You have accessJournal of UrologyProstate Cancer: Detection and Screening VI1 Apr 2015MP77-03 GLEASON SCORE UPGRADING TO 8-10 PREDICTS BIOCHEMICAL RECURRENCE IN MEN UNDERGOING RADICAL PROSTATECTOMY: ANALYSIS ON 7310 HIGH-RISK PATIENTS FROM THE EMPACT DATABASE. Marco Oderda, Paolo Gontero, Giancarlo Marra, Rafael Sanchez-Salas, Joachen Walz, Patrick Bastian, Felix Chun, Henk Van Der Poel, Markus Graefen, Bertrand Tombal, Giansilvio Marchioro, Piotr Chlosta, Lorenzo Tosco, Marco Bianchi, Alberto Briganti, Martin Spahn, Robert Jeffrey Karnes, and Steven Joniau Marco OderdaMarco Oderda More articles by this author , Paolo GonteroPaolo Gontero More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Joachen WalzJoachen Walz More articles by this author , Patrick BastianPatrick Bastian More articles by this author , Felix ChunFelix Chun More articles by this author , Henk Van Der PoelHenk Van Der Poel More articles by this author , Markus GraefenMarkus Graefen More articles by this author , Bertrand TombalBertrand Tombal More articles by this author , Giansilvio MarchioroGiansilvio Marchioro More articles by this author , Piotr ChlostaPiotr Chlosta More articles by this author , Lorenzo ToscoLorenzo Tosco More articles by this author , Marco BianchiMarco Bianchi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Martin SpahnMartin Spahn More articles by this author , Robert Jeffrey KarnesRobert Jeffrey Karnes More articles by this author , and Steven JoniauSteven Joniau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.543AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gleason score (GS) is the single strongest prognostic factor for clinical behavior and treatment response of prostate cancer (PCa), being a predictor of the risk of biochemical recurrence (BCR) after radical prostatectomy (RP), which has been estimated up to 40%. A biopsy GS (bGS) that is upgraded at pathology (pGS) is a dangerously common finding which can lead to a suboptimal surgical treatment, in the misbelief of addressing a more indolent cancer than what actually is. The aim of this study was to evaluate the impact of GS upgrade and downgrade on the surgical outcomes and BCR-free survival in a large cohort of high-risk PCa patients. METHODS 7310 men underwent RP between 1986 and 2014 were retrospectively analyzed from the EMPaCT database and stratified as high-risk PCa according to at least: PSA ≥20 ng/ml, bGS ≥8, cT ≥3. According to GS, patients were subdivided in: A) bGS ≥8 downgraded to pGS 6-7; B) bGS and pGS 6-7; C) bGS and pGS 8- 10; D) bGS <8 upgraded to pGS 8-10. To compare groups, ANOVA and Chi-square tests were used. Kaplan-Meier curves were plotted for BCR-free survival. Univariate and multivariate logistic regression analyses were performed to test predictors of BCR. RESULTS Table 1 shows baseline characteristics and surgical outcomes. Overall, bGS 8-10 was downgraded to pGS 6-7 in 51.3% (n=1954) and bGS 6-7 was upgraded to pGS 8-10 in 11.8% (n=416). Positive margins, N+ and BCR were higher in patients with pGS 8-10, irrespectively of GS upgrade. BCR-free survival was lower in upgraded GS (figure 1) which were associated with BCR both at univariate (OR 1.49 (1.21-1.83), p<0.001) and multivariate (OR 1.05 (0.83-1.33), p 0.04) regression analyses. CONCLUSIONS Downgrading to pGS 6-7 is a common event in high-risk PCa defined as bGS 8-10 and RP should be strongly considered in these patients. Upgrade from bGS 6-7 to pGS 8-10 is a rare event, which is associated with increased risk of BCR, pointing to a more careful follow-up for these patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e992-e993 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Oderda More articles by this author Paolo Gontero More articles by this author Giancarlo Marra More articles by this author Rafael Sanchez-Salas More articles by this author Joachen Walz More articles by this author Patrick Bastian More articles by this author Felix Chun More articles by this author Henk Van Der Poel More articles by this author Markus Graefen More articles by this author Bertrand Tombal More articles by this author Giansilvio Marchioro More articles by this author Piotr Chlosta More articles by this author Lorenzo Tosco More articles by this author Marco Bianchi More articles by this author Alberto Briganti More articles by this author Martin Spahn More articles by this author Robert Jeffrey Karnes More articles by this author Steven Joniau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...