Clinical factors stratifying the risk of tumor upgrading to high-grade disease in low-risk prostate cancer

Porcaro, Antonio Benito; Siracusano, Salvatore; Luyk, Nicolò De; Corsi, Paolo; Sebben, Marco; Tafuri, Alessandro; Processali, Tania; Cerasuolo, Mattia; Mattevi, Daniele; Inverardi, Davide; Cerruto, Maria Angela; Brunelli, Matteo; Artibani, Walter

doi:10.5301/tj.5000580

Cited by 21 publications

(15 citation statements)

References 29 publications

(44 reference statements)

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“…Upgrading from the lowest grade group was more likely with older age, higher pre-treatment PSA levels, fewer cores at biopsy and more positive cores, which is consistent with others recent studies [9], [17], [23], [25], [27], [28], [29]. These findings suggested inadequate sampling in men with greater tumour burden [27].…”

Section: Discussionsupporting

confidence: 89%

Extent and predictors of grade upgrading and downgrading in an Australian cohort according to the new prostate cancer grade groupings

Beckmann

O’Callaghan

Vincent

et al. 2019

Asian Journal of Urology

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ObjectTo determine the extent and impact of upgrading and downgrading among men who underwent radical prostatectomy (RP) according to new grade groupings and to identify predictors of upgrading from biopsy grade Group I and II, and downgrading to grade Group I, in a community setting.MethodsStudy participants included 2279 men with non-metastatic prostate cancer diagnosed 2006–2015 who underwent prostatectomy, from the multi-institutional South Australia Prostate Cancer Clinical Outcomes Collaborative registry. Extent of up- or down-grading was assessed by comparing biopsy and prostatectomy grade groupings. Risk of biochemical recurrence (BCR) with upgrading was assessed using multivariable competing risk regression. Binomial logistic regression was used to identify pre-treatment predictors of upgrading from grade Groups I and II, and risk group reclassification among men with low risk disease.ResultsUpgrading occurred in 35% of cases, while downgrading occurred in 13% of cases. Sixty percent with grade Group I disease were upgraded following prostatectomy. Upgrading from grade Group I was associated with greater risk of BCR compared with concordant grading (Hazard ratio: 3.1, 95% confidence interval: 1.7–6.0). Older age, higher prostate-specific antigen levels (PSA), fewer biopsy cores, higher number of positive cores and more recent diagnosis predicted upgrading from grade Group I, while higher PSA and clinical stage predicted upgrading from grade Group II. No clinical risk factors for reclassification were identified.ConclusionBiopsy sampling errors may play an important role in upgrading from grade Group I. Improved clinical assessment of grade is needed to encourage greater uptake of active surveillance.

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Section: Discussionsupporting

confidence: 89%

Extent and predictors of grade upgrading and downgrading in an Australian cohort according to the new prostate cancer grade groupings

Beckmann

O’Callaghan

Vincent

et al. 2019

Asian Journal of Urology

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“…All these findings are more important considering that in our previous experience we demonstrated that the NPC is strongly associated with more aggressive PCA resulting in tumor upgrading and upstaging, unilateral or bilateral lymph node metastasis and seminal vesical invasion ( 30 - 34 ).…”

Section: Discussionmentioning

confidence: 81%

Elevated prostate volume index and prostatic chronic inflammation reduce the number of positive cores at first prostate biopsy set: results in 945 consecutive patients

et al. 2020

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Objective To assess the association between prostate volume index (PVI), and prostatic chronic inflammation (PCI) as predictors of prostate cancer (PCA). PVI is the ratio between the central transition zone volume (CTZV) and the peripheral zone volume (PZV). Materials and methods Parameters evaluated included age, prostate specific antigen (PSA), total prostate volume (TPV), PSA density (PSAD), digital rectal exam (DRE), PVI, PCI and number of positive cores (NPC). All patients underwent baseline 14-core, trans-perineal random biopsies. Associations of parameters with the NPC were investigated by univariate and multivariate linear regression analysis. Results Between September 2010 to September 2017, 945 patients were evaluated. PCA was detected in 477 cases (50.7%), PCI in 205 cases (21.7%). PCA patients, compared to negative cases, were older (68.3 vs. 64.4 years) with smaller TPV (36 vs. 48.3mL) and CTZV (19.2 vs. 25.4), higher PSAD (0.24 vs. 0.15ng/mL/mL), further PVI values were lower (0.9 vs. 1.18) and biopsy cores less frequently involved by PCI (9.4% vs. 34.2%).High PVI and the presence of PCI were independent negative predictors of NPC in model I considering PSA and TVP (PVI, regression coefficient, RC -0,6; p=0.002) and PCI (RC -1,4; p <0.0001); and in model II considering PSAD (PVI:RC -0,7; p <0,0001; and PCI: RC -1,5; p <0.0001). Conclusions High PVI and the presence of PCI lowered the mean rate of NPC and is associated with less aggressive tumor biology expressed by low tumor burden. PVI can give prognostic information before planning baseline random biopsies. Confirmatory studies are required.

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“…The decision to perform an ePLND was mainly based on preoperative nomograms showing a risk of LNI greater than 5% [12]. In low-risk patients, the decision to perform an ePLND was based on clinical factors indicating an increased risk of tumor upgrading in the surgical specimen according to our previous experience [13-15].…”

Section: Methodsmentioning

confidence: 99%

Association between Basal Total Testosterone Levels and Prostate Cancer D’Amico Risk Classes

et al. 2020

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Objective: To test the hypothesis that basal total testosterone (TT) serum levels are associated with the D'Amico risk classification at diagnosis of prostate cancer (PCA). Materials and Methods: From November 2014 to March 2018, preoperative basal levels of TT and prostate-specific antigen (PSA) were measured in 601 consecutive PCA patients who were not under androgen deprivation therapy or undergoing prior prostate surgery. Patients were classified into low (reference group), intermediate, and high risk classes according to biopsy findings. The association of TT and other clinical factors with risk classes was evaluated using a multivariate multinomial logistic regression model. Results: According to the D'Amico classification, 124 patients (24%) were low risk, 316 (52.6%) were intermediate risk, and 141 (23.4%) were high risk. Median basal TT circulating levels were significantly increased along clinical risk classes. TT along with PSA, percentage of biopsy positive cores, and tumor clinical stage were independently associated with a high risk (OR = 1.002; p = 0.022) but not with an intermediate risk of PCA when compared to the low risk class. In the intermediate-risk group, endogenous TT together with PSA were independently associated with tumor grade groups 2 (OR = 1.003; p = 0.022) and 3 (OR = 1.003; p = 0.043) compared to grade group 1 cancers. Conclusions: Basal TT levels are positively associated with the D'Amico risk classification, but the association is significant for the high-risk group compared to the low-risk group.

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Clinical factors stratifying the risk of tumor upgrading to high-grade disease in low-risk prostate cancer

Cited by 21 publications

References 29 publications

Extent and predictors of grade upgrading and downgrading in an Australian cohort according to the new prostate cancer grade groupings

Extent and predictors of grade upgrading and downgrading in an Australian cohort according to the new prostate cancer grade groupings

Elevated prostate volume index and prostatic chronic inflammation reduce the number of positive cores at first prostate biopsy set: results in 945 consecutive patients

Association between Basal Total Testosterone Levels and Prostate Cancer D’Amico Risk Classes

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