Adverse upgrading and/or upstaging in contemporary low-risk prostate cancer patients

Flammia, Rocco Simone; Hoeh, Benedikt; Hohenhorst, Lukas; Sorce, Gabriele; Chierigo, Francesco; Panunzio, Andrea; Tian, Zhe; Saad, Fred; Leonardo, Costantino; Briganti, Alberto; Antonelli, Alessandro; Terrone, Carlo; Shariat, Shahrokh F.; Anceschi, Umberto; Graefen, Markus; Chun, Felix K.‐H.; Montorsi, Francesco; Gallucci, Michele; Karakiewicz, Pierre I.

doi:10.1007/s11255-022-03250-0

Cited by 7 publications

(13 citation statements)

References 35 publications

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“…In accordance with the aforementioned, we observed a high prevalence of adverse features within our cohort. The rate of upstaging/upgrading stood at 33%, similar to contemporary series (ranging from 24.8% to 45%) [ 17 , 18 ]. Furthermore, most ECE cases presented a non-focal extension.…”

Section: Discussionsupporting

confidence: 78%

Managing prostate cancer after proctocolectomy and ileal pouch-anal anastomosis: feasibility and outcomes of single-port transvesical robot-assisted radical prostatectomy

Pedraza,

Ferguson,

Ramos-Carpinteyro

et al. 2024

World J Urol

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Introduction Patients with proctocolectomy and ileal pouch-anal anastomosis (PC-IPAA) face unique challenges in managing prostate cancer due to their hostile abdomens and heightened small bowel mucosa radiosensitivity. In such cases, external beam radiation therapy (EBRT) is contraindicated, and while brachytherapy provides a safer option, its oncologic effectiveness is limited. The Single-Port Transvesical Robot-Assisted Radical Prostatectomy (SP TV-RARP) offers promise by avoiding the peritoneal cavity. Our study aims to evaluate its feasibility and outcomes in patients with PC-IPAA. Methods A retrospective evaluation was done on patients with PC-IPAA who had undergone SP TV-RARP from June 2020 to June 2023 at a high-volume center. Outcomes and clinicopathologic variables were analyzed. Results Eighteen patients underwent SP TV-RARP without experiencing any complications. The median hospital stay was 5.7 h, with 89% of cases discharged without opioids. Foley catheters were removed in an average of 5.5 days. Immediate urinary continence was seen in 39% of the patients, rising to 76 and 86% at 6- and 12-month follow-ups. Half of the cohort had non-organ confined disease on final pathology. Two patients with ISUP GG3 and GG4 exhibited detectable PSA post-surgery and required systemic therapy; both had SVI, multifocal ECE, and large cribriform pattern. Positive surgical margins were found in 44% of cases, mostly Gleason pattern 3, unifocal, and limited. After 11.1 months of follow-up, no pouch failure or additional BCR cases were found. Conclusion Patients with PC-IPAA often exhibit aggressive prostate cancer features and may derive the greatest benefit from surgical interventions, particularly given that radiation therapy is contraindicated. SP TV-RARP is a safe option for this group, reducing the risk of bowel complications and promoting faster recovery.

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Section: Discussionsupporting

confidence: 78%

Managing prostate cancer after proctocolectomy and ileal pouch-anal anastomosis: feasibility and outcomes of single-port transvesical robot-assisted radical prostatectomy

Pedraza,

Ferguson,

Ramos-Carpinteyro

et al. 2024

World J Urol

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“…In prostate cancer, the discrepancy between the biopsy Gleason score and the radical prostatectomy (RP) Gleason score is a well-known phenomenon [1][2][3][4][5][6][7][8]. In particular, upgrading has been thoroughly studied in several single-and multi-institutional, as well as population-based databases [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

