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

Abstract

Objective: To investigate the factors to predict Gleason score upgrading (GSU) of patients with prostate cancer who were evaluated by using the International Society for Urological Pathology (ISUP) 2014 Gleason grading system. Material and methods: Between January 2008 and December 2015, we retrospectively investigated patients who had undergone radical prostatectomy and followed up in the uro-oncology outpatient clinic. The pathologic specimens of the patients were evaluated based on the ISUP 2014 classification system. The patients were divided into two groups with or without upgraded Gleason scores. Factors that could be effective in predicting upgrading such as age, prostate-specific antigen (PSA), prostate volume, D'Amico risk classification, PSA density, cancer of the prostate risk assessment (CAPRA) scores, biopsy tumor percentage, body mass index, and clinical stage parameters were compared between both groups. Results: Of the 265 patients who could be evaluated and followed up regularly, Gleason score upgrades were observed in 110 (41.5%) patients. Advanced age (p= 0.009), PSA >20 ng/mL (p= 0.036), PSA density >0.35 (p=0.005), high CAPRA score (p=0.031), and high biopsy tumor percentage (p=0.009) were discovered to be correlated with Gleason score upgrade in univariate logistic regression analysis. Advanced age alone was a predictor for GSU in multivariate logistic regression analysis (p= 0.002). Five-year biochemical recurrence-free survival rate was 86% in the non-GSU group and 55% in the GSU group (p<0.001). Conclusion: GSU risk should be taken into consideration in making therapeutic decisions for older patients with prostate cancer, and precautions should be taken against development of aggressive disease.

A nomogram to predict the upgrading rate of ISUP grades of RP in patients undergoing transrectal prostate biopsy and transperineal prostate biopsy

“…In general, RP is not required at diagnosis for patients with low-risk PCa as these patients are safely managed with active surveillance (AS) protocols. However, some authors have pointed out that postoperative pathological upgrading does exist in these patients, with other literature reporting that this is more often seen in younger patients with PCa [21] . Therefore, accurate examination results before surgery and precise prediction of postoperative pathological results were of great signi cance to the decisions of further treatment.…”

“…Therefore, accurate examination results before surgery and precise prediction of postoperative pathological results were of great signi cance to the decisions of further treatment. It was reported that postoperative pathological upgrade was related to younger age patients with prostate cancer [21] . In the current study, although age was not an independent risk factor for ISUP-upgrade, the mean age in the ISUP-upgrade group was signi cantly younger than the no-ISUP-upgrade group (p = 0.043).…”

A nomogram to Predict the Upgrading Rate of ISUP grades of Radical Prostatectomy in Patients Undergoing Transrectal Prostate Biopsy and Transperineal Prostate Cognitive Fusion Biopsy

“…Therefore, accurate examination results before surgery and precise prediction of postoperative pathological results were of great signi cance to the decisions of further treatment. It was reported that postoperative pathological upgrade was related to younger age patients with prostate cancer [23] . This was similar with our study, although the age in our study was not the independent factor for the ISUP-upgrade, the age in the group of ISUPupgrade was relative younger than the no ISUP upgrade group.…”

The modified International Society of Urological Pathology system improves concordance between biopsy and prostatectomy tumour grade

“…Turan et al. [21] similarly demonstrated statistically significant decrease between the 5‐year biochemical recurrence‐free survival rates in patients with upgraded and concordant disease at RP when using the 2014 ISUP modification of the Gleason grading system (55% vs 86%, respectively). For this reason, the overall accuracy of the biopsy grade in representing true disease status is crucial.…”