Risk of Upgrading and Upstaging Among 10 000 Patients with Gleason 3 + 4 Favorable Intermediate-risk Prostate Cancer

Yang, David D.; Mahal, Brandon A.; Muralidhar, Vinayak; Nezolosky, Michelle D.; Vastola, Marie E.; Labe, Shelby A.; Boldbaatar, Ninjin; King, Martin T.; Martin, Neil E.; Orio, Peter F.; Beard, Clair J.; Hoffman, Karen E.; Trinh, Quoc Dien; Spratt, Daniel E.; Feng, Felix Y.; Nguyen, Paul L.

doi:10.1016/j.euf.2017.05.011

Cited by 41 publications

(41 citation statements)

References 28 publications

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“…Clearly, men with FIR disease should be informed of the risks of harbouring undetected higher-grade and higher-stage disease, since rates of postoperative upgrading and upstaging were higher in both Gleason 6 and Gleason 3 + 4 FIR patients compared to low-risk patients (upgrading: 13.8% and 10.6% vs. 7.2%; p < 0.001; upstaging: 24.1% and 16.6% vs. 12.0%; p < 0.001), which could impact secondary therapies and increase risk of PCa progression. Reported rates of upgrading and upstaging are mostly consistent with results in the recent literature [12,[23][24][25]. Interestingly, a higher PSA level at diagnosis was a significant predictor of both upgrading and upstaging in low risk and Gleason 3 + 4 FIR PCa, but not in Gleason 6 FIR PCa.…”

Section: Discussionsupporting

confidence: 86%

“…In the present analysis, older age was only associated with a higher risk of upgrading among low-risk PCa patients. Contradictory results have been likewise reported in the literature [24,26,28,29]. Nevertheless, this factor merits further investigation to avoid overtreatment in elderly patients who have a higher risk of death from competing causes when treated with definitive curative treatment [30].…”

Section: Discussionmentioning

confidence: 79%

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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

et al. 2020

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Purpose To assess whether a first-degree family history or a fatal family history of prostate cancer (PCa) are associated with postoperative upgrading and upstaging among men with low risk and favourable intermediate-risk (FIR) PCa and to provide guidance on clinical decision making for active surveillance (AS) in this patient population. Methods Participants in the German Familial Prostate Cancer database diagnosed from 1994 to 2019 with (1) low risk (clinical T1c–T2a, biopsy Gleason Grade Group (GGG) 1, PSA < 10 ng/ml), (2) Gleason 6 FIR (clinical T1c–T2a, GGG 1, PSA 10–20 ng/ml), and (3) Gleason 3 + 4 FIR (clinical T1c–T2a, GGG 2, PSA < 10 ng/ml) PCa who were subsequently treated with radical prostatectomy (RP) were analysed for upgrading, defined as postoperative GGG 3 tumour or upstaging, defined as pT3–pT4 or pN1 disease at RP. Logistic regression analysis was used to assess whether PCa family history was associated with postoperative upgrading or upstaging. Results Among 4091 men who underwent RP, mean age at surgery was 64.4 (SD 6.7) years, 24.7% reported a family history, and 3.4% a fatal family history. Neither family history nor fatal family history were associated with upgrading or upstaging at low risk, Gleason 6 FIR, and Gleason 3 + 4 FIR PCa patients. Conclusion Results from the current study indicated no detrimental effect of family history on postoperative upgrading or upstaging. Therefore, a positive family history or fatal family history of PCa in FIR PCa patients should not be a reason to refrain from AS in men otherwise suitable.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 79%

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

et al. 2020

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“…Although the GS score is regarded as the single most important determinant in risk assessment, evidence supporting AS in the majority of studies is based on biopsy results instead of whole-specimen pathology [ 8 9 ]. Many patients with GS 3+4 prostate cancer harboring higher grade disease than their biopsy need immediate active treatment, rather than AS, because of the high potential to progress [ 10 ]. We, therefore, examined the incidence and predictors of upgrading in GS 3+4 patients underwent radical prostatectomy (RP) to provide simple guidance on selecting GS 3+4 patients who would benefit from AS.…”