External Tertiary-Care-Hospital Validation of the Epidemiological SEER-Based Nomogram Predicting Downgrading in High-Risk Prostate Cancer Patients Treated with Radical Prostatectomy

et al. 2023

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We aimed to externally validate the SEER-based nomogram used to predict downgrading in biopsied high-risk prostate cancer patients treated with radical prostatectomy (RP) in a contemporary European tertiary-care-hospital cohort. We relied on an institutional tertiary-care database to identify biopsied high-risk prostate cancer patients in the National Comprehensive Cancer Network (NCCN) who underwent RP between January 2014 and December 2022. The model’s downgrading performance was evaluated using accuracy and calibration. The net benefit of the nomogram was tested with decision-curve analyses. Overall, 241 biopsied high-risk prostate cancer patients were identified. In total, 51% were downgraded at RP. Moreover, of the 99 patients with a biopsy Gleason pattern of 5, 43% were significantly downgraded to RP Gleason pattern ≤ 4 + 4. The nomogram predicted the downgrading with 72% accuracy. A high level of agreement between the predicted and observed downgrading rates was observed. In the prediction of significant downgrading from a biopsy Gleason pattern of 5 to a RP Gleason pattern ≤ 4 + 4, the accuracy was 71%. Deviations from the ideal predictions were noted for predicted probabilities between 30% and 50%, where the nomogram overestimated the observed rate of significant downgrading. This external validation of the SEER-based nomogram confirmed its ability to predict the downgrading of biopsy high-risk prostate cancer patients and its accurate use for patient counseling in high-volume RP centers.

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“…Moreover, studies have shown that in approximately half of patients, tumor grades reported in diagnostic biopsies are lower than those determined in prostatectomy specimens. 11,20,21 This is of vital importance in terms of active surveillance (AS) and/or the timely evaluation of curative treatment options, especially in patients diagnosed at an early age. 24 Although there are studies in the literature on the parameters that can predict a histological upgrade, clear conclusions that can guide the clinical approach have not yet been reached.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17][18][19] It has been reported that the histological grade of the tumor increases in approximately half of patients who have undergone Rp compared to their diagnostic prostate biopsies. 11,20,21 In these patients, there is an increase in disease recurrence rates after prostatectomy and the need for additional oncological treatment. 22 Although there are some studies in the literature investigating parameters that can predict an increase in histological grade, such as age at the time of diagnosis, serum PSA and PSA density values, prostate volume, the number of tumor-positive cores in biopsies, and tumor quantification), it is not yet possible to draw clear conclusions that can guide the clinical approach in this field.…”

Section: Introductionmentioning

confidence: 99%

Clinical and histopathological parameters in transrectal ultrasound‐guided biopsies associated with tumor upgrading after radical prostatectomy: A comparative analysis of risk groups

