Abstract
BackgroundTo identify potential prognostic factors among patients with favorable intermediate risk prostate cancer with a biopsy Gleason score 6.MethodsFrom 2003 to 2019, favorable intermediate risk patients who underwent radical prostatectomy were included in this study. All patients were evaluated preoperatively with MRI. Using PI-RADS scores, patients were divided into two groups, and clinic-pathological outcomes were compared. The impact of preoperative factors on significant pathologic Gleason score upgrading (≥ 4 + 3) and biochemical recurrence were assessed via multivariate analysis. Subgroup analysis was performed in patients with PI-RADS ≤ 2.ResultsAmong the 239 patients, 116 (48.5%) were MRI-negative (PI-RADS ≤ 3) and 123 (51.5%) were MRI-positive (PI-RADS > 3). Six patients in the MRI-negative group (5.2%) were characterized as requiring significant pathologic Gleason score upgrading compared with 34 patients (27.6%) in the MRI-positive group (p < 0.001). PI-RADS score was shown to be a significant predictor of significant pathologic Gleason score upgrading (OR = 6.246, p < 0.001) and biochemical recurrence (HR = 2.595, p = 0.043). 10-years biochemical recurrence-free survival was estimated to be 84.4% and 72.6% in the MRI-negative and MRI-positive groups (p = 0.035). In the 79 patients with PI-RADS ≤ 2, tumor length in biopsy cores was identified as a significant predictor of pathologic Gleason score (OR = 11.336, p = 0.014).ConclusionsAmong the patients with favorable intermediate risk prostate cancer with a biopsy Gleason score 6, preoperative MRI was capable of predicting significant pathologic Gleason score upgrading and biochemical recurrence. Especially, the patients with PI-RADS ≤ 2 and low biopsy tumor length could be a potential candidate to active surveillance.
Highlights
To identify potential prognostic factors among patients with favorable intermediate risk prostate can‐ cer with a biopsy Gleason score 6
All data analysis was carried out in accordance with applicable laws and regulations described in the Declaration of Helsinki and approved by institutional review board approval (Seoul National University Bundang Hospital (B-2004–608-104), we reviewed the records of patients who underwent radical prostatectomy (RP) in a single tertiary hospital between November 2003 and April 2019
The percentage of patients demonstrated pathologic Gleason score upgrading (PGU) was significantly higher in the Magnetic resonance imaging (MRI)-positive group (96.7%) compared with the MRInegative group (69.0%) (p < 0.001); similar results were noted for significant PGU (SPGU) (≥ 4 + 3) (27.6% vs 5.2% in the MRI-positive and MRI-negative group, respectively) (p < 0.001)
Summary
To identify potential prognostic factors among patients with favorable intermediate risk prostate can‐ cer with a biopsy Gleason score 6. Localized prostate cancer can be managed with active surveillance (AS) [1]. Oh et al BMC Urol (2021) 21:52 group had better prognoses compared with those within the unfavorable intermediate risk (UFIR) group [5]; other studies revealed similar oncological results compared to LR PCa [6, 7]. Data from one long-term study revealed that a similar percentage of those in the IR group with a biopsy Gleason score of 6 and PSA between 10–20 ng/ ml experienced 15-year metastatic-free survival compared to those with LR PCa (94% for both groups) [3]. Here we evaluated the potential utility of AS in individuals within the IR group, those characterized as FIR
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