Clinical and pathologic predictors of Gleason sum upgrading in patients after radical prostatectomy: Results from a single institution series

Tilki, Derya; Schlenker, Boris; John, Majnu; Büchner, Alexander; Stanislaus, Peter; Gratzke, Christian; Karl, Alexander; Tan, Gerald; Ergün, Süleyman; Tewari, Ashutosh; Stief, Christian G.; Seitz, Michael; Reich, Oliver

doi:10.1016/j.urolonc.2009.07.003

Cited by 60 publications

(57 citation statements)

References 30 publications

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“…Analyzing the preoperative factors, the PSA level was significantly higher in the upgraded group. This observation is consistent with the reports published by Freedland et al [16] and Tilki et al [17] who have demonstrated that a high PSA level is associated with upgrading of the GS. Using the ROC analysis, the optimal cutoff value for predicting the risk of upgrading in the present study was 4.73 ng/ml (sensitivity 85.7%, specificity 57.8%).…”

Section: Discussionsupporting

confidence: 93%

Incidence of Upgrading and Upstaging in Patients with Low-Volume Gleason Score 3+4 Prostate Cancers at Biopsy: Finding a New Group Eligible for Active Surveillance

Park¹,

Park

et al. 2013

Urol Int

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Introduction: The aim of this study was to identify patients with low-volume Gleason score 3+4 (GS3+4) prostate cancer (PCa) who may be candidates for active surveillance (AS) by analyzing the incidence of upgrading and upstaging following radical prostatectomy (RP). Patients and Methods: Of 907 patients who underwent RP at our institute over the last 5 years, 66 men diagnosed with low-volume GS3+4 PCa at needle biopsy were identified. The incidence of upstaging and upgrading was assessed. Results: The overall rate of upgrading and upstaging was 31.8 and 25.6%, respectively. Preoperative PSA levels were significantly higher in patients who were upgraded (p = 0.015). The optimal preoperative PSA cutoff level for the prediction of upgrading was 4.73 ng/ml (sensitivity 85.7%, specificity 57.8%). Patients with <15% of maximum cores positive had significantly lower upstaging rate than those with >15% of maximum cores positive (p = 0.035). Clinical stage and number of positive cores had marginal association with upgrading and upstaging statistically (p = 0.061 and 0.081, respectively). Conclusions: In patients with low-volume GS3+4 PCa at biopsy, underestimation may be effectively avoided when we select patients with PSA <4.73 and % maximum cancer involvement on positive cores <15%.

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Section: Discussionsupporting

confidence: 93%

Incidence of Upgrading and Upstaging in Patients with Low-Volume Gleason Score 3+4 Prostate Cancers at Biopsy: Finding a New Group Eligible for Active Surveillance

Park¹,

Park

et al. 2013

Urol Int

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“…In PCA patients, the risk of biopsy tumor upgrading in the surgical specimen is a subject that has already been well investigated and has shown that age, clinical stage, PSA plasma levels and PSAD are the main risk factors predicting bGS upgrading in the surgical specimen [12,13,14,15,19]. …”

Section: Discussionmentioning

confidence: 99%

“…The pathological Gleason score (pGS) represents the most effective factor for predicting the natural history of the disease including biochemical recurrence, development of metastases and PCA-specific mortality [8,9,10,11]. In clinical practice, it is well known that the biopsy Gleason score (bGS) underestimates the pGS [12,13,14,15]. As a consequence, it is important to identify clinical factors that might predict pGS upgrading because they effectively help the urologist and radiation oncologist to choose the optimal treatment approach.…”

Section: Introductionmentioning

confidence: 99%

High Testosterone Preoperative Plasma Levels Independently Predict Biopsy Gleason Score Upgrading in Men with Prostate Cancer Undergoing Radical Prostatectomy

Porcaro

Petroziello²,

Brunelli³

et al. 2016

Urol Int

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Purpose: The study aims to investigate the potential associations between preoperative plasma levels of total testosterone (TT) and biopsy Gleason score (bGS) upgrading in prostate cancer (PCA) patients undergoing radical prostatectomy (RP). Materials and Methods: Exclusion criteria were treatment with 5α-reductase inhibitors, LH-releasing hormone analogues or testosterone replacement. Criteria of bGS upgrading were as follows: (i) bGS 6 to pathological Gleason score (pGS) >6, (ii) bGS 7 with pattern 3 + 4 to pGS 7 with pattern 4 + 3 or to pGS >7, (iii) bGS 7 with pattern 4 + 3 to pGS >7. Patients who showed bGS >7 were excluded from the cohort. Results: The study included 209 patients. Tumor upgrading was assessed in 76 (36.4%) cases of the entire cohort, in 51 out of 130 cases (39.2%) of the bGS 6 group and 25 out of 79 patients (31.6%) in the bGS 7 cluster. Logistic regression models showed that independent clinical covariates predicting the risk of bGS upgrading included TT (OR 1.058; p = 0.027) and prostate-specific antigen (PSA) density (OR 23.3; p = 0.008) as well as TT (OR 1.057; p = 0.029) with PSA (OR 1.061; p = 0.023). The model suggests that 1 unit increase in TT plasma levels increases the odds of bGS upgrading by 5.8 or 5.7%. Conclusions: In summary, we have determined that high TT preoperative plasma levels independently predict bGS upgrading in men with PCA undergoing RP. Preoperative plasma levels of TT might be included as a potential marker for assessing the risk bGS upgrading.

