Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range

Colleselli, Daniela; Pelzer, Alexandre; Steiner, Eberhard; Ongarello, Stefano; Schaefer, Georg; Bartsch, Georg; Schwentner, Christian

doi:10.1038/pcan.2009.54

Cited by 26 publications

(17 citation statements)

References 20 publications

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“…The biopsy GS and clinical stage contributed most for surgeons in selecting therapy of PCa; however, pathological upgrading and upstaging after RP were common. 6 7 8 According to previous studies, 2 6 9 the rate of upgrading after RP was 30%–60%, means nearly half of the biopsy grades were not correctly presenting the real malignancy. Epstein et al .…”

Section: Discussionmentioning

confidence: 99%

Low serum testosterone predicts upgrading and upstaging of prostate cancer after radical prostatectomy

Gao¹,

Jiang²,

Mao³

et al. 2016

Asian J Androl

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Often, pathological Gleason Score (GS) and stage of prostate cancer (PCa) were inconsistent with biopsy GS and clinical stage. However, there were no widely accepted methods predicting upgrading and upstaging PCa. In our study, we investigated the association between serum testosterone and upgrading or upstaging of PCa after radical prostatectomy (RP). We enrolled 167 patients with PCa with biopsy GS ≤6, clinical stage ≤T2c, and prostate-specific antigen (PSA) <10 ng ml−1 from April 2009 to April 2015. Data including age, body mass index, preoperative PSA level, comorbidity, clinical presentation, and preoperative serum total testosterone level were collected. Upgrading occurred in 62 (37.1%) patients, and upstaging occurred in 73 (43.7%) patients. Preoperative testosterone was lower in the upgrading than nonupgrading group (3.72 vs 4.56, P< 0.01). Patients in the upstaging group had lower preoperative testosterone than those in the nonupstaging group (3.84 vs 4.57, P= 0.01). In multivariate logistic regression analysis, as both continuous and categorical variables, low serum testosterone was confirmed to be an independent predictor of pathological upgrading (P = 0.01 and P= 0.01) and upstaging (P = 0.01 and P = 0.02) after RP. We suggest that low serum testosterone (<3 ng ml−1) is associated with a high rate of upgrading and upstaging after RP. It is better for surgeons to ensure close monitoring of PSA levels and imaging examination when selecting non-RP treatment, to be cautious in proceeding with nerve-sparing surgery, and to be enthusiastic in performing extended lymph node dissection when selecting RP treatment for patients with low serum testosterone.

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Section: Discussionmentioning

confidence: 99%

Low serum testosterone predicts upgrading and upstaging of prostate cancer after radical prostatectomy

Gao¹,

Jiang²,

Mao³

et al. 2016

Asian J Androl

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“…When low‐risk men undergo immediate radical prostatectomy (RP), approximately 30% are found to have Gleason ≥ 7 in the surgical specimen re‐classifying them as intermediate‐risk 6–8. In this setting the grade discrepancy is thought to be due to sampling error of the standard 8–12 core biopsy 9.…”

Section: Introductionmentioning

confidence: 99%

Delayed radical prostatectomy for intermediate‐risk prostate cancer is associated with biochemical recurrence: Possible implications for active surveillance from the SEARCH database

et al. 2012

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“…Long follow up and correlation with prostatectomy results is needed in future studies for selecting more precise cut-off points. We expect underestimation of the aggressiveness or the grade of the cancer as well as missing cancers on biopsy 16 . Therefore, correlation with prostatectomy or fusion biopsy is necessary for better evaluation of the reliability of such testing.…”

Section: Discussionmentioning

confidence: 99%

A Multi-Center Prospective Study to Validate an Algorithm Using Urine and Plasma Biomarkers for Predicting Gleason ≥3+4 Prostate Cancer on Biopsy

Albitar

Lund

et al. 2017

J. Cancer

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Background: Unnecessary biopsies and overdiagnosis of prostate cancer (PCa) remain a serious healthcare problem. We have previously shown that urine- and plasma-based prostate-specific biomarkers when combined can predict high grade prostate cancer (PCa). To further validate this test, we performed a prospective multicenter study recruiting patients from community-based practices.Patients and Methods: Urine and plasma samples from 2528 men were tested prospectively. Results were correlated with biopsy findings, if a biopsy was performed as deemed necessary by the practicing urologist. Of the 2528 patients, biopsy was performed on only 524 (21%) patients.Results: Of the 524 patients, Gleason≥3+4 PCa was found in 161 (31%) and Gleason ≥4+3 was found in 62 (12%) of the patients.The urine/plasma biomarkers algorithm showed sensitivity and specificity of 75% and 69% for predicting Gleason ≥3+4. However, upon incorporating prostate size and prior history of biopsy in the algorithm, we achieved a sensitivity between 97% and 86% and a specificity between 36% and 57%, dependent on the used cut-off point. Sensitivity for predicting PCa Gleason ≥4+3 was between 96% and 99% and specificity between 59% and 37%, dependent on the cut-off point. Diagnosis of Gleason ≥3+4 was missed in 1% to 3% of tested patients and of Gleason ≥4+3 in 0.2% to 1%.Conclusion: This test when integrated with prostate volume and the prior prostate biopsy enhance the sensitivity and specificity for predicting the presence of high grade prostate cancer with negative predictive value (NPV) of 90% to 97% for Gleason ≥3+4 and between 98% to 99% for Gleason ≥4+3.

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Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range

Cited by 26 publications

References 20 publications

Low serum testosterone predicts upgrading and upstaging of prostate cancer after radical prostatectomy

Low serum testosterone predicts upgrading and upstaging of prostate cancer after radical prostatectomy

Delayed radical prostatectomy for intermediate‐risk prostate cancer is associated with biochemical recurrence: Possible implications for active surveillance from the SEARCH database

A Multi-Center Prospective Study to Validate an Algorithm Using Urine and Plasma Biomarkers for Predicting Gleason ≥3+4 Prostate Cancer on Biopsy

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