Kulkarni et al identified factors which can help identify a patient whose original Gleason score is likely to be upgraded from <= 6 to >= 7 on histologic review. This can help identify patients who should have a slide review before pursuing a conservative management policy. The authors are from the University of Toronto.
Patient selection: prostate cancer with low Gleason score
Parameters:
(1) age in years
(2) prebiopsy serum PSA in ng/mL
(3) type of pathologist
(4) digital rectal exam
(5) prostatic intra-epithelial neoplasia (PIN)
(6) prostate volume in mL on transrectal ultrasound (TRUS)
(7) possible tumor identified (hypoechoic region) on transrectal ultrasound (TRUS)
(8) number of biopsy cores taken
(9) percent cancer in cores
|
Age in Years |
Points |
|
< 35 |
0 |
|
35 to 80 |
(0.9778 * (age)) - 34.223 |
|
> 80 |
44 |
|
Serum PSA |
Points |
|
< 2 |
0 |
|
2 to 10 |
(-1.104 * ((PSA)^2)) + (25.15 * (PSA)) - 42.78 |
|
> 10 |
100 |
|
TRUS Volume |
Points |
|
> 140 mL |
0 |
|
50 to 140 |
(0.001402 * ((volume)^2)) - (0.5087 * (volume)) + 43.72 |
|
10 to 50 |
(0.01643 * ((volume)^2)) - (1.836 * (volume)) + 73.2 |
|
< 10 |
57 |
|
Parameter |
Finding |
Points |
|
type of pathologist |
expert uropathologist |
0 |
|
|
not a uropathologist |
86 |
|
digital rectal exam |
negative |
0 |
|
|
positive |
22 |
|
PIN |
absent |
0 |
|
|
present |
33 |
|
TRUS |
positive for hypoechoic region |
0 |
|
|
negative |
21 |
|
number of biopsy cores |
sextant (6 core minimum) |
0 |
|
|
extended (10 cores minimum) |
19 |
|
percent cancer in cores |
<= 5% |
0 |
|
|
10% |
11 |
|
|
15 - 40% |
22 |
|
|
>= 50% |
33 |
where:
• The points for percent involvement seem to go in 5% increments. 45% cancer will be given 22 points in the implementation.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: > 260
• The higher the score the more likely the original Gleason score would be upgraded if reviewed.
|
Total Score |
Probability of Upgrading |
|
< 46 |
< 5% |
|
46 to 162 |
(0.002489 * ((score)^2)) - (0.1315 * (score)) + 5.887 |
|
162 to 248 |
(-0.001213 * ((score)^2)) + (0.9519 * (score)) - 71.02 |
|
> 248 |
> 90% |
Limitations:
• The score assumes that all pathologists who are not uropathologists will not do a good job in grading. This may be true for some but not all pathologists.
• My guess is that many of the upgrades went from 6 to 7.
Specialty: Hematology Oncology, Surgery, general, Urology
ICD-10: ,
