The pathological upgrading after radical prostatectomy in low‐risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology?

Abstract

Background Active surveillance (AS) is one of the treatment alternatives in low‐risk prostate cancer (PCa). The pathological upgrading after radical prostatectomy (RP) were investigated in patients who were eligible for AS in the present study. Methods Between August 2006 and July 2017, 627 patients underwent RP in our institution. One hundred and thirty‐six patients who were eligible for AS at the time of RP were included in this study. The previously defined AS criteria Gleason 3 + 3=6 adenocarcinoma at maximum two biopsy cores, prostate‐specific antigen (PSA) < 10 ng/mL and clinical T stage ≤ 2a were used in the study. The demographics, clinical, and histopathological outcomes were retrospectively compared between two groups, which were divided in accordance with the upgrading status at final pathology as Group 1 (n = 67, upgrading) and Group 2 (n = 69, nonupgrading). Results Gleason upgrading (GU) was found in 67 (49.3%) patients, and 17 patients (12.5%) were upstaged to pT3a. The upgrading to Gleason 3 + 4 was reported in 38.7% of patients, however, 7.4%, and 3.7% of the patients were upgraded to Gleason 4 + 3, and Gleason 4 + 4, respectively. The 10.3% of the patients had extraprostatic involvement, and the rate (19.4% vs 1.4%, P = .002) was significantly higher in Group 1. PSA density (P = .001), tumor size (P < .001), tumor percentage (P < .001), apical involvement (P = .013), and perineural invasion (P < .001) in RP specimen were higher in Group 1. Multivariate analysis showed that perineural invasion (OR = 4.26; 95%CI: 1.76‐10.33; P = .001) and pathologic T stage (OR = 5.45; 95%CI: 1.08‐27.4; P = .04) were independently associated with GU. Conclusions Since 12.5% of the patients upstaged to pT3a disease, and there is a possible risk of Gleason 4 pattern, upgrading of the tumor should carefully be kept in mind before offering AS to low‐risk patients with PCa.

The role of mpMRI in qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy

“…PSA and PSA density were found to be the strongest upgrade predictors. However, no data on the correlation of upgrade with mpMRI score has been included [ 23 ].…”

Multiparametric magnetic resonance imaging facilitates reclassification during active surveillance for prostate cancer

“…Indeed, MRI‐guided PBx improves the detection of aggressive PCa [5] and helps identify patients who might forgo prostate biopsy (PBx) [6]. As such, mpMRI is very attractive for men on AS for PCa because: (i) it is non‐invasive; (ii) it may decrease sampling error and improve patient selection for AS [7]; and (iii) it has the potential to evaluate PCa progression on AS follow‐up. Recent reports have shown the impact of MRI on reclassification of PCa during AS [8,9].…”

C‐reactive protein and procalcitonin levels in prostate cancer

“…Serum prostate‐specific antigen (PSA) testing is the most commonly used test for the diagnosis and screening of PCa 2 . The patients may be diagnosed as from clinically indolent to metastatic disease 3 4 .…”