Factors associated with downgrading in patients with high grade prostate cancer

Abstract

Objective: To determine the factors associated with downgrading between biopsy and prostatectomy in the contemporary era using extended-template biopsy techniques. Materials and methods:The UCSF Urologic Oncology Database was used to identify subjects diagnosed with high grade prostate cancer (primary pattern 4 or 5) in at least one core on extended-pattern biopsy. Multivariable logistic regression analysis was performed to identify independent factors associated with downgrading at radical prostatectomy, defined as a change from primary pattern 4 or 5 to primary pattern 3.Results: Downgrading occurred in 68 (34%) of 202 subjects who met the study criteria. Fourteen (47%) of 30 subjects with Յ25% of cores that were high grade and 9 (43%) of 21 subjects with Ͻ10% of total tissue containing cancer were downgraded. In a multivariable model, patients with mixed grade cores had much higher odds of downgrading than those with all high grade cores (OR 3.0 95% 1.3-7.1), P Ͻ 0.01). The proportion (per 10% increment) of positive cores containing high grade cancer (OR 0.8 95% CI 0.7-0.9 P Ͻ 0.01) and the percent (per 10% increment) of total tissue containing cancer (OR 0.7 95% CI 0.6 -0.9 P ϭ 0.01) were significantly associated with lower odds of downgrading.Conclusions: Downgrading following radical prostatectomy is a common event. Biopsy over-grading may preclude men from active surveillance or lead to unnecessary lymphadenectomy, excess radiation, or prolonged hormone therapy. The proportion of positive biopsy cores that are high grade and the percent of total tissue containing cancer should be incorporated into decision making.

The Effect of Differing Gleason Scores at Biopsy on the Odds of Upgrading and the Risk of Death From Prostate Cancer

“…6–9 In order to improve counseling regarding prognosis, investigators have identified predictors of upgrading based on information available at diagnosis. 6–16 However, only a single study 17 has observed that the presence of differing Gleason scores (i.e. a lower in addition to the highest GS) at biopsy (termed ComboGS in the current study) lowered the odds of upgrading at RP.…”

The Impact of Differing Gleason Scores at Biopsy on the Odds of Upgrading and the Risk of Death From Prostate Cancer

“…[6][7][8][9] In order to improve counseling regarding prognosis, investigators have identified predictors of upgrading based on information available at diagnosis. [6][7][8][9][10][11][12][13][14][15][16] However, only a single study 17 has observed that the presence of differing Gleason scores (i.e. a lower in addition to the highest GS) at biopsy (termed ComboGS in the current study) lowered the odds of upgrading at RP.…”

Clinical role of pathological downgrading after radical prostatectomy in patients with biopsy confirmed Gleason score 3 + 4 prostate cancer

“…Although discrepancies in Gleason score between biopsy and RP are well recognised, few studies have focused on downgrading from the biopsy to the RP specimen . A large prostate volume, lower maximum percentage of cancer in any core, more biopsy cores taken, lower serum PSA level, and lower clinical T stage have been reported as significant predictors of downgrading .…”

“…A certain subset of patients will have downgrading at radical prostatectomy (RP) and these men have been shown to have more favourable outcomes after RP than would have been predicted by the biopsy Gleason score . Furthermore, recent evidence suggests that men with Gleason score 6 prostate cancer in their RP specimen rarely develop distant metastasis or die from prostate cancer .…”