Preoperative Factors Related to Stage and Grade Increase in D’Amico Low-Risk and Intermediate-Risk Group Patients

Abstract

Objective: In this study we searched preoperative factors that may cause upstaging and upgrading at D'Amico low-risk and intermediate-risk group patients who underwent radical prostatectomy (RRP) due to prostate adenocarcinoma. Materials and Methods: Among patients undergoing RRP retrospective evaluation, those who have PSA<10ng/mL, prostate needle biopsy (PNB) Gleason score (GS) ≤6 and clinical T1c-T2a were placed in the low-risk group. Patients with PSA 10-20 ng/mL and/or PNB GS=7 and/or clinical T2b were placed in the intermediate-risk group. In accordance with PNB GS and clinical stage, patients whose RRP GS and T stage increased or not with PNB GS 3+4=7 (7a) and RRP GS 4+3=7 (7b) were assessed as upgrade. The PSA data, PNB and RRP pathological data and biochemical recurrence rates of patients were investigated. Current data were used to separately assess and compare low-risk and intermediate-risk groups according to upstaging and upgrading. Results: Among the 151 patients in the low-risk group, it was identified that 21 had upstage and 63 had upgrade, while in the 187 patients in the intermediaterisk group 84 had upstage and 39 had upgrade. In the low-risk group, the PNB tumor percentage was identified to be high in the upgrade group (p<0.001). In the intermediate-risk group, PSA, PSA density, PNB perineural invasion (PNI) positivity, tumor percentage and positive core numbers were high in the upstage group. However, in the intermediate-risk group PSA, fPSA, PSA density, PNB GS and tumor percentage were high in the upgrade group (p<0.05). When postoperative factors were examined, tumor volume and surgical margin positivity were observed to be correlated with upstaging and upgrading. Conclusion: In conclusion, in the low-risk group PNB tumor percentage was related to upgrading, in the intermediate-risk group, PSA, PSA density and PNB tumor percentage were correlated with both upstaging and upgrading, while PNB PNI positivity and positive core numbers were observed to be correlated with T stage increase only. Keywords: D'Amico risk classification, low-risk and intermediate-risk prostate cancer, prostate needle biopsy, upgrading, upstaging Amaç: Bu yazıda kliniğimizde prostat adenokarsinomu nedenli radikal retropubik prostatektomi (RRP) yapılan D'Amico düşük-risk ve orta-risk grubundaki hastalarda evre ve derece yükselmesine neden olabilecek preoperatif faktörler araştırıldı. Gereç ve Yöntem: RRP yapılan hastalardan prostat spesifik antijen (PSA) <10 ng/mL ve prostat iğne biyopsisi (PİB) Gleason skoru (GS) ≤6 ve klinik T1c-T2a olan hastalar D'Amico düşük-risk grubunda; PSA 10-20 ng/mL ve/veya PİB GS=7 ve/veya klinik T2b olan hastalar D'Amico orta-risk grubunda değerlendirildi. PİB GS ve klinik evresine göre RRP GS ve T evresinde yükselme olan ve olmayan hastalarda, PİB GS ve klinik evresine göre RRP GS ve T evresinde yükselme olan ve olmayan hastalar araştırıldı, bununla birlikte PİB GS 3+4=7 (7a) olup da RRP GS 4+3=7 (7b) olanlar da derecede yükselme olarak değerlendirildi. Hastaların PSA verileri, PİB ve RRP...

Relationship Between Tumor Density in Radical Prostatectomy Material, Preoperative Predictive Factors and Biochemical Recurrence

“…Fakat bazı çalışmalarda da tümör hacminin BR'ye etkisinin olmasına rağmen PSA, RRP T evresi ve GS gibi bağımsız bir risk faktörü olmadığı raporlanmıştır (18). Diğer çalışmalarda ise postoperatif evre ve derece yükselmesi gözlenen hastalarda tümör hacminin evre ve derece yükselmesi olmayan hastalara göre daha yüksek olduğu saptanmıştır (19,20). Bunun dışında maksimum tümör çapının araştırıldığı çalışmalarda mevcuttur (21,22,23).…”