Gleason Grade 1 Prostate Cancer Volume at Biopsy Is Associated With Upgrading but Not Adverse Pathology or Recurrence After Radical Prostatectomy: Results From a Large Institutional Cohort

Abstract

Purpose: Clinical guidelines suggest that for low-grade, clinically localized prostate cancer, patients with higher volume of disease at diagnosis may benefit from definitive therapy, although the data remain unclear. Our objective was to determine associations between low-grade prostate cancer volume and outcomes in men managed with primary radical prostatectomy. Materials and Methods: Men with cT1-2N0/xM0/x prostate cancer, prostate specific antigen at diagnosis <10 ng/mL, and Gleason grade group 1 pathology on diagnostic biopsy managed with primary radical prostatectomy were included. Outcomes were pathological upgrade at radical prostatectomy (Gleason grade group 2), University of California, San Francisco adverse pathology at radical prostatectomy (Gleason grade group 3, pT3/4, or pN1), alternate adverse pathology at radical prostatectomy (Gleason grade group 3, pT3b, or pN1), and recurrence (biochemical failure with 2 prostate specific antigen 0.2 ng/mL or salvage treatment). Multivariable logistic regression models were used to estimate associations between percentage of positive cores and risk of upgrade and adverse pathology at radical prostatectomy. Multivariable Cox proportional hazards regression models were used to estimate associations between percentage of positive cores and hazard of recurrence after radical prostatectomy. Results: A total of 1,029 men met inclusion criteria. Multivariable logistic regression models demonstrated significant associations between percentage of positive cores and pathological upgrade (OR 1.31, 95% CI 1.1-1.57, P < .01), but not University of California, San Francisco adverse pathology at radical prostatectomy (P [ .84); percentage of positive cores was negatively associated with alternate adverse pathology (OR 0.67, 95% CI 0.48-0.93, P [ .02). Multivariable Cox regression models demonstrated no association between percentage of positive cores and hazard of recurrence after radical prostatectomy (P [ .11). Conclusions: In men with Gleason grade group 1 prostate cancer, tumor volume may be associated with upgrading at radical prostatectomy, but not more clinically significant outcomes of adverse pathology or recurrence.

A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial Nephrectomy. Letter.

“…Gabriel C. Dos Anjos, 1 To the Editor: We read with great interest the article by Shee et al, reporting on the oncologic outcomes of radical prostatectomy in men with Gleason Grade Group (GGG) 1 prostate cancer (PCa), which was published recently in The Journal of Urology Ò . 1 First of all, we would like to congratulate the authors for their effort in rigorously collecting and presenting very important data that will help to refine and expand patient eligibility for active surveillance (AS). AS is the way to go for all low-risk PCa patients, and the authors have demonstrated this brilliantly.…”

“…To the Editor: Guglielmetti et al report the results of a prospective, randomized trial comparing the outcomes of open (OPN) vs laparoscopic partial nephrectomy (LPN). 1 The authors report difficulty randomizing patients (LPN vs OPN) and closed the trial early (2020) without reaching the planned sample size enrollment. A total of 208 patients were randomized, and 84 LPNs and 96 OPNs were included.…”

“…Recent studies have shown that the most important factor in long-term renal function is to preserve renal parenchyma. 1 Ebbing et al concluded that ischemia time was an independent factor for acute renal insufficiency in patients submitted to partial nephrectomy but there was no impact on long-term function. 2 Our study had 15% of zero ischemia in the laparoscopic partial nephrectomy group vs 35% in the open partial nephrectomy group, with a median ischemia time of 14 minutes (7-25 minutes) for both groups, demonstrating the hypothesis that ischemia time has a shorter impact in long-term renal function.…”

Gleason Grade 1 Prostate Cancer Volume at Biopsy Is Associated With Upgrading, but Not Adverse Pathology or Recurrence After Radical Prostatectomy: Results From a Large Institutional Cohort. Letter.

“…To the Editor: We read with great interest the article by Shee et al, reporting on the oncologic outcomes of radical prostatectomy in men with Gleason Grade Group (GGG) 1 prostate cancer (PCa), which was published recently in The Journal of Urology ® . 1 First of all, we would like to congratulate the authors for their effort in rigorously collecting and presenting very important data that will help to refine and expand patient eligibility for active surveillance (AS). AS is the way to go for all low-risk PCa patients, and the authors have demonstrated this brilliantly.…”

A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial Nephrectomy. Reply.

“…Giuliano B. Guglielmetti, 1 Jos e P. Junior, 1 Maurı ´cio Cordeiro,1 Rafael F. Coelho,1 and William C. Nahas 1 *…”