Ozkaya,

Simsekoglu,

Kalender

et al. 2024

The Prostate

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BackgroundThanks to technological advances, prostate cancer (PCa) can be diagnosed at a younger age. It is known that most of these patients are in the low‐intermediate risk group, and the histological grade of the tumor increases in half of those undergoing radical prostatectomy (Rp) compared to their diagnostic biopsies. This is especially important in terms of active surveillance (AS) and/or the timely evaluation of curative treatment options in patients diagnosed at an early age. Our aim was to investigate clinical and histopathological parameters that may be associated with an increase in the histological grade of the tumor in patients with acinar adenocarcinoma who were diagnosed by transrectal ultrasound‐guided biopsy (TRUS‐Bx) and underwent Rp.MethodsA total of 205 patients with classical acinar adenocarcinoma diagnosed by TRUS‐Bx without metastasis and who underwent Rp were grouped according to the D'Amico risk classification. Age at diagnosis, serum prostate‐specific antigen (PSA), PSA density, prostate volume, Prostate Imaging Reporting and Data System (PI‐RADS) score, clinical stage, Gleason Grade Group (GGG), high‐grade intraepithelial neoplasia in tumor‐free cores (HGPIN) (single and ≥2 cores), perineural invasion (PNI), and lymphovascular invasion (LVI) was obtained. Additionally, GGG, pathological stage, lymph node metastasis, surgical margin positivity, and tumor volume obtained from Rp were evaluated. Comparisons were made between the case groups in which the tumor grade increased and remained the same, in terms of age, serum PSA, PSA density, HGPIN in tumor‐free cores (single and ≥2 cores), PNI, and LVI in all biopsies (with or without tumors), as well as risk groups. In addition, the relationships of HGPIN in tumor‐free cores (single and ≥2 cores), PNI, and LVI on TRUS‐Bx with age, serum PSA and PSA density, tumor volume, surgical margin positivity, pathological stage, lymph node metastasis, and risk groups were examined separately.ResultsOf the patients, 72 (35.1%) were in the low‐risk group, 95 (46.3%) in the intermediate‐risk group, and 38 (18.5%) in the high‐risk group. Most of the patients with an increased histological grade (n = 38, 48.1%) were in the low‐risk group (p < 0.05) and had an advanced median age. HGPIN in single and ≥2 tumor‐free cores and PNI were more common in these patients (p < 0.01, p < 0.001, and p < 0.05, respectively). According to the multivariable analysis, advanced age (odds ratio [OR]: 1.087, 95% confidence interval [CI]: 1.029–1.148, p < 0.05), high serum PSA (OR: 1.047, 95% CI: 1.006–1.090, p < 0.05), HGPIN in ≥2 tumor‐free cores (OR: 6.346, 95% CI: 3.136–12.912, p < 0.001), and PNI (OR: 3.138, 95% CI: 1.179–8.356, p < 0.05) were independent risk factors for a tumor upgrade. Furthermore, being in the low‐risk group was an independent risk factor when compared to the intermediate‐ and high‐risk groups (OR: 0.187, 95% CI: 0.080–0.437, p < 0.001 and OR: 0.054, 95% CI: 0.013–0.230, p < 0.001, respectively). The HGPIN diagnosis was more common in the low‐ and intermediate‐risk groups. Advanced age at diagnosis, high serum PSA and PSA density values were associated with PNI on TRUS‐Bx. High serum PSA and PSA density values were associated with LVI on TRUS‐Bx. Surgical margin positivity was higher in cases with PNI and LVI detected by TRUS‐Bx. HGPIN in ≥2 tumor‐free cores, PNI, and LVI on TRUS‐Bx were associated with a higher rate of lymph node metastases.ConclusionsIn patients diagnosed with acinar adenocarcinoma, the presence of HGPIN even in a single tumor‐free core on TRUS‐Bx was found to be significant in terms of showing an increase in the histological tumor grade in Rp. The diagnosis of HGPIN in ≥2 tumor‐free cores on TRUS‐Bx was determined as an independent risk factor for an increased Gleason score after Rp. Furthermore, an advanced age, a high serum PSA value, being in the low‐risk group, and the presence of PNI were associated with a tumor upgrade. HGPIN in ≥2 tumor‐free cores, PNI, and LVI were also associated with lymph node metastasis. Therefore, the diagnosis of HGPIN should be signed out on pathological reports.

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Adverse upgrading and/or upstaging in contemporary low-risk prostate cancer patients

Cited by 7 publications

References 35 publications

Managing prostate cancer after proctocolectomy and ileal pouch-anal anastomosis: feasibility and outcomes of single-port transvesical robot-assisted radical prostatectomy

Managing prostate cancer after proctocolectomy and ileal pouch-anal anastomosis: feasibility and outcomes of single-port transvesical robot-assisted radical prostatectomy

External Tertiary-Care-Hospital Validation of the Epidemiological SEER-Based Nomogram Predicting Downgrading in High-Risk Prostate Cancer Patients Treated with Radical Prostatectomy

Clinical and histopathological parameters in transrectal ultrasound‐guided biopsies associated with tumor upgrading after radical prostatectomy: A comparative analysis of risk groups

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