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“…Bunlara ek olarak uyumsuzluğa neden olabilecek çok sayıda faktör bulunmaktadır. Bu faktörler arasında küçük prostat hacmi (18,19), yüksek PSA değerleri (19)(20)(21), ileri yaş, tümörlü kor sayısı (11,22), biyopsideki tümör hacminin büyük (22-24) olması sayılabilir. GS artış insidansı ve prediktif faktörlerin değerlendirildiği literatürdeki en geniş seride 7643 hastanın biyopsi ve RP GS değerleri karşılaştırılmış ve GS artış oranı %36.3 olarak bulunmuştur (17).…”

Section: Discussionunclassified

“…Bazı araştırmacılar yüksek PSA değeri ile GS artışı arasında anlamlı ilişki saptasa da (17,20,21) bunun aksini belirten yayınlar da bulunmaktadır (16,31 …”

Section: Biyopsi Ve Radikal Prostatektomi Patoloji Verileriunclassified

Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması

Şahinkanat¹,

Küçükdurmaz²,

Efe³

et al. 2017

Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi

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Amaç: Prostat biyopsisi ile elde edilen Gleason skoru (GS), lokalize prostat kanseri olgularının tedavi kararında önem taşıdığı için radikal prostatektominin (RP) GS ile uyumu oldukça önemlidir. Ancak literatürde bu uyum % 24-50 arasında bildirilmektedir. Çalışmamızda kliniğimizde yapılan prostat biyopsileri ile RP sonrası elde edilen patolojik bulguların uyumu değerlendirilmiştir.Gereç ve Yöntemler: KSÜ Tıp Fakültesi Üroloji Kliniği'nde standart 12 kor transrektal biyopsi ile prostat kanseri tanısı konan ve sonraki sekiz haftada RP yapılan 24 hastanın patoloji sonuçları retrospektif olarak değerlendirildi. Biyopsilerde GS, kanserli kor sayısı, kanserli korlardaki kanser yüzdesi değerlendirildi. Ayrıca yaş, prostat hacmi, PSA değerlerinin biyopsi ve RP GS'ları arasındaki uyuma etkisi araştırıldı. GS artışı ya da azalışı bir prognostik gruptan diğerine geçiş olarak tanımlandı. Prognostik gruplar GS 6; 7 ve 8≤ olarak kategorize edildi.Bulgular: Hastaların ortanca yaşı 68 (58-79) yıl, ortanca PSA değeri 9,65 ng/ml (4.2-149) ve prostat hacmi 46.5 ml (27-70) idi. Tüm hastalar değerlendirildiğinde yalnızca bir olguda (%4.2) GS düşüşü saptandı. Biyopsisinde GS=6 olan olguların % 43.5' inde (n:7/16) RP GS'unda artış saptanırken, GS=7 olan 7 hastanın ise sadece birinde GS artışı izlendi. GS=8 olan bir hastanın RP GS, biyopsi GS'u ile aynıy-dı. Prostat biyopsi ve patolojik GS arasındaki genel uyum % 62,5 ve kappa değeri 0,31 (p:0,025) idi. GS artışı ile ileri yaş arasında k: 0.47 (p=0.01), PSA> 9 olan 14 vaka için k: 0.50 (p=0.021) ve prostat hacmi ≥30 cc olan olgularda k: 0.42 (p=0.014) olarak bulundu.Sonuç: Çalışmamızda iğne biyopsi GS ile RP GS arasındaki uyum oranı literatürle uyumlu bulunmakla birlikte, verilerimiz biyopsi ile daha doğru derecelendirme için yeni teknik yaklaşımlara yönelmemiz gerektiğini düşündürtmektedir.Anahtar Kelimeler: Biyopsi, prostat kanseri, Gleason skoru, radikal prostatektomi AbstractObjective: Prostate biopsy Gleason score is important for treatment planning in patients with localized prostate cancer. Therefore, concordance between biopsy and radical prostatectomy (RP) pathologies is critically important. However, discordance rates between those two was reported as 24-50% in the literature. Aim of present study is to evaluate concordance rates between biopsy and RP results.Material and Methods: A retrospective review of 24 patients, who underwent prostate biopsy (standart 12 cores) due to elevated PSA or abnormal digital rectal examination and diagnosed with localised prostate cancer was performed. All patients underwent radical prostatectomy within 8 weeks after biopsy. Associations between preoperative clinical factors and Gleason score upgrading were analyzed. Those factors include Gleason scores, percentage of positive cores, age, prostate volume and PSA value. Gleason upgrading or downgrading was defined as an increase or decrease from one prognostic group to another. Prognostic groups were categorised as GS 6; 7 and 8≤.Results: Median age of patients was68 (58-79) years and median PS...

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Clinical and pathologic predictors of Gleason sum upgrading in patients after radical prostatectomy: Results from a single institution series

Cited by 60 publications

References 30 publications

Incidence of Upgrading and Upstaging in Patients with Low-Volume Gleason Score 3+4 Prostate Cancers at Biopsy: Finding a New Group Eligible for Active Surveillance

Incidence of Upgrading and Upstaging in Patients with Low-Volume Gleason Score 3+4 Prostate Cancers at Biopsy: Finding a New Group Eligible for Active Surveillance

High Testosterone Preoperative Plasma Levels Independently Predict Biopsy Gleason Score Upgrading in Men with Prostate Cancer Undergoing Radical Prostatectomy

Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması

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