Aktif İzlem İçin Uygun Olan ve Radikal Prostatektomi ile Tedavi Edilen Prostat Kanserli Hastalarda Patolojik Yükselmeyi Gösteren Prediktif Faktörler

Abstract

Objective: To evaluate the factors to predict Gleason score upgrading in prostate cancer patients who are suitable for active surveillance (AS) and the role of prostate-specific antigen (PSA) density in the management of these patients. Material and Methods: Seventy seven prostate cancer patients who had active surveillance criteria but preferred radical prostatectomy as the treatment instead of active surveillance protocol were included in the study. In our study, Gleason 3+3≤6 adenocarcinoma, positivity in maximum 2 biopsy cores in ≥12 core transrectal ultrasound guided systematic biopsy, PSA<10 ng/mL, and Clinical T Stage ≤2a were used as active follow-up criteria. Tumor grade in the radical prostate and prostate biopsy specimens were compared. Predictive factors of pathological upgrading after radical prostatectomy have been investigated. Results: There is statistically significant correlation between PSA density (p=0.042), prostate volume (p=0.010), maximum tumor length in a core (p=0.001), maximum percentage of tumor in a core (p=0.002), bladder neck involvement (p=0.023) and postoperative Gleason score upgrading in univariate analysis. The optimal cut-off values of PSA density and prostate volume were 0.12 ng/mL2 and 48 cc, respectively. There isn't statistically significant correlation between PSA, free PSA, free/total PSA, the length of biopsy core, perineural invasion, apical involment and postoperative Gleason score upgrading in univariate analysis. Maximum tumor length in a core and prostate volume were independent predictors of pathological Gleason score upgrading on multivariate regression. Conclusion: Prostate volume and maximum tumor length in a core are independent predictors of pathological Gleason score upgrading in our study. These factors should also be included in current AS criterias in addition to PSA density and tumor percentage.