1482 FACTORS FOR PREDICTION OF GLEASON SCORE UPGRADING AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening (II)1 Apr 20131482 FACTORS FOR PREDICTION OF GLEASON SCORE UPGRADING AFTER RADICAL PROSTATECTOMY Ching-Wei Yang, Tzu-Ping Lin, Yi-Hsiu Huang, Hsiao-Jen Chung, Junne-Yih Kuo, William Huang, Howard Wu, Yen-Hwa Chang, Alex Lin, and Kuang-Kuo Chen Ching-Wei YangChing-Wei Yang Taipei, Taiwan More articles by this author , Tzu-Ping LinTzu-Ping Lin Taipei, Taiwan More articles by this author , Yi-Hsiu HuangYi-Hsiu Huang Taipei, Taiwan More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung Taipei, Taiwan More articles by this author , Junne-Yih KuoJunne-Yih Kuo Taipei, Taiwan More articles by this author , William HuangWilliam Huang Taipei, Taiwan More articles by this author , Howard WuHoward Wu Taipei, Taiwan More articles by this author , Yen-Hwa ChangYen-Hwa Chang Taipei, Taiwan More articles by this author , Alex LinAlex Lin Taipei, Taiwan More articles by this author , and Kuang-Kuo ChenKuang-Kuo Chen Taipei, Taiwan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2947AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gleason score upgrading after radical prostatectomy existed in a significant portion of patients who were diagnosed prostate cancer by needle biopsy and may has untoward effect regarding treatment outcomes. We identified clinical and pathological parameters that predict pathological upgrading in this population. METHODS A total of 324 patients who underwent biopsy and radical prostatectomy between March 2000 and September 2011 were included in the study. Clinical Gleason score upgrading was defined as higher Gleason score sum in prostatectomy than in needle biopsy specimen pathologically. Pretreatment characteristics were analyzed to identify predictors of pathological upgrading. Upgrading significance was established in cases that were and were not upgrade. RESULTS A total of 125 patients (38 %) had upgraded and 199 patients (62 %) had non-upgraded Gleason score postoperatively. Preoperative serum prostate specific antigen (PSA) greater than 12ng/ml (p = 0.008) and prostate specific antigen density (PSAD) greater than 0.35 (p = 0.04) was associated with pathological upgrading. Prostate specific antigen, prostate volume, biopsy number, biopsy cores, positive biopsy side, number of positive cores, highest tumor percentage of positive cores, interval to surgery, methods of operation and different operators were not associated with upgrading. Higher PSAD, number of positive cores and tumor percentage of positive cores were associated with pathologically extraprostatic extension or positive surgical margin while Gleason score upgrading were not significant difference associated with extraprostatic extension or positive surgical margin in prostatectomy specimens. CONCLUSIONS Higher serum PSA and PSAD predict clinically significant upgrading in prostate cancer patients who were treated with radical prostatectomy. These parameters should be considered in the pretreatment risk assessment and counseling of prostate cancer patients. Table 1. Pre-RP predictors in upgrading and non-upgrading groups Predictors Upgrading (N=105) Non-upgrading (N=93) P value Mean age (y/o) 68 65 0.012 PSA (ng/ml) 14 11 0.280 Prostate volume (ml) 34 37 0.201 PSA density (ng/ml2) 0.46 0.36 0.128 Mean max% Ca in any core 49 36 0.007 Mean days from Biopsy to RP 55 61 0.117 Number of biopsies 1.1 1.1 0.930 Mean No. of biopsy cores 9.2 8.9 0.504 Mean No. of positive cores 2.8 1.9 0.004 Bx Primary GS 3.0 3.2 0.031 Bx Secondary GS 3.0 3.1 0.967 Bx GS sum 6.0 6.3 0.678 T test & Mann-Whitney test Table 2. Multivariate logistic regression analysis of Gleason Score upgrading after RP Predictors OR 95% CI P value PSA <>12 ng/ml 4.323 1.704 ∼10.967 0.002 PSA density > 0.35 ng/ml2 2.539 1.193∼5.406 0.016 Max Ca > 20% in any core 1.649 0.760∼3.578 0.206 Biopsy positive >2 cores 1.971 0.904∼4.296 0.088 T test & Mann-Whitney test © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e607-e608 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ching-Wei Yang Taipei, Taiwan More articles by this author Tzu-Ping Lin Taipei, Taiwan More articles by this author Yi-Hsiu Huang Taipei, Taiwan More articles by this author Hsiao-Jen Chung Taipei, Taiwan More articles by this author Junne-Yih Kuo Taipei, Taiwan More articles by this author William Huang Taipei, Taiwan More articles by this author Howard Wu Taipei, Taiwan More articles by this author Yen-Hwa Chang Taipei, Taiwan More articles by this author Alex Lin Taipei, Taiwan More articles by this author Kuang-Kuo Chen Taipei, Taiwan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...