Does the Time From Biopsy to Radical Prostatectomy Affect Gleason Score Upgrading in Patients With Clinical T1c Prostate Cancer?

Abstract

PurposeIt is debated whether treatment delay worsens oncologic results in localized prostate cancer (PCa). Few studies have focused on the role of a delay between the time of biopsy and the time of surgery. Thus, we aimed to investigate the effect of the time period between biopsy and surgery on Gleason score upgrading (GSU).Materials and MethodsA total of 290 patients who underwent radical retropubic prostatectomy in Ankara Training and Research Hospital were included in the study. The biopsy Gleason score, age, total prostate-specific antigen (PSA) value, prostate volumes, and PSA density (PSAD) were analyzed in all patients. The patients were divided into two groups: patients with GSU (group 1) and patients without GSU (group 2). Variables having a p-value of ≤0.05 in the univariate analysis were selected and then evaluated by use of multivariate logistic regression models. Results were considered significant at p<0.05.ResultsGSU occurred in 121 of 290 patients (41.7%). The mean age of the patients was 66.0±7.2 years in group 1 and 65.05±5.60 years in group 2 (p=0.18). The mean PSA values of groups 1 and 2 were 8.6±4.1 and 8.8±4.3 ng/dL, respectively. The mean prostate volumes of groups 1 and 2 were 43.8±14.1 and 59.5±29.8 mL, respectively. The PSAD of group 1 was significantly higher than that of group 2 (0.20 vs. 0.17, p=0.003). The mean time to surgery was shorter in group 2 (group 1, 52.2±22.6 days; group 2, 45.3±15.5 days; p=0.004). According to the logistic regression, time from biopsy to surgery is important in the prediction of GSU.ConclusionsWe suggest that the time period between biopsy and surgery is a significant factor that affects GSU in patients with clinically localized PCa.

Gleason group concordance between biopsy and radical prostatectomy specimens: A cohort study from Prostate Cancer Outcome Registry – Victoria

“…This is consistent with previous findings 7, 23. Furthermore, we have shown that a delay of > 9 months or even 6 months not only predicted upgrading, but was also associated with greater biochemical recurrence and positive surgical margins, 26 suggesting that a delay may compromise patient outcomes.…”

“…Predictors from the literature include low prostate volume/weight, 3 higher PSA level,5, 22, 23 higher PSA density, 24 older age, 5 clinical stage T2, 25 time interval between diagnosis to RP,7, 23 percentage positive biopsy cores,7, 22 Cancer of the Prostate Risk Assessment (CAPRA) score, 22 higher body mass index,22, 24 and low serum testosterone 8 …”

“…Many studies have examined variables that may help to predict pathological upgrading of GS from biopsy to RP, including high prostate-specific antigen (PSA) level, 5 advanced patient age, 5 the level of pathologist expertise, 6 time from biopsy to surgery, 7 serum testosterone level, 8 treatment with brachytherapy, 9 percentage tumor involvement, 10 prostate size or volume, 1 and number of core biopsies 11 …”

The factors predicting upgrading of prostate cancer by using International Society for Urological Pathology (ISUP) 2014 Gleason grading system

“…[10] Factors such as PSA, PSA density, prostate volume, BMI, CAPRA score, positive core percentage, low serum testosterone level, and prolonged time intervals between biopsy and surgery were found to be correlated with upgrades. [11][12][13][14][15][16] In our study, most of these factors were found to be effective in the univariate analysis but insignificant in the multivariate analysis. The reasoning behind this could be the fact that we used the new grading system.…”

Prostate Cancers Detected by Magnetic Resonance Imaging–Targeted Biopsies Have a Higher Percentage of Gleason Pattern 4 Component and Are Less Likely to Be Upgraded in Radical Prostatectomies

“…17,18 A number of clinicopathologic parameters are associated with Gleason upgrading in RP. [19][20][21][22][23][24][25] However, only 1 study has briefly mentioned the effect of the quantity of GP 4 in needle biopsy on Gleason upgrading, without presenting detailed data. 26 Targeted biopsy using multiparametric magnetic resonance imaging (MRI)-ultrasound fusion techniques has been increasingly used recently in the diagnosis and characterization of PCa.…”