Prostate-specific Antigen Density Is a Good Predictor of Upstaging and Upgrading, According to the New Grading System: The Keys We Are Seeking May Be Already in Our Pocket

Brassetti, Aldo; Lombardo, Riccardo; Emiliozzi, P.; Cardi, Antonio; Antonio, De Vico; Iannello, A.; Scapellato, A.; Riga, T.; Alberto, Pansadoro; D’Elia, G.

doi:10.1016/j.urology.2017.07.071

Cited by 32 publications

(23 citation statements)

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“…Gleason upgrading at final pathology was reported as 41.4% of 379 patients undergoing RP in another study which is not limited with AS patients. The authors stated that GU rate was statistically higher in patients with smaller prostate volume and they also reported PSAD and the number of positive bioptic cores as a valuable predictor of GU risk in the final pathology …”

Section: Discussionmentioning

confidence: 99%

“…The authors stated that GU rate was statistically higher in patients with smaller prostate volume and they also reported PSAD and the number of positive bioptic cores as a valuable predictor of GU risk in the final pathology. 16 Kaye et al 17 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.…”

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confidence: 99%

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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?

et al. 2019

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Background Active surveillance (AS) is one of the treatment alternatives in low‐risk prostate cancer (PCa). The pathological upgrading after radical prostatectomy (RP) were investigated in patients who were eligible for AS in the present study. Methods Between August 2006 and July 2017, 627 patients underwent RP in our institution. One hundred and thirty‐six patients who were eligible for AS at the time of RP were included in this study. The previously defined AS criteria Gleason 3 + 3=6 adenocarcinoma at maximum two biopsy cores, prostate‐specific antigen (PSA) < 10 ng/mL and clinical T stage ≤ 2a were used in the study. The demographics, clinical, and histopathological outcomes were retrospectively compared between two groups, which were divided in accordance with the upgrading status at final pathology as Group 1 (n = 67, upgrading) and Group 2 (n = 69, nonupgrading). Results Gleason upgrading (GU) was found in 67 (49.3%) patients, and 17 patients (12.5%) were upstaged to pT3a. The upgrading to Gleason 3 + 4 was reported in 38.7% of patients, however, 7.4%, and 3.7% of the patients were upgraded to Gleason 4 + 3, and Gleason 4 + 4, respectively. The 10.3% of the patients had extraprostatic involvement, and the rate (19.4% vs 1.4%, P = .002) was significantly higher in Group 1. PSA density (P = .001), tumor size (P < .001), tumor percentage (P < .001), apical involvement (P = .013), and perineural invasion (P < .001) in RP specimen were higher in Group 1. Multivariate analysis showed that perineural invasion (OR = 4.26; 95%CI: 1.76‐10.33; P = .001) and pathologic T stage (OR = 5.45; 95%CI: 1.08‐27.4; P = .04) were independently associated with GU. Conclusions Since 12.5% of the patients upstaged to pT3a disease, and there is a possible risk of Gleason 4 pattern, upgrading of the tumor should carefully be kept in mind before offering AS to low‐risk patients with PCa.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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?

et al. 2019

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“…Probably the best marker in terms of upgrading is PSA density which has been confirmed an accurate marker of upgrading. In Brassetti, study AUC for PSA density was as high as 0.89 confirming a role for PSA density in predicting upgrading . Unfortunately, prostate volume was not available for all patients and therefore PSA density accuracy could not be calculated in this setting and is to be considered a limitation of our study.…”

Section: Discussionmentioning

confidence: 78%

Urotensin II receptor expression in prostate cancer patients: A new possible marker

