Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance?
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...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Urological Association
2020-07-01
|
| Series: | Investigative and Clinical Urology |
| Subjects: | |
| Online Access: | https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-61-405.pdf |
| _version_ | 1819015901179019264 |
|---|---|
| author | Duc Minh Pham Jung Kwon Kim Sangchul Lee Sung Kyu Hong Seok-Soo Byun Sang Eun Lee |
| author_facet | Duc Minh Pham Jung Kwon Kim Sangchul Lee Sung Kyu Hong Seok-Soo Byun Sang Eun Lee |
| author_sort | Duc Minh Pham |
| collection | DOAJ |
| description | 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/mL2 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. |
| first_indexed | 2024-12-21T02:39:06Z |
| format | Article |
| id | doaj.art-5cd4cba82905436fb0039b86dda384bc |
| institution | Directory Open Access Journal |
| issn | 2466-0493 2466-054X |
| language | English |
| last_indexed | 2024-12-21T02:39:06Z |
| publishDate | 2020-07-01 |
| publisher | Korean Urological Association |
| record_format | Article |
| series | Investigative and Clinical Urology |
| spelling | doaj.art-5cd4cba82905436fb0039b86dda384bc2022-12-21T19:18:43ZengKorean Urological AssociationInvestigative and Clinical Urology2466-04932466-054X2020-07-0161440541010.4111/icu.2020.61.4.405Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance?Duc Minh Pham 0https://orcid.org/0000-0001-6752-400XJung Kwon Kim 1https://orcid.org/0000-0002-8069-6225Sangchul Lee 2https://orcid.org/0000-0003-0844-6843Sung Kyu Hong 3https://orcid.org/0000-0002-8344-6774Seok-Soo Byun 4https://orcid.org/0000-0001-9356-9500Sang Eun Lee 5https://orcid.org/0000-0001-5480-9970Department of Urology, Cho Ray Hospital, Ho Chi Minh, Viet Nam.Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.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/mL2 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.https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-61-405.pdfpathologyprognosisprostate neoplasmsprostatectomy |
| spellingShingle | Duc Minh Pham Jung Kwon Kim Sangchul Lee Sung Kyu Hong Seok-Soo Byun Sang Eun Lee Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance? Investigative and Clinical Urology pathology prognosis prostate neoplasms prostatectomy |
| title | Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance? |
| title_full | Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance? |
| title_fullStr | Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance? |
| title_full_unstemmed | Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance? |
| title_short | Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance? |
| title_sort | prediction of pathologic upgrading in gleason score 3 4 prostate cancer who is a candidate for active surveillance |
| topic | pathology prognosis prostate neoplasms prostatectomy |
| url | https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-61-405.pdf |
| work_keys_str_mv | AT ducminhpham predictionofpathologicupgradingingleasonscore34prostatecancerwhoisacandidateforactivesurveillance AT jungkwonkim predictionofpathologicupgradingingleasonscore34prostatecancerwhoisacandidateforactivesurveillance AT sangchullee predictionofpathologicupgradingingleasonscore34prostatecancerwhoisacandidateforactivesurveillance AT sungkyuhong predictionofpathologicupgradingingleasonscore34prostatecancerwhoisacandidateforactivesurveillance AT seoksoobyun predictionofpathologicupgradingingleasonscore34prostatecancerwhoisacandidateforactivesurveillance AT sangeunlee predictionofpathologicupgradingingleasonscore34prostatecancerwhoisacandidateforactivesurveillance |