Upgrading and upstaging of low-risk prostate cancer among Korean patients: a multicenter study

Hwang, In-Sun; Lim, Dong-Hoon; Jeong, Young Beom; Park, Seung Chol; Noh, Ji Heon; Kwon, Dong Deuk; Kang, Taek Won

doi:10.4103/1008-682x.143751

Cited by 18 publications

(20 citation statements)

References 27 publications

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“…Our results are similar to other studies that have shown associations between PSA levels as well as percentage positive cores and upgrading and upstaging [9,10,12,16,17]. Dinh et al [10] reported that a PSA greater than 5.0 ng/mL was associated with upgrading and upstaging in men with low-risk PCa (p < 0.01).…”

Section: Discussionsupporting

confidence: 91%

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Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer

Morrison¹,

Aiken²,

Reid³

et al. 2019

ecancer

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Several studies suggest race-based health disparities in men with low-risk prostate cancer (PCa), with African American males having poorer oncological outcomes. We sought to determine the prevalence and predictors of pathological upgrading and upstaging in Jamaican men with low-risk PCa treated with radical prostatectomy (RP). Data on 141 men who met the National Comprehensive Cancer Network criteria for low-risk PCa and underwent RP at a single institution were reviewed. All men had a transrectal ultrasound-guided biopsy. Pre-operative clinical and final pathological data were obtained. Data were summarised as means and standard deviations or percentages as appropriate. Bivariate analyses such as independent samples t-tests and chi-square tables were conducted and logistic regression models were estimated to predict upgrading (>Gleason 6) and upstaging (p ≥ T3). The mean age was 59.5 ± 7.8 years with mean prostate specific antigen (PSA) of 6.6 ± 2 ng/mL. A total of 48.3% of men were upgraded and 11.4% were upstaged. Bivariate analyses indicated that PSA (p = 0.008) and percentage positive cores (p = 0.002) were associated with upgrading. PSA (p = 0.042) and percentage positive cores (p = 0.003) were significantly associated with upstaging. The odds of upgrading increased with increased PSA levels (OR 1.40, 95% CI 1.05-1.87, p = 0.021) or increased percentage positive cores (OR 8.27, 95% CI 2.19-31.16, p = 0.002). The odds of upstaging increased with increased PSA levels (OR 1.4, 95% CI 1.01-1.96, p = 0.046) and with increased percentages positive cores (OR 11.4; 95% CI 2.06-63.09, p = 0.005). Jamaican men with low-risk PCa are at high risk of pathological upgrading and upstaging at RP. These findings should be taken into consideration when discussing treatment options with these patients.

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Section: Discussionsupporting

confidence: 91%

“…Age greater than 60 years has been found in previous studies to be associated with pathological upgrading and upstaging [10]. Other useful predictors of upgrading and upstaging not evaluated in our study include prostate volume and obesity [16][17][18].…”

Section: Discussionmentioning

confidence: 48%

Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer

Morrison¹,

Aiken²,

Reid³

et al. 2019

ecancer

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“… 39 However, the potential risk of tumor progression and metastasis exists in patients with low- or intermediate-risk PCa. 42 43 44 A minimum two-point increase in the CAPRA-S score indicates at least a doubling of the risk of recurrence. 12 …”

Section: Discussionmentioning

confidence: 99%

Combined analysis of CRMP4 methylation levels and CAPRA-S score predicts metastasis and outcomes in prostate cancer patients

et al. 2018

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The present study analyzed the predictive value of combined analysis of collapsin response mediator protein 4 (CRMP4) methylation levels and the Cancer of the Prostate Risk Assessment (CAPRA-S) Postsurgical score of patients who required adjuvant hormone therapy (AHT) after radical prostatectomy (RP). We retrospectively analyzed 305 patients with prostate cancer (PCa) who received RP and subsequent androgen deprivation therapy (ADT). Two hundred and thirty patients with clinically high-risk PCa underwent immediate ADT, and 75 patients with intermediate risk PCa underwent deferred ADT. CRMP4 methylation levels in biopsies were determined, and CAPRA-S scores were calculated. In the deferred ADT group, the values of the hazard ratios for tumor progression and cancer-specific mortality (CSM) in patients with ≥15% CRMP4 methylation were 6.81 (95% CI: 2.34–19.80) and 12.83 (95% CI: 2.16–26.10), respectively. Receiver-operating characteristic curve analysis indicated that CRMP4 methylation levels ≥15% served as a significant prognostic marker of tumor progression and CSM. In the immediate ADT group, CAPRA-S scores ≥6 and CRMP4 methylation levels ≥15% were independent predictors of these outcomes (uni- and multi-variable Cox regression analyses). The differences in the 5-year progression-free survival between each combination were statistically significant. Combining CAPRA-S score and CRMP4 methylation levels improved the area under the curve compared with the CRMP4 or CAPRA-S model. Therefore, CRMP4 methylation levels ≥15% were significantly associated with a poor prognosis and their combination with CAPRA-S score accurately predicted tumor progression and metastasis for patients requiring AHT after RP.

