Clinical significance and risk factors of International Society of Urological Pathology (ISUP) grade upgrading in prostate cancer patients undergoing robot-assisted radical prostatectomy

Abstract

Background The objective of this study is to investigate the clinical significance and risk factors of upgrading in the International Society of Urological Pathology (ISUP) Grade Group System in men undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer. Methods A total of 583 patients diagnosed with prostate cancer by systematic biopsy were treated with RARP without neoadjuvant therapy from November 2011 to December 2018. Clinicopathological data were obtained from our clinical records. ISUP grade upgrading (IGU) was defined as ‘ISUP grade in prostatectomy specimen determined to be higher than that in the biopsy specimen’. Clinicopathological factors, including age, PSA, prostate volume at biopsy (PV), PSA density, clinical stage, body mass index (BMI), interval from biopsy to prostatectomy, maximum percentage of cancer involvement per core (%CI), total number of biopsy cores, percentage of cancer positive biopsy cores (%PC), and sampling density were analyzed to detect potential risk factors of IGU. Biochemical recurrence (BCR) rates were calculated to analyze the effect of IGU on cancer prognosis. Results In univariate analysis, BMI was a positive predictor of IGU, while %CI, %PC, and sampling density were negative predictors of IGU. BMI and %PC were statistically significant predictors of IGU in multivariate analysis. For cases diagnosed as ISUP grade group 2 or higher at biopsy, there was a significant difference in BCR rates between cases with and without IGU. Conclusions The results from our cohort showed that elements of both high-grade cancer risk (such as BMI) and sampling efficiency (such as %PC) contribute to IGU. Excluding cases diagnosed as ISUP grade group 1 at biopsy, BCR-free rates were significantly worse in cases with IGU, highlighting the need for more accurate pathological diagnosis at biopsy.

A nomogram for accurately predicting the pathological upgrading of prostate cancer, based on 68Ga‐PSMA PET/CT

“…Among patients with pathological upgrading in training cohort, 51.6% of them are ISUP Grade 1, 20.3% to ISUP Grade 2, 20.3% to ISUP Grade 3, and 7.8% to ISUP Grade 4. This phenomenon has also been described in previous studies 26,33 . In our study, the difference between ISUP1 and ISUP4 ( p = 0.011) was statistically significant, while the difference between ISUP2 and ISUP4 ( p = 0.488), ISUP3 and ISUP4 ( p = 0.443) was not statistically significant.…”

“…Through univariate analysis and subsequent multivariable regression analysis, we got five independent risk predictors as follows: PV, SUV max of the 68 Ga‐PSMA PET/CT examination on prostate lesions, BMI, PPC, and biopsy ISUP grade. These findings were in high concordance with previous reports on risk predictors for PCa pathological upgrading 33 . Then we developed a multiple logistic regression analysis model, and based on it we created a nomogram.…”

“…Previous studies reported that the BMI is correlated with the incidence of PCa, 38 especially the strength of this correlation with high GS is more obvious. In addition, studies have reported that BMI is associated with the pathological upgrading of PCa 33,39 …”

“…These findings were in high concordance with previous reports on risk predictors for PCa pathological upgrading. 33 Then we developed a multiple logistic regression analysis model, and based on it we created a nomogram. In the nomogram, SUV max was the most important independent risk predictor, followed by PV, BMI, PPC, and biopsy ISUP grade.…”

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review. Part 2: Clinic–Pathologic Correlations

“…Indeed, tumor nodules of variable GG may be present in the same prostate, and/or the relative percentages of the different Gleason patterns identified in a biopsy may change in RP/MTS samples. Higher Gleason patterns may be identified only in RPs/MTS, being absent in previous biopsies [174]. The abovementioned studies of Xian et al and Calagua et al analyzed RP specimens [43,75], while other series included biopsies [12,80] or TMAs variably assessing ≥1 specimen types (biopsies, RPs, autopsy material, transurethral resections of prostate) [29,39,41,48,66].…”