years. Because biopsy underestimates the grade in GSS 6 patients by 50%, the actual frequency is approximately 80%. In patients with prostate cancer who had an abnormal DRE result, 74% had a GSS of 7 to 10—approximately 85% when accounting for biopsy under-grading. [Rev Urol. 2016;18(4):181-187 doi: 10.3909/riu0732] © 2016 MedReviews®, LLC

Cancer, prostate Gleason score Age

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Treatment Update

Highlights from the 2003 Annual Meeting of the American Urological Association, April 26-May 1, 2003

Cancer Screening Update