Predictive risk factor for Gleason score upgrading in low risk prostate cancer after radical prostatectomy
Zhang Fan1, Huang Yi1, Lu Min2, Ma Lulin1
1Department of Urology, Peking University Third Hospital, Beijing, 100191, China; 2Department of Pathology, Basic Medical College of Beijing University
Abstract：Objective:To explore the risk factors of Gleason Score upgrading in low risk prostate cancer after radical prostatectomy. Methods:We retrospectively evaluated 121 patients who were biopsy proved prostatic carcinoma and performed radical prostatectomy. All patients included in the study was diagnosed low risk prostate cancer according to D'Amico classification, they had complete information for clinical variables, including age, body mass index(BMI), preoperative PSA level, prostate volume(PV), number of biopsy cores obtained, percentage of positive biopsy, clinical stage, biopsy GS. Grading of NB Gleason Score was compared with their corresponding radical prostatectomy specimens and assess the discrepancy of NB and prostatectomy specimens GS. Univariable and multivariable logistic regression analysis was used to identify predictors of Gleason Score upgrading. Results:Of the 121 patients, the specimen GS was upgraded in 49(40.5%) patients and remained no change in 72(59.5%) patients. Univariate and multivariate regression analysis shows that prostate volume were independent predictors with postoperative upgrading of GS(P=0.001). Conclusions:Smaller prostate volume was an independent factor for Gleason Score upgrading in clinically low risk prostate cancer after radical prostatectomy. This fact should be kept in mind when deciding on therapy decisions for patients with prostate cancer.
[1]D'Amico AV, Whittington R, Malkowicz SB, et al.Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA,1998,280(11):969-974. [2]Heidenreich A, Bellmunt J, Bolla M, et al. European Association of Urology. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol, 2011,59(1):61-71. [3]Mohler J, Bahnson RR, Boston B, et al. NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw, 2010,8(2):162-200. [4]那彦群,叶章群,孙光.中国泌尿外科疾病诊断治疗指南(2011).北京:人民卫生出版社,2011. [5]King CR. Patterns of prostate cancer biopsy grading: trends and clinical implications. Int J Cancer, 2000,90(6):305-311. [6]Kwon T, Jeong IG, You D, et al. Effect of prostate size on pathological outcome and biochemical recurrence after radical prostatectomy for prostate cancer: is it correlated with serum testosterone level? BJU Int, 2010,106(5):633-638. [7]Freedland SJ, Isaacs WB, Platz EA, et al.Prostate size and risk of high-grade, advanced prostate cancer and biochemical progression after radical prostatectomy: a search database study. J Clin Oncol,2005,23(30):7546-7554. [8]Moussa AS, Kattan MW, Berglund R, et al.A nomogram for predicting upgrading in patients with low- and intermediate-grade prostate cancer in the era of extended prostate sampling. BJU Int,2010,105(3):352-358. [9]Dong F, Jones JS, Stephenson AJ, et al. Prostate cancer volume at biopsy predicts clinically significant upgrading. J Urol, 2008,179(3):896-900. [10]Turley RS, Hamilton RJ, Terris MK, et al. Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy: results from the SEARCH database. J Urol, 2008,179(2):523-527. [11]Kassouf W, Nakanishi H, Ochiai A, et al. Effect of prostate volume on tumor grade in patients undergoing radical prostatectomy in the era of extended prostatic biopsies. J Urol, 2007,178(1):111-114.
