The prevailing study analyzed the lack of prognostic knowledge regarding the abandonment of Gleason score (GS) 2-4 by the International Society of Urological Pathology (ISUP-2005).

Within a ten-year period ahead of the modification of GS, 856 patients (mean age 64.2 years) underwent radical prostatectomy (RP). The grade of agreement between GS in biopsy and definitive histology was calculated by Kappa statistics (k). Grades are in accordance with the level to which the epithelium assumes an ordinary glandular structure. A grade of 1 indicates a near-normal pattern, and grade 5 indicates the absence of any glandular pattern (less malignant to more malignant). This scheme of grading histological features greatly depends on the skill and experience of the pathologist and is subject to a few degree of character variation. Univariable and multivariable outcomes of different preoperatively available parameters on disease-free survival (DFS) were assessed. The mean follow-up period was 39 months.

Concordance amongst GS in biopsy versus RP samples was 58% (k-value 0.354) and was improved by an increased collection of biopsy cores. Undergrading in biopsy was present in 38% and never significantly enhanced by a longer time-period between biopsy and RP (threshold 90d). PSA level, clinical tumour stage, fraction of sure cores (dichotomized at 34%), cases of RP per year and establishment (dichotomized at 75), and GS alone influenced DFS. An upgrading to GS ≥ 7 was found in only 5.7% of patients presenting with GS 2-4 within the biopsy. Free from ultimate histology, patients with GS 2-4 had a significantly better prognosis in comparison to patients with a higher GS.

The present analyze shows an independent prognostic result of GS in biopsy samples categorized in response to the previous classification. The removal of GS 2-4 by the ISUP 2005 ends up in a substantial deficit of pretherapeutic prognostic facts and thus need being questioned particularly with reference to the increasing demand for active surveillance regimens. Men with PSA levels less than 10 ng/mL and low- or moderate-grade histology (Gleason score <7) with no findings or minimal findings on actual examination would possibly proceed to surgery or brachytherapy without further research. Men with PSA levels more than 10 ng/mL, high-grade histology (Gleason score ≥ 7), or physical findings that suggest stage T3 disease should possibly undergo a staging CT scanning and bone scan. The CT scanning can be used to evaluate extension into the bladder and lymph nodes to support stage the patient's cancer or to consider lymph node sampling prior to treatment.
 

Men who have tried External Beam Radiation Therapy (EBRT) or Interstitial Brachytherapy for clinically localized prostate cancer possess a 20-30% greater probability of having prostate-specific antigen (PSA) failure. Salvage therapy is indicated when men are treated with radiotherapy, brachytherapy, or a combination of these for presumed localized prostate cancer and have a recurrence. The success rates after salvage procedures are considerably less than those that have been reported after more fundamental treatments. The results of the use of HIFU as a salvage therapy for patients with recurrent prostate cancer have been good, with negative biopsy rates as elevated as 80% and 61% achieving a PSA nadir of <0.5 µg/L (n = 71); 44% were reported as freed from biochemical relapse at the follow up exam, at an average follow-up of 14.8 (6-86) months.

To analyze the usage of high-intensity focused ultrasound (HIFU) as a salvage therapy in patients with a recurrence of localized prostate cancer after external beam radiation (EBRT), brachytherapy, or proton therapy, the charts of all patients who had undergone salvage HIFU for biopsy-proven prostate cancer after primary radiation therapy, were reviewed retrospectively. Patient characteristics and oncological effects were assessed.

Records of 22 patients with a median (range) follow-up of 24 (5-80) months were reviewed. Patients were men with presumed organ-confined disease who were treated with salvage HIFU following recurrent disease after EBRT (fourteen patients), brachytherapy (five patients: four with high-dose brachytherapy using In (192); and one with low-dose brachytherapy applying Au (98)) or proton therapy (three patients). The median (range) age at salvage HIFU was 65 (52-80) years, with a median (range) prostate-specific antigen (PSA) level before radiation therapy of 14.3 (5.7-118) ng/mL and an average (range) PSA level of 4.0 (1.2-30.1) ng/mL before HIFU. The median (range) period to HIFU after radiation therapy was 36 (4-96) months. The biochemical disease-free survival (bDFS) rate in all patients at 5 years was 52%. Rates of bDFS in low-, intermediate- and high-risk groups were 100%, 86%, and 14%, respectively. One among the twelve patients who received post-HIFU prostate biopsy showed malignancy. Side effects included urethral stricture in four patients, grade I urinary incontinence in four patients, rectourethral fistula and epididymitis in one of each patient.

This preliminary data recommend that high intensity focused ultrasound represents a legitimate alternative treatment strategy for patients with localized prostate cancer. Salvage HIFU is often a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other types of salvage treatment. A careful choice by the patient is imperative depending upon the aforementioned prognostic factors.