Heterogeneity in D׳Amico classification–based low-risk prostate cancer: Differences in upgrading and upstaging according to active surveillance eligibility

Schiffmann, Jonas; Wenzel, Philipp; Salomon, Georg; Budäus, Lars; Schlomm, Thorsten; Minner, Sarah; Wittmer, Corinna; Kraft, Stefan; Krech, Till; Steurer, Stefan; Sauter, Guido; Boehm, Katharina; Tilki, Derya; Michl, Uwe; Huland, Hartwig; Graefen, Markus; Karakiewicz, Pierre I.

doi:10.1016/j.urolonc.2015.04.004

Cited by 41 publications

(41 citation statements)

References 27 publications

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“…In selected cohorts of patients under active surveillance, further risk factors associating with disease reclassification have been identified and include cancer involvement >50% per core, the number of biopsy cores and even immediate repeat biopsy [20,21,22]. …”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…However, low-risk PCA is a heterogeneous population and prostate biopsies can underestimate the true grade of the cancer when compared to prostatectomy specimens as it has been reported in past series referring to the preceding Gleason score system [13,16,17,18]. Recently, in large contemporary series referring to the modified Gleason score system, it has been shown that there is still a wide variation of tumor upgrading, which ranges between 43% [19] and 63.8% [20]. In our study, low-risk PCA, which included 38.8% of the operated cases, tumor upgrade was detected in 65.3% of the surgical specimens.…”

Section: Discussionmentioning

confidence: 99%

“…In contemporary series, it has been shown that independent predictors of tumor upgrading in low-risk PCA include non-white race [19], older age [19,20], higher PSA levels [19,20], higher proportion of positive cores and tumor involvement greater than 50% per each core as well [20]. In our study, we tried to identify prognostic factors associating with tumor upgrading to the pGP = 3 + 4 and to the pGP >3 + 4.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, we have demonstrated that patients with low-risk disease have a higher probability of harboring occult high-grade disease, including patterns pGP >3 + 4 if their PSA value was elevated (especially >5.0 μg/l) and/or if the proportion of positive biopsy cores were higher than 0.20. A high PSA value as an indicator of high-grade disease has been demonstrated and is biologically intuitive, as one would expect more PSA secretion from more aggressive tumors such as pGP >3 + 4 when compared to pGP = 3 + 4 or with pGP = 3 + 3 [20,21]. …”

Section: Discussionmentioning

confidence: 99%

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Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

Porcaro

Siracusano²,

Luyk³

et al. 2016

Urol Int

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Objective: To identify clinical factors associated with prostate cancer (PCA) upgrading to higher patterns of the surgical specimen in low-risk PCA. Materials and Methods: We evaluated the records of 438 patients. The multinomial logistic regression model was used. Results: Low-risk PCA included 170 cases (38.8%) and tumor upgrading was detected in 111 patients (65.3%) of whom 72 (42.4%) had pathological Gleason patterns (pGP) = 3 + 4 and 39 (22.9%) pGP >3 + 4. Prostate-specific antigen (PSA) and proportion of positive cores (P+) were independent predictors of tumor upgrading to higher patterns. The main difference between upgraded cancers related to PSA and to P+ >0.20. The population was stratified into risk classes by PSA ≤5 μg/l and P+ ≤0.20 (class A), PSA >5 μg/l and P+ ≤0.20 (class B), PSA ≤5 μg/l and P+ >0.20 (class C) and PSA >5 μg/l and P+ 0.20 (class D). Upgrading rates to pGP >3 + 4 were extremely low in class A (5.1%), extremely high in D (53.8%). Conclusions: Low-risk PCA is a heterogeneous population with significant rates of undetected high-grade disease. Significant clinical predictors of upgrading to higher patterns include PSA and P+, which identify a very high-risk class that needs repeat biopsies in order to reclassify tumor grade.

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“…Second, due to a lack of detailed information from SEER-Medicare-derived analyses, we relied on pathological Gleason score. Since high rates of upgrading were recorded between clinical and pathological Gleason score, 15 a corresponding bias might exist in our analyses. Finally, other limitations known to affect SEER-Medicare-derived analyses are also operational, for example, use of claims data or lack of detailed parameters that are included in prospective trials.…”

Section: Discussionmentioning

confidence: 99%

Suboptimal use of pelvic lymph node dissection: Differences in guideline adherence between robot-assisted and open radical prostatectomy

Schiffmann

Larcher²,

Sun³

et al. 2016

CUAJ

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Introduction: Our aim was to assess adherence to National Comprehensive Cancer Network (NCCN) and American Urological Association (AUA) guidelines for pelvic lymph node dissection (PLND) at the time of either robot-assisted (RARP) or open radical prostatectomy (ORP). Methods: We relied on the Surveillance, Epidemiology, and End Results-Medicare linked database and focused on localized prostate cancer (PCa) patients who were treated with either RARP or ORP between October 2008 and December 2009. Categorical and multivariable logistic regression analyses targeted two endpoints: 1) probability of guideline-recommended PLND; and 2) probability of no PLND, when not guideline-recommended. Results: Among 5268 PCa patients, adherence to NCCN PLND guideline was 56.9% during RARP and 76.5% during ORP (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.3-0.6). AUA PLND guideline adherence was 68.1% during RARP and 82.4% during ORP (OR 0.7, 95% CI 0.5-0.9). When PLND was not recommended, it was more frequently performed during ORP according to either NCCN (OR 3.7, 95% CI 3.5-3.9) or AUA (OR 2.7, 95% CI 2.6-2.8). According to the NCCN guideline, at recommended PLND in ORP patients, 6.3% harboured lymph node invasion (LNI) (number needed to treat [NNT] 16) vs. 3.2% at RARP (NNT 31). According to the AUA guideline, at recommended PLND in ORP patients, 12.3% harboured LNI (NNT 8) vs. 5.1% RARP (NNT 19). Conclusions: Adherence to NCCN and AUA PLND guidelines was lower during RARP than during ORP when PLND was recommended. The rate of non-recommended PLND was also higher during ORP than during RARP. Technical considerations may be at play.

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Heterogeneity in D׳Amico classification–based low-risk prostate cancer: Differences in upgrading and upstaging according to active surveillance eligibility

Cited by 41 publications

References 27 publications

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

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

Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

Suboptimal use of pelvic lymph node dissection: Differences in guideline adherence between robot-assisted and open radical prostatectomy

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