Pathological upgrading at radical prostatectomy for patients with Grade Group 1 prostate cancer: implications of confirmatory testing for patients considering active surveillance

Abstract

Objective To examine the association between National Comprehensive Cancer Network (NCCN) risk, number of positive biopsy cores, age, and early confirmatory test results on pathological upgrading at radical prostatectomy (RP), in order to better understand whether early confirmatory testing and better risk stratification are necessary for all men with Grade Group (GG) 1 cancers who are considering active surveillance (AS). Patients and Methods We identified men in Michigan initially diagnosed with GG1 prostate cancer, from January 2012 to November 2017, who had a RP within 1 year of diagnosis. Our endpoints were: (i) ≥GG2 cancer at RP and (ii) adverse pathology (≥GG3 and/or ≥pT3a). We compared upgrading according to NCCN risk, number of positive biopsy cores, and age. Last, we examined if confirmatory test results were associated with upgrading or adverse pathology at RP. Results Amongst 1966 patients with GG1 cancer at diagnosis, the rates of upgrading to ≥GG2 and adverse pathology were 40% and 59% (P< 0.001), and 10% and 17% (P= 0.003) for patients with very-low-and low-risk cancers, respectively. Upgrading by volume ranged from 49% to 67% for ≥GG2, and 16% to 23% for adverse pathology. Generally, more patients aged ≥70 vs <70 years had adverse pathology. Unreassuring confirmatory test results had a higher likelihood of adverse pathology than reassuring tests (35% vs 18%, P= 0.017). Conclusions Upgrading and adverse pathology are common amongst patients initially diagnosed with GG1 prostate cancer. Early use of confirmatory testing may facilitate the identification of patients with more aggressive disease ensuring improved risk classification and safer selection of patients for AS.

The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

“…Kaye et al investigated the postprostatectomy results of 1966 patients whose prostate biopsy result was Gleason grade group 1. In that study, the GU rates were 40% and 59% in patients with very low and low‐risk PCa, respectively.…”

“…They also reported the association between the increased number of positive bioptic cores and GU in RP specimens. The authors emphasized that the GU in patients over the age of 70 was two‐fold higher than the GU in patients below 70 years old . In another study, Capitanio et al specified that the increased number of samples taken during prostate biopsy resulted in the statistical reduction in the GU rates.…”

“…The authors emphasized that the GU in patients over the age of 70 was two-fold higher than the GU in patients below 70 years old. 17 In another study, Capitanio et al 18 specified that the increased number of samples taken during prostate biopsy resulted in the statistical reduction in the GU rates. They emphasized that the GU rate in patients with ≥18 biopsy cores was almost half of the GU rate in patients with 10 to 12 biopsy cores (23.5% vs 47.9%; P < .001).…”

No detrimental effect of a positive family history on postoperative upgrading and upstaging in men with low risk and favourable intermediate-risk prostate cancer: implications for active surveillance

“…Risk stratifications prior to treatment decisions are primarily based on biopsy Gleason Grade Group (GGG), clinical stage, and prostate-specific antigen (PSA) levels. Significant sampling error and morbidity associated with prostate biopsy complicates differentiation between aggressive and indolent disease so that post-radical prostatectomy (RP) upgrading and upstaging is common [5][6][7]. Recently, multi-parametric magnetic resonance imaging (mpMRI) showed improvements in risk stratification of men on AS and was recommended for enhancing enrolment and monitoring decision [8][9][10].…”

Predictors of adverse pathology on radical prostatectomy specimen in men initially enrolled in active surveillance for low-risk prostate cancer

“…Reese et al evaluated 130 patients initially on AS who underwent RP and concluded that disease reclassification during AS was the only significant factor associated with adverse pathology (AP) at RP [10]. Other studies have looked at predictors of AP in patient populations eligible, but not enrolled in AS [11][12][13]. Only the PRIAS study included a statistical analysis of which variables observed during AS could predict AP at RP [9].…”