Section: Introductionmentioning

confidence: 99%

Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance?

et al. 2020

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Purpose Whether active surveillance (AS) can be safely extended to patients with Gleason score (GS) 3+4 prostate cancer is highly debated. We examined the incidence and predictors of upgrading among patients with GS 3+4 disease. Materials and Methods The study involved 377 patients with biopsy GS 3+4 who underwent robot-assisted laparoscopic radical prostatectomy (RP) from 2014 to 2018 at a single institution. We analyzed the rate of GS upgrading and used logistic regression to determine the predictors of upgrading. Results A total of 168 (44.6%) patients with GS 3+4 experienced an upgrade in GS. In multivariable analysis, advanced age, prostate-specific antigen (PSA) level, PSA density (PSAD) and Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2) score were significant predictors of GS upgrading. When structured into a predictive model that included age ≥65 years, PSA ≥7.7 ng/mL, PSAD ≥0.475 ng/mL 2 and PI-RADS v2 score 4–5, the probability of GS upgrading ranged from 36.4% to 65.7% when one to four of these factors were included. Conclusions A substantial proportion of patients with GS 3+4 prostate cancer were upgraded after RP. However, according to our model combining clinical and imaging predictors, patients with a low risk of GS upgrading may be eligible candidates for AS.

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“…Similar to previous studies, advanced age was found to have a correlation with increased upgrade risk in the multivariate analysis. [6][7][8][9] Decisions should be made more carefully for advanced-age groups due to their comorbidities, and despite popular belief, these patients have a higher risk for an aggressive disease. Moreover, patients undergoing radiotherapy (RT) and also active surveillance groups whose final Gleason scores cannot be found should be watched closely in order to prevent emergence of poor oncologic results.…”

Section: Discussionmentioning

confidence: 99%

The factors predicting upgrading of prostate cancer by using International Society for Urological Pathology (ISUP) 2014 Gleason grading system

Turan

Güçlüer

Efiloğlu

et al. 2019

Turkish Journal of Urology

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Objective: To investigate the factors to predict Gleason score upgrading (GSU) of patients with prostate cancer who were evaluated by using the International Society for Urological Pathology (ISUP) 2014 Gleason grading system. Material and methods: Between January 2008 and December 2015, we retrospectively investigated patients who had undergone radical prostatectomy and followed up in the uro-oncology outpatient clinic. The pathologic specimens of the patients were evaluated based on the ISUP 2014 classification system. The patients were divided into two groups with or without upgraded Gleason scores. Factors that could be effective in predicting upgrading such as age, prostate-specific antigen (PSA), prostate volume, D'Amico risk classification, PSA density, cancer of the prostate risk assessment (CAPRA) scores, biopsy tumor percentage, body mass index, and clinical stage parameters were compared between both groups. Results: Of the 265 patients who could be evaluated and followed up regularly, Gleason score upgrades were observed in 110 (41.5%) patients. Advanced age (p= 0.009), PSA >20 ng/mL (p= 0.036), PSA density >0.35 (p=0.005), high CAPRA score (p=0.031), and high biopsy tumor percentage (p=0.009) were discovered to be correlated with Gleason score upgrade in univariate logistic regression analysis. Advanced age alone was a predictor for GSU in multivariate logistic regression analysis (p= 0.002). Five-year biochemical recurrence-free survival rate was 86% in the non-GSU group and 55% in the GSU group (p<0.001). Conclusion: GSU risk should be taken into consideration in making therapeutic decisions for older patients with prostate cancer, and precautions should be taken against development of aggressive disease.

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Risk of Upgrading and Upstaging Among 10 000 Patients with Gleason 3 + 4 Favorable Intermediate-risk Prostate Cancer

Cited by 41 publications

References 28 publications

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

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

Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance?

The factors predicting upgrading of prostate cancer by using International Society for Urological Pathology (ISUP) 2014 Gleason grading system

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