Giulianelli¹,

Nardoni²,

Falavolti³

et al. 2018

The Prostate

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Background: Urotensin II receptor has been poorly studied in prostate cancer. To evaluate the expression of urotensin II receptor (UII-R) in patients undergoing radical prostatectomy.Methods: Overall, we identified 140 patients treated with retropubic radical prostatectomy (RP) in one center. UII-R was evaluated in prostate biopsies with immunohistochemical staining, resulting in a granular cytoplasmic positivity, through automated system using the kit Urotensin II Receptor Detection System provided by Pharmabullet srl. Immunostained slides were independently and blindly evaluated by ten uro-pathologists. To evaluate UTII-R expression three different parameters were considered: localization, granules dimensions and intensity of expression. A score from 0 to 3 was applied to each parameter to obtain a score from 0 to 9. Each parameter and the total score were evaluated as predictors of high grade disease on surgical pathology and of advanced stage disease. Accuracy of total score for the prediction of upgrading and upstaging was analyzed using receiver operator characteristics curve and decision curve analysis (DCA).Results: On radical prostatectomy 92/140 (66%) presented high grade disease on surgical pathology. Patients with high grade disease presented an apical distribution of the receptor, larger granules and a more intense expression when compared to patients with low grade disease. A well they presented a higher total score. Subscores and total scores were found to be predictors of upgrading and upstaging. On ROC analysis total score presented an AUC of 0.72 and 0.70, respectively, for the prediction of upgrading and upstaging. On DCA total score showed a clinical benefit in the prediction of adverse pathological outcomes.Conclusion: Urotensin II receptor is a potential marker of adverse pathological outcomes. Further studies should confirm our data and evaluate its role as a prognostic marker. K E Y W O R D S accuracy, upgrading, upstaging, urotensin 288 |

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“…Therefore, accurate assessment of tumour characteristics at diagnosis is essential for optimal disease management. The D'Amico classification is the most commonly used criterion for the definition of PCa [13], however high rates of upgrading (24%-41%) and upstaging (29%-34%) have been reported after RP so far [6,[14][15][16]. Discrepancies between prostate biopsy results and final pathological assessment of prostatectomy specimens may be attributed to diagnostic problems, especially when a higher Gleason grade tumour is missed on the needle biopsy or insufficient biopsy material is available for pathological examination [17].…”

Section: Discussionmentioning

confidence: 99%

“…PCa characterisation is still based on the needle biopsy, where the Gleason grading system with clinical tumour staging provide the strongest prognostic power for oncological outcomes after treatment with curative intent. Knowing such heterogeneity of the disease and diagnostic limitations of prostate biopsy, it is not surprising that a significant number of PCa patients undergoing radical prostatectomy are upgraded and upstaged [6].…”

Section: Of 11mentioning

confidence: 99%

The Impact of Prostate Cancer Upgrading and Upstaging on Biochemical Recurrence and Cancer-Specific Survival

et al. 2020

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Background and Objectives: Significant numbers of prostate cancer (PCa) patients experience tumour upgrading and upstaging between prostate biopsy and radical prostatectomy (RP) specimens. The aim of our study was to investigate the role of grade and stage increase on surgical and oncological outcomes. Materials and Methods: Upgrading and upstaging rates were analysed in 676 treatment-naïve PCa patients who underwent RP with subsequent follow-up. Positive surgical margin (PSM), biochemical recurrence (BCR), metastasis-free survival (MFS), overall (OS) and cancer specific survival (CSS) were analysed according to upgrading and upstaging. Results: Upgrading was observed in 29% and upstaging in 22% of PCa patients. Patients undergoing upgrading or upstaging were 1.5 times more likely to have a PSM on RP pathology. Both upgrading and upstaging were associated with increased risk for BCR: 1.8 and 2.1 times, respectively. Mean time to BCR after RP was 2.1 years in upgraded cases and 2.7 years in patients with no upgrading (p < 0.001), while mean time to BCR was 1.9 years in upstaged and 2.8 years in non-upstaged cases (p < 0.001). Grade and stage increase after RP were associated with inferior MFS rates and ten-year CSS: 89% vs. 98% for upgrading (p = 0.039) and 87% vs. 98% for upstaging (p = 0.008). Conclusions: Currently used risk stratification models are associated with substantial misdiagnosis. Pathological upgrading and upstaging have been associated with inferior surgical results, substantial higher risk of BCR and inferior rates of important oncological outcomes, which should be considered when counselling PCa patients at the time of diagnosis or after definitive therapy.

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Prostate-specific Antigen Density Is a Good Predictor of Upstaging and Upgrading, According to the New Grading System: The Keys We Are Seeking May Be Already in Our Pocket

Cited by 32 publications

References 29 publications

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?

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?

Urotensin II receptor expression in prostate cancer patients: A new possible marker

The Impact of Prostate Cancer Upgrading and Upstaging on Biochemical Recurrence and Cancer-Specific Survival

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