MP97-08 PREDICTION OF EXTREME UPGRADE FROM BIOPSY GRADE 1 TO GRADE 4 OR 5 AT RADICAL PROSTATECTOMY: THE IMPORTANCE OF THE EXTENT OF BIOPSY SAMPLING

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VIII1 Apr 2017MP97-08 PREDICTION OF EXTREME UPGRADE FROM BIOPSY GRADE 1 TO GRADE 4 OR 5 AT RADICAL PROSTATECTOMY: THE IMPORTANCE OF THE EXTENT OF BIOPSY SAMPLING Emanuele Zaffuto, Giorgio Gandaglia, Marco Bandini, Paolo Dell'Oglio, Nicola Fossati, Francesco Pellegrino, Vincenzo Mirone, Vito Cucchiara, Marco Bianchi, Federico Dehó, Emanuele Montanari, Nazareno Suardi, Rodolfo Montironi, Francesco Montorsi, and Alberto Briganti Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Marco BandiniMarco Bandini More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Marco BianchiMarco Bianchi More articles by this author , Federico DehóFederico Dehó More articles by this author , Emanuele MontanariEmanuele Montanari More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Rodolfo MontironiRodolfo Montironi More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3052AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gleason grading is an important predictor of oncologic outcomes in prostate cancer (PCa) patients. However, some patients with biopsy grade 1 disease might experience extreme upgrading to grade group 4-5 at radical prostatectomy (RP). We identified predictors of extreme upgrading in men treated at a single referral center METHODS We identified 1,718 patients diagnosed with biopsy grade group 1 PCa, clinical stage T1/T2, at a single center between 1991 and 2015 and treated with RP. Extreme upgrading was defined as switching to grade 4 or 5 at final pathology. Patients were stratified according to presence of extreme upgrading. Uni- and multivariable logistic regression analyses (MVA) assessed the relationship between clinical and preoperative characteristics and the risk of extreme upgrading. Finally, 146 individuals diagnosed with biopsy grade 4-5 PCa and clinical T1 or T2 disease were abstracted from the database and compared with patients who experienced extreme upgrading at RP. Cox regression analyses evaluated differences in biochemical recurrence (BCR) rates according to grade group 1 vs. grade 4-5 PCa at biopsy after adjusting for confounders RESULTS 46 individuals (2.7%) were diagnosed with grade 4-5 PCa after RP. These patients were older compared to those who did not experience extreme upgrading (p<0.01) and had a significantly higher PSA at diagnosis (7.6 vs. 6.2 mg/dL; p=0.03). A lower number of cores were taken during biopsy for patients who experienced extreme upgrading at RP (12 vs 14; p<0.01). At MVA, age (OR: 1.05; p=0.03), PSA (OR: 1.04; p<0.001) and the number of cores taken (OR: 0.92; p=0.01) were independent predictors of extreme upgrading. The MVA model was used to plot predicted probability of extreme upgrading at RP according to the number of cores taken (Fig. 1). When comparing patients who experienced extreme upgrading with 146 individuals diagnosed with biopsy grade 4-5 PCa, those diagnosed with biopsy grade 1 were at lower risk of BCR (HR: 0.52; p=0.02) CONCLUSIONS An adequate biopsy sampling reduces the risk of underestimation of high-risk PCa. Patients with grade 1 PCa experience better outcomes compared to those diagnosed with more aggressive disease at biopsy. These considerations are of pivotal importance for more accurate risk stratification © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1306 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Emanuele Zaffuto More articles by this author Giorgio Gandaglia More articles by this author Marco Bandini More articles by this author Paolo Dell'Oglio More articles by this author Nicola Fossati More articles by this author Francesco Pellegrino More articles by this author Vincenzo Mirone More articles by this author Vito Cucchiara More articles by this author Marco Bianchi More articles by this author Federico Dehó More articles by this author Emanuele Montanari More articles by this author Nazareno Suardi More articles by this author Rodolfo Montironi More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...