Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance?

Abstract

Purpose Whether active surveillance (AS) can be safely extended to patients with Gleason score (GS) 3+4 prostate cancer is highly debated. We examined the incidence and predictors of upgrading among patients with GS 3+4 disease. Materials and Methods The study involved 377 patients with biopsy GS 3+4 who underwent robot-assisted laparoscopic radical prostatectomy (RP) from 2014 to 2018 at a single institution. We analyzed the rate of GS upgrading and used logistic regression to determine the predictors of upgrading. Results A total of 168 (44.6%) patients with GS 3+4 experienced an upgrade in GS. In multivariable analysis, advanced age, prostate-specific antigen (PSA) level, PSA density (PSAD) and Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2) score were significant predictors of GS upgrading. When structured into a predictive model that included age ≥65 years, PSA ≥7.7 ng/mL, PSAD ≥0.475 ng/mL 2 and PI-RADS v2 score 4–5, the probability of GS upgrading ranged from 36.4% to 65.7% when one to four of these factors were included. Conclusions A substantial proportion of patients with GS 3+4 prostate cancer were upgraded after RP. However, according to our model combining clinical and imaging predictors, patients with a low risk of GS upgrading may be eligible candidates for AS.

Risk and predictors of adverse pathology after radical prostatectomy in patients diagnosed with IUSP 1–2 prostate cancer at MRI-targeted biopsy: a multicenter analysis

“…Although we describe similar predictors, some findings should be further discussed. PI-RADS was identified as a predictor for upgrading to ISUP ≥ 3 and AP as previously reported in a single-institution study by Pham et al [25]. Moreover, ECE on mpMRI predicted AP in the subgroup with low-risk PCa and lesion volume predicted upgrading to ISUP ≥ 3 in the subgroup with favorable intermediate-risk PCa.…”

Clinicopathological factors associated with pathological upgrading from biopsy to prostatectomy in patients with ISUP grade group ≤2 prostate cancer

“…Pham et al . 5 reported that tPSA, age, PI-RADS score, and PSAD were the independent predictors of GG upgrading. Yang et al .…”

“…For biopsy GG 2, our data revealed that 46.9% of patients experienced upgrading at RP among clinical T1–3 PCa. This result was consistent with the findings by Pham et al ., 5 which demonstrated an upgrading rate of 44.6% for patients with biopsy GG 2 and clinical T1–3 PCa.…”

Prostate Cancer Biomarker Development: National Cancer Institute's Early Detection Research Network Prostate Cancer Collaborative Group Review

“…This concern results in many men electing to undergo additional therapy, despite their low-grade cancer diagnosis. Their anxiety is clearly warranted as numerous studies find evidence of more aggressive disease in a subset of their patients (62)(63)(64)(65)(66). The prostate cancer can be either upgraded (i.e., the Gleason score is higher in the prostatectomy than in the biopsy) or upstaged (i.e., the tumor-node-metastasis stage is higher at time of surgery than was originally recorded).…”