Skip to main content
SpringerLink
Log in

The effect of Rapid Access Prostate Clinics on the outcomes of Gleason 7 prostate cancer: does earlier diagnosis lead to better outcomes?

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Introduction

Rapid Access Prostate Clinics (RAPC) were introduced in Ireland by the National Cancer Control Programme bringing about expedited referral pathways and increased detection rates of prostate cancer. Lower Gleason (G) grade at diagnosis due to RAPC has been previously reported but grade at prostatectomy has not been assessed. The aim of this study was to assess the impact of RAPC on the outcomes of patients with G7 disease on radical prostatectomy (RP).

Methods

A retrospective analysis was carried out of all RPs performed over a 9-year period (2006–2014). Outcomes for G7 prostatectomies were compared before and after the introduction of the RAPC, with a further sub-analysis of G4 + 3 versus G3 + 4. The primary outcome was biochemical recurrence (BCR). Other outcomes were adjuvant/salvage radiotherapy, extra prostatic extension, positive surgical margins, seminal vesicle involvement and tumour stage.

Results

In total, 240 RPs were performed with 167 cases graded G7 (70 graded G4 + 3 and 97 graded G3 + 4). Since the introduction of RAPC the proportion of G4 + 3 compared to G3 + 4 has increased from 37.9 to 42%. There was no statistical difference in outcomes for G4 + 3 treated before and after the introduction of RAPC. G4 + 3 was associated with higher rates of BCR (24.4 vs. 0%, p < 0.0001, radiotherapy (41.1 vs. 4.8%, p < 0.0001) and worse histological features than G3 + 4.

Conclusion

Despite the benefits in diagnosis of prostate cancer brought about by RAPC in Ireland, this has not translated to a lower grade for surgically treated patients. There has been no improvement in outcomes especially for higher grade G4 + 3 disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Gleason DF (1966) Classification of prostatic carcinomas. Cancer Chemother Rep 50(3):125–128

    CAS  PubMed  Google Scholar 

  2. Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29(9):1228–1242

    Article  PubMed  Google Scholar 

  3. D’Amico AV, Desjardin A, Chung A, Chen MH, Schultz D, Whittington R et al (1998) Assessment of outcome prediction models for patients with localized prostate carcinoma managed with radical prostatectomy or external beam radiation therapy. Cancer 82(10):1887–1896

    Article  PubMed  Google Scholar 

  4. Eggener SE, Scardino PT, Walsh PC, Han M, Partin AW, Trock BJ et al (2011) Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol 185(3):869–875

    Article  PubMed  PubMed Central  Google Scholar 

  5. Helpap B (1998) Prognostic factors of prostatic carcinoma. Der Pathologe 19(1):42–52

    Article  CAS  PubMed  Google Scholar 

  6. Zagars GK, Ayala AG, von Eschenbach AC, Pollack A (1995) The prognostic importance of Gleason grade in prostatic adenocarcinoma: a long-term follow-up study of 648 patients treated with radiation therapy. Int J Radiat Oncol Biol Phys 31(2):237–245

    Article  CAS  PubMed  Google Scholar 

  7. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Schnall M, Tomaszewski JE et al (1997) Combined modality staging of prostate carcinoma and its utility in predicting pathologic stage and postoperative prostate specific antigen failure. Urology 49(3A Suppl):23–30

    Article  PubMed  Google Scholar 

  8. Lavery HJ, Droller MJ (2012) Do Gleason patterns 3 and 4 prostate cancer represent separate disease states? J Urol 188(5):1667–1675

    Article  PubMed  Google Scholar 

  9. Kang DE, Fitzsimons NJ, Presti JC Jr, Kane CJ, Terris MK, Aronson WJ et al (2007) Risk stratification of men with Gleason score 7 to 10 tumors by primary and secondary Gleason score: results from the SEARCH database. Urology 70(2):277–282

    Article  PubMed  PubMed Central  Google Scholar 

  10. Han M, Partin AW, Pound CR, Epstein JI, Walsh PC (2001) Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin N Am 28(3):555–565

    Article  CAS  Google Scholar 

  11. Sakr WA, Tefilli MV, Grignon DJ, Banerjee M, Dey J, Gheiler EL et al (2000) Gleason score 7 prostate cancer: a heterogeneous entity? Correlation with pathologic parameters and disease-free survival. Urology 56(5):730–734

