MP11-09 METABOLIC SYNDROME INCREASES THE RISK OF UPGRADING EPSTEIN 2015 GLEASON SCORE IN PATIENTS WITH PROSTATE CANCER ON BIOPSY: A RADICAL PROSTATECTOMY MULTICENTER COHORT STUDY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2018MP11-09 METABOLIC SYNDROME INCREASES THE RISK OF UPGRADING EPSTEIN 2015 GLEASON SCORE IN PATIENTS WITH PROSTATE CANCER ON BIOPSY: A RADICAL PROSTATECTOMY MULTICENTER COHORT STUDY Cosimo De Nunzio, Giuseppe Simone, Costantino Leonardo, Riccardo Mastroianni, Collura Devis, Giovanni Muto, Michele Gallucci, Riccardo Lombardo, Carlo De Dominicis, and Andrea Tubaro Cosimo De NunzioCosimo De Nunzio More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Collura DevisCollura Devis More articles by this author , Giovanni MutoGiovanni Muto More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Carlo De DominicisCarlo De Dominicis More articles by this author , and Andrea TubaroAndrea Tubaro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.375AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aim of our study was to investigate the association of metabolic syndrome (Mets) with the risk of upgrading and down grading in patients with PCA on biopsy using the new Epstein Gleason score classification in a series of men undergoing radical prostatectomy(RP). METHODS Between 2012 and 2016, 400 patients with clinically localized PCa were treated with retropubic radical prostatectomy (RRP) at three tertiary referral centres. Body mass index (BMI) and waist circumference were measured before RRP. Blood samples were collected for PSA, fasting glucose, triglycerides and HDLs. Blood pressure was recorded. All the patients underwent a 12 core trans-rectal ultrasound-guided prostate needle biopsy in the same referral center where the radical prostatectomy was performed. Biopsy specimens as well as radical prostatectomy specimens were graded according to 2015 Epstein Gleason grading system and then compared. Clinically significant upgrading was defined as: Epstein score raising from = 2 to =3 or from 3 to 5. As well clinically significant downgrading was defined as: Epstein score decreasing from =3 to = 2 or from 5 to = 3. The accuracy of the biopsy for patients with and without MetS was determined using the kappa coefficient of agreement: <0.4 poor agreement, 0.4-0.75 good agreement and > 0.75 excellent agreement. MetS was defined according to Adult Treatment Panel III (ATPIII). RESULTS Median age and preoperative PSA levels were 65 years (IQR: 60-70) and 7.4 ng/ml (IQR: 5.5-10.9), respectively. Median BMI was 26.0 kg/m2 (IQR: 24.3-28.0). On pathological evaluation 163/400 (40,8%) had locally advanced disease (=pT3a), 115/400 (28,7%) had high grade disease and 15/400 (3,8%) had nodal involvement. Overall 148/400 (37%) patients presented the MetS. Patients with MetS presented higher upgrading rates (33/148:22.3% vs 25/252:9.9%; p = 0.001) on RRP specimens when compared to patients without MetS while downgrading rates were similar (13/148 : 8.7% vs 18/252: 7.1 %; p=0.566). The kappa-statistics measures of agreement between needle biopsy and radical prostatectomy specimens was worst for patients with MetS when compared to patients without MetS (k= 0.439±0.071 vs k= 0.553±0.071). Patients with MetS also presented a significantly higher rates of pT3 disease (84/148:56.8% vs 79/252:31,3%, p=0.001) and Epstain Gleason score > 2 (61/148:41% vs 54/252, p=0.001), data confirmed on multivariate analysis (OR: 2.818; CI: 1.774-4.476, p=0.001 and OR: 3.577; CI: 2.230-5.737, p=0.001respectively) CONCLUSIONS In this multicenter radical prostatectomy cohort, MetS represents a significant risk factor for advanced disease and high grade disease. Nonetheless patients with MetS carry a higher risk of upgrading on RRP specimens. Further studies with a pathological review and reclassification of the specimens are needed to confirm our data. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e130-e131 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Cosimo De Nunzio More articles by this author Giuseppe Simone More articles by this author Costantino Leonardo More articles by this author Riccardo Mastroianni More articles by this author Collura Devis More articles by this author Giovanni Muto More articles by this author Michele Gallucci More articles by this author Riccardo Lombardo More articles by this author Carlo De Dominicis More articles by this author Andrea Tubaro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...