2036 GLEASON SCORE UPGRADING IN PATIENTS WITH UNILATERAL PROSTATE CANCER: IMPLICATIONS FOR SELECTION INTO ACTIVE SURVEILLANCE REGIMEN

Abstract

You have accessJournal of UrologyProstate Cancer: Localized X1 Apr 20102036 GLEASON SCORE UPGRADING IN PATIENTS WITH UNILATERAL PROSTATE CANCER: IMPLICATIONS FOR SELECTION INTO ACTIVE SURVEILLANCE REGIMEN Sonal Grover, Abhishek Srivastava, Gerald Tan, David Peters, Kumaran Mudaliar, Youssef El-Douaihy, Robert Leung, and Ashutosh Tewari Sonal GroverSonal Grover More articles by this author , Abhishek SrivastavaAbhishek Srivastava More articles by this author , Gerald TanGerald Tan More articles by this author , David PetersDavid Peters More articles by this author , Kumaran MudaliarKumaran Mudaliar More articles by this author , Youssef El-DouaihyYoussef El-Douaihy More articles by this author , Robert LeungRobert Leung More articles by this author , and Ashutosh TewariAshutosh Tewari More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2082AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clinicians often rely heavily on biopsy Gleason score when selecting patients for active surveillance, focal or curative (prostatectomy or radiation) therapy. Unfortunately, discordance between the biopsy and true pathological Gleason score has been well documented. We sort to identify possible predictors for Gleason upgrading, where the Gleason Sum was higher on final histopathology when compared to that found on biopsy, based on pre operative clinico-pathologic characters METHODS Data were prospectively gathered using our IRB approved protocol. From June 2005 to July 2009, there were 1114 patients with unilateral disease on preoperative biopsy who eventually opted for radical prostatectomy at our institute. We reviewed biopsy, operative and clinical data to record age, BMI, preoperative prostate specific antigen (PSA), clinical stage, biopsy Gleason score, presence of high grade intraepithelial neoplasm (HGPIN), perineural invasion (PNI), prostate volume, number of positive cores and maximum percentage of positive cores. Clinical and biopsy variables were correlated against final surgical pathology. Logistic regression and Backward Wald analysis were performed to identify possible predictors of Gleason upgrading. Odd ratios (OR) were also determined. RESULTS Of 1114 patients with unilateral disease on biopsy, Gleason upgrading was found in 376 (33.75%) patients. Preoperative PSA (P= 0.016; OR=1.037) and biopsy Gleason score of ≥ 7 (P=0.00; OR=0.111) were only significant predictors of Gleason upgrading on univariate analysis. Age (P=0.021; OR= 1.032), BMI (P=0.075; OR= 1.037), preoperative PSA(log) (P=0.001; OR= 1.077), total positive cores (P=0.001; OR= 1.321), maximum percentage of positive cores (P=0.044; OR= 1.011), biopsy Gleason score of ≥ 7 (P=0.000; OR=0.045), Prostate volume (log) (P=0.049; OR= 0.993) were significant predictors of Gleason upgrading on multivariate analysis. CONCLUSIONS There is little correlation between biopsy and the final surgical pathology which makes patient selection for active surveillance challenging. The risk for Gleason upgrading is influenced by preoperative PSA, biopsy Gleason of ≥ 7, total number of positive cores, maximum percentage of cancer on biopsy and prostate volume. These variables should be taken in account while making management decisions. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e790 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sonal Grover More articles by this author Abhishek Srivastava More articles by this author Gerald Tan More articles by this author David Peters More articles by this author Kumaran Mudaliar More articles by this author Youssef El-Douaihy More articles by this author Robert Leung More articles by this author Ashutosh Tewari More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...