    Article  CAS  PubMed  Google Scholar 

  12. Chan TY, Partin AW, Walsh PC, Epstein JI (2000) Prognostic significance of Gleason score 3 + 4 versus Gleason score 4 + 3 tumor at radical prostatectomy. Urology 56(5):823–827

    Article  CAS  PubMed  Google Scholar 

  13. Alenda O, Ploussard G, Mouracade P, Xylinas E, de la Taille A, Allory Y et al (2011) Impact of the primary Gleason pattern on biochemical recurrence-free survival after radical prostatectomy: a single-center cohort of 1,248 patients with Gleason 7 tumors. World J Urol 29(5):671–676

    Article  CAS  PubMed  Google Scholar 

  14. Rasiah KK, Stricker PD, Haynes AM, Delprado W, Turner JJ, Golovsky D et al (2003) Prognostic significance of Gleason pattern in patients with Gleason score 7 prostate carcinoma. Cancer 98(12):2560–2565

    Article  PubMed  Google Scholar 

  15. Miyake H, Muramaki M, Furukawa J, Tanaka H, Inoue TA, Fujisawa M (2013) Prognostic significance of primary Gleason pattern in Japanese men with Gleason score 7 prostate cancer treated with radical prostatectomy. Urol Oncol 31(8):1511–1516

    Article  PubMed  Google Scholar 

  16. Stark JR, Perner S, Stampfer MJ, Sinnott JA, Finn S, Eisenstein AS et al (2009) Gleason score and lethal prostate cancer: does 3 + 4 = 4 + 3? J Clin Oncol 27(21):3459–3464

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wright JL, Salinas CA, Lin DW, Kolb S, Koopmeiners J, Feng Z et al (2009) Prostate cancer specific mortality and Gleason 7 disease differences in prostate cancer outcomes between cases with Gleason 4 + 3 and Gleason 3 + 4 tumors in a population based cohort. J Urol 182(6):2702–2707

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chandra RA, Chen MH, Zhang D, Loffredo M, D’Amico AV (2015) Age, comorbidity, and the risk of prostate cancer-specific mortality in men with biopsy Gleason score 4 + 3: implications on patient selection for multiparametric MRI. Clin Genitourin Cancer 13(4):400–405

    Article  PubMed  Google Scholar 

  19. Health Service Executive (2006) National Cancer Control Strategy Ireland. http://www.hse.ie/eng/services/Publications/HealthProtection/Public_Health_/National_Cancer_Control_Strategy.pdf. Accessed 15 Sept 2015

  20. Forde JC, O’Connor KM, Casey L, O’Brien M, Bowen S, Casey RG et al (2011) A rapid access diagnostic clinic for prostate cancer: the experience after one year. Ir J Med Sci 180(2):505–508

    Article  CAS  PubMed  Google Scholar 

  21. Oon SF, Cullen IM, Moran D, Bolton EM, McDermott T, Grainger R et al (2014) The effect of a Rapid Access Prostate Cancer Clinic on prostate cancer patient and disease characteristics, primary treatment and surgical workload. Ir J Med Sci 183(2):241–247

    Article  CAS  PubMed  Google Scholar 

  22. O’Kelly F, Thomas AZ, Murray D, Lee P, O’Carroll RF, Nicholson P et al (2013) Emerging evidence for Gleason grade migration and distance impact in prostate cancer? An analysis of the rapid access prostate clinic in a tertiary referral center: St. Vincent’s University Hospital, Dublin (2009–2011). Ir J Med Sci 182(3):487–491

    Article  PubMed  Google Scholar 

  23. Daly T, Hickey BE, Lehman M, Francis DP, See AM (2011) Adjuvant radiotherapy following radical prostatectomy for prostate cancer. Cochrane Database Syst Rev 12:Cd007234

    Google Scholar 

  24. Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M et al (2012) Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 62(3):382–404

    Article  PubMed  Google Scholar 

  25. Wolff RF, Ryder S, Bossi A, Briganti A, Crook J, Henry A et al (2015) A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer. Eur J Cancer (Oxf, Engl: 1990) 51(16):2345–2367