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“…(0.95-6.24), after adjusting for age, % positive biopsy cores, PSA and prostate volume [20]. The Partin tables that predict extraprostatic extension, seminal vesicle positivity and lymphnode positivity also include clinical stage, along with biopsy Gleason score and serum PSA [6].…”

Section: Discussionmentioning

confidence: 99%

Urotensin II Receptor on Preoperative Biopsy is Associated with Upstaging and Upgrading in Prostate Cancer

et al. 2015

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Aim: A higher Gleason score was associated with a lower tumor urotensin II receptor (UTII-R) expression in prostate cancer patients. Methods: A retrospective review of formalinfixed paraffin-embedded tumor tissue derived from those who had prostatectomy and matching biopsy specimens was conducted at six Institutions. UTII-R expression was evaluated on biopsy by immunohistochemistry. Results: A total of 58 subjects undergoing radical prostatectomy were included. At multivariate analysis, low UTII-R expression was a significant predictor of Gleason upgrading, with an odds ratio of 10.3 (95% CI: 1.55-68.4), and of pathology upstaging, with an odds ratio of 11.1 (95% CI: 1.23-100.48). Conclusions: UTII-R expression on biopsy was associated with Gleason upgrading and pathology upstaging in prostate cancer patients. KEYWORDS• Gleason score • prostate cancer • urotensin II receptor Prostate cancer is the most prevalent malignant tumor in men, with varying incidences among different geographical areas and populations because of a complex interplay of genetic and socioeconomic factors [1]. The highly heterogeneous prognosis of localized disease poses a great challenge for clinicians and investigators, since prognostic assessment is essential to assess the balance of benefits and harms of treatment [2][3][4][5]. While a subset of patients can be safely actively monitored avoiding sexual, urinary and bowel toxicity associated with local treatments [2], patients with aggressive disease require a multimodality approach that includes surgery [3] and/or radiation therapy plus adjuvant hormonal treatment [4]. The clinical stage, prostate-specific antigen (PSA) levels and the biopsy Gleason score have been incorporated in an extensively employed risk classification model originally 3092RESEaRch aRticlE Ferro, Buonerba, Terracciano et al. future science group developed by D'Amico et^al. [5]. The biopsy Gleason score has also been included in models predicting organ-confined disease [6] as well as lymph node involvement [7], and it is associated with outcome even in patients with advanced disease receiving systemic treatment [8,9].Preoperative staging underestimates pathologic stage and prostate biopsies underestimate the Gleason score compared with prostatectomy specimens in up to 66% of patients, depending on PSA levels, biopsy Gleason score and clinical stage [10]. Apart from these variables, which have been incorporated in a validated predictive model to predict Gleason upgrading [11], a number of biomolecular markers were associated with Gleason upgrading [12,13]. Upgrading and upstaging have important therapeutic implications, as biopsy Gleason score and clinical stage along with PSA levels are the mainstay of the treatment-decision algorithm for localized prostate cancer [2][3][4][5]. Notably, baseline radiographic clinical staging has serious limitations.Urotensin II (UTII) is a vasoconstrictive agent that binds to UTII receptor (UTII-R) and is able to stimulate human corticoadrenal carcinoma proliferation [14]. In thr...

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Upgrading and upstaging of low-risk prostate cancer among Korean patients: a multicenter study

Cited by 18 publications

References 27 publications

Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer

Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer

Combined analysis of CRMP4 methylation levels and CAPRA-S score predicts metastasis and outcomes in prostate cancer patients

Urotensin II Receptor on Preoperative Biopsy is Associated with Upstaging and Upgrading in Prostate Cancer

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