Predictors of Gleason Grading Group Upgrading in Low-Risk Prostate Cancer Patients From Transperineal Biopsy After Radical Prostatectomy

Abstract

Rational and ObjectivesTo investigate the predictors of Gleason Grading Group (GGG) upgrading in low-risk prostate cancer (PC) (Gleason score=3+3) from transperineal biopsy after radical prostatectomy (RP). Materials and MethodsThe clinical data of 160 patients who underwent transperineal biopsy and RP from January 2017 to December 2022 were retrospectively analyzed. First, univariate and multivariate logistic regression analysis were used to obtain independent predictors of postoperative GGG upgrading. Then receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of predictors. Finally, Linear-by-Linear Association test was used to analyze the risk trends of patients in different predictor groups in the postoperative GGG. ResultsIn this study, there were 81 cases (50.6%) in the GGG concordance group and 79 cases (49.4%) in the GGG upgrading group. Univariate analysis showed age, f/tPSA, proportion of positive biopsies, positive target of magnetic-resonance imaging (MRI) and positive target of contrast-enhanced ultrasound had significant effects on GGG upgrading (all P<0.05). In multivariate logistic regression analysis, age (OR=1.066, 95%CI=1.007~1.127, P=0.027), f/tPSA (OR=0.001, 95%CI=0~0.146, P=0.001) and positive target of MRI (OR=3.005, 95%CI=1.353~76.674, P=0.007) were independent predictors. The prediction model (AUC=0.751 P<0.001)) had higher predictive efficacy than all independent predictors. The proportion of patients in exposed group of different GGG increased with the level of GGG, but decreased in non-exposed group, and the linear trend was significantly different (all P<0.001). ConclusionAge, f/tPSA and positive target of MRI were independent predictors of postoperative GGG upgrading. The predictive model constructed had the best diagnostic efficacy.