    Article  Google Scholar 

  26. Winters BR, Wright JL, Holt SK, Lin DW, Ellis WJ, Dalkin BL et al (2016) Extreme gleason upgrading from biopsy to radical prostatectomy: a population-based analysis. Urology 96:148–155

    Article  PubMed  Google Scholar 

  27. Corcoran NM, Hong MK, Casey RG, Hurtado-Coll A, Peters J, Harewood L et al (2011) Upgrade in Gleason score between prostate biopsies and pathology following radical prostatectomy significantly impacts upon the risk of biochemical recurrence. BJU Int 108(8 Pt 2):E202–E210

    Article  PubMed  Google Scholar 

  28. Hattab EM, Koch MO, Eble JN, Lin H, Cheng L (2006) Tertiary Gleason pattern 5 is a powerful predictor of biochemical relapse in patients with Gleason score 7 prostatic adenocarcinoma. J Urol. 175(5):1695–1699 (discussion 9)

    Article  PubMed  Google Scholar 

  29. Whittemore DE, Hick EJ, Carter MR, Moul JW, Miranda-Sousa AJ, Sexton WJ (2008) Significance of tertiary Gleason pattern 5 in Gleason score 7 radical prostatectomy specimens. J Urol 179(2):516–522 (discussion 22)

    Article  PubMed  Google Scholar 

  30. Adam M, Hannah A, Budaus L, Steuber T, Salomon G, Michl U et al (2014) A tertiary Gleason pattern in the prostatectomy specimen and its association with adverse outcome after radical prostatectomy. J Urol 192(1):97–101

    Article  PubMed  Google Scholar 

  31. van Oort IM, Schout BM, Kiemeney LA, Hulsbergen CA, Witjes JA (2005) Does the tertiary Gleason pattern influence the PSA progression-free interval after retropubic radical prostatectomy for organ-confined prostate cancer? Eur Urol 48(4):572–576

    Article  PubMed  Google Scholar 

  32. Yossepowitch O, Briganti A, Eastham JA, Epstein J, Graefen M, Montironi R et al (2014) Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol 65(2):303–313

    Article  PubMed  Google Scholar 

  33. Meeks JJ, Eastham JA (2013) Radical prostatectomy: positive surgical margins matter. Urol Oncol 31(7):974–979

    Article  PubMed  Google Scholar 

  34. Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ Jr, Dotan ZA, DiBlasio CJ et al (2005) Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Clin Oncol 23(28):7005–7012

    Article  PubMed  PubMed Central  Google Scholar 

  35. Makarov DV, Sanderson H, Partin AW, Epstein JI (2002) Gleason score 7 prostate cancer on needle biopsy: is the prognostic difference in Gleason scores 4 + 3 and 3 + 4 independent of the number of involved cores? J Urol 167(6):2440–2442

    Article  PubMed  Google Scholar 

Download references

Author contributions

MPB was responsible for data collection or management, data analysis and manuscript writing/editing. JCF was responsible for protocol/project development, data analysis and manuscript writing/editing. MSI was responsible for statistical analysis. DMQ was responsible for protocol/project development and manuscript writing/editing.

Author information

Authors and Affiliations

  1. Department of Urology, St. Vincent’s University Hospital, Dublin 4, Ireland

    M. P. Broe, J. C. Forde, M. S. Inder, D. J. Galvin, D. W. Mulvin & D. M. Quinlan

Authors
  1. M. P. Broe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. C. Forde
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. S. Inder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. J. Galvin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. W. Mulvin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. M. Quinlan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. P. Broe.

Ethics declarations

There was no funding for this study.

Ethical approval

This article does not contain any studies with patient participants or animals performed by any of the authors. As this was a retrospective review of anonymised data, formal ethics approval was not deemed necessary by the local ethics committee. Informed consent was not necessary for this study.

Conflict of interest

All the authors can confirm they have no financial relationships with any organisations that might have an interest in the submitted work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Broe, M.P., Forde, J.C., Inder, M.S. et al. The effect of Rapid Access Prostate Clinics on the outcomes of Gleason 7 prostate cancer: does earlier diagnosis lead to better outcomes?. Ir J Med Sci 186, 583–588 (2017). https://doi.org/10.1007/s11845-017-1583-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-017-1583-2

Keywords

Search

Navigation