Assessment of PSIM (Prostatic Systemic Inflammatory Markers) Score in Predicting Pathologic Features at Robotic Radical Prostatectomy in Patients with Low-Risk Prostate Cancer Who Met the Inclusion Criteria for Active Surveillance

Matteo Ferro,Angelo Porreca,Danilo Bottero,Roberto Bianchi,Alessandro Francesco Mistretta,Marina Di Mauro,Giuseppe Lucarelli,Giuseppe Renne,Antonio Cioffi,Gian Maria Busetto,Deliu Victor Matei,Stefano Luzzago,Francesco Del Giudice,Giovanni Cordima,Michele Catellani,Ettore Di Trapani,Ottavio De Cobelli,Gennaro Musi,Giorgio Ivan Russo,A Brescia ,Guido Cozzi

doi:10.3390/diagnostics11020355

Abstract

Background: circulating levels of lymphocytes, platelets and neutrophils have been identified as factors related to unfavorable clinical outcome for many solid tumors. The aim of this cohort study is to evaluate and validate the use of the Prostatic Systemic Inflammatory Markers (PSIM) score in predicting and improving the detection of clinically significant prostate cancer (csPCa) in men undergoing robotic radical prostatectomy for low-risk prostate cancer who met the inclusion criteria for active surveillance. Methods: we reviewed the medical records of 260 patients who fulfilled the inclusion criteria for active surveillance. We performed a head-to-head comparison between the histological findings of specimens after radical prostatectomy (RP) and prostate biopsies. The PSIM score was calculated on the basis of positivity according to cutoffs (neutrophil-to-lymphocyte ratio (NLR) 2.0, platelets-to-lymphocyte ratio (PLR) 118 and monocyte-to-lymphocyte-ratio (MLR) 5.0), with 1 point assigned for each value exceeding the specified threshold and then summed, yielding a final score ranging from 0 to 3. Results: median NLR was 2.07, median PLR was 114.83, median MLR was 3.69. Conclusion: we found a significantly increase in the rate of pathological International Society of Urological Pathology (ISUP) ≥ 2 with the increase of PSIM. At the multivariate logistic regression analysis adjusted for age, prostate specific antigen (PSA), PSA density, prostate volume and PSIM, the latter was found the sole independent prognostic variable influencing probability of adverse pathology.

Highlights

Prostate cancer (PCa) is the second most commonly diagnosed neoplasm in men worldwide, with the highest incidence in the Western countries largely due to the widespread use of prostate-specific antigen (PSA) testing [1]
Recent observational and randomized clinical trials have shown that men harboring low-volume, low-grade PCa presented less than 6% risk of disease progression within a decade from diagnosis and demonstrated that cancer-related mortality from untreated patients with International Society of Urological Pathology (ISUP) grade 1–2 might be as low as 7% at 15-year follow-up [5]
We reviewed the medical records of 260 patients who fulfilled the inclusion criteria for “Prostate Cancer Research International: Active Surveillance” [18] defined as follows: clinical stage T2a or less, PSA level < 10 ng/mL, 2 or fewer cores involved with cancer after a biopsy scheme of at least 12 cores, Gleason score (GS) ≤ 6, and PSA density (PSAD) < 0.2 ng/mL/cc

Summary

Introduction

Prostate cancer (PCa) is the second most commonly diagnosed neoplasm in men worldwide, with the highest incidence in the Western countries largely due to the widespread use of prostate-specific antigen (PSA) testing [1]. Radical prostatectomy (RP) is a therapeutic option for patients with clinically localized PCa, with a life expectancy of ≥10 years without serious comorbid conditions. Many men with low-risk localized PCa may not benefit from active treatment modalities [4]. Recent observational and randomized clinical trials have shown that men harboring low-volume, low-grade PCa presented less than 6% risk of disease progression within a decade from diagnosis and demonstrated that cancer-related mortality from untreated patients with International Society of Urological Pathology (ISUP) grade 1–2 might be as low as 7% at 15-year follow-up [5]. Active surveillance (AS) is mainly applicable to men with seemingly indolent cancer with the goal to defer or avoid treatment and its potential side effects, and to preserve a clinical window in which to intervene in cases of cancer progression. A growing body of evidence has demonstrated that these clinical variables may fail to accurately predict PCa aggressiveness and underestimate Gleason score (GS) with prostatectomy specimens in up to 66% of patients, missing discrimination among indolent and clinically significant PCa (iPCa; csPCa) [7,8]

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Discussion

Conclusion