Yuta Takeshima1, Yuta Yamada2, Taro Teshima3, Tetsuya Fujimura4, Shigenori Kakutani5, Yuji Hakozaki3, Naoki Kimura3, Yoshiyuki Akiyama3, Yusuke Sato3, Taketo Kawai3, Daisuke Yamada3, Haruki Kume3. 1. Division of Innovative Cancer Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Minato-Ku, Tokyo, Japan. 2. Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan. yyamada2029@gmail.com. 3. Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan. 4. Department of Urology, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan. 5. Department of Urology, Chiba Tokushukai Hospital, Funabashi-shi, Chiba, Japan.
Abstract
BACKGROUND: The objective of this study is to investigate the clinical significance and risk factors of upgrading in the International Society of Urological Pathology (ISUP) Grade Group System in men undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer. METHODS: A total of 583 patients diagnosed with prostate cancer by systematic biopsy were treated with RARP without neoadjuvant therapy from November 2011 to December 2018. Clinicopathological data were obtained from our clinical records. ISUP grade upgrading (IGU) was defined as 'ISUP grade in prostatectomy specimen determined to be higher than that in the biopsy specimen'. Clinicopathological factors, including age, PSA, prostate volume at biopsy (PV), PSA density, clinical stage, body mass index (BMI), interval from biopsy to prostatectomy, maximum percentage of cancer involvement per core (%CI), total number of biopsy cores, percentage of cancer positive biopsy cores (%PC), and sampling density were analyzed to detect potential risk factors of IGU. Biochemical recurrence (BCR) rates were calculated to analyze the effect of IGU on cancer prognosis. RESULTS: In univariate analysis, BMI was a positive predictor of IGU, while %CI, %PC, and sampling density were negative predictors of IGU. BMI and %PC were statistically significant predictors of IGU in multivariate analysis. For cases diagnosed as ISUP grade group 2 or higher at biopsy, there was a significant difference in BCR rates between cases with and without IGU. CONCLUSIONS: The results from our cohort showed that elements of both high-grade cancer risk (such as BMI) and sampling efficiency (such as %PC) contribute to IGU. Excluding cases diagnosed as ISUP grade group 1 at biopsy, BCR-free rates were significantly worse in cases with IGU, highlighting the need for more accurate pathological diagnosis at biopsy.
BACKGROUND: The objective of this study is to investigate the clinical significance and risk factors of upgrading in the International Society of Urological Pathology (ISUP) Grade Group System in men undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer. METHODS: A total of 583 patients diagnosed with prostate cancer by systematic biopsy were treated with RARP without neoadjuvant therapy from November 2011 to December 2018. Clinicopathological data were obtained from our clinical records. ISUP grade upgrading (IGU) was defined as 'ISUP grade in prostatectomy specimen determined to be higher than that in the biopsy specimen'. Clinicopathological factors, including age, PSA, prostate volume at biopsy (PV), PSA density, clinical stage, body mass index (BMI), interval from biopsy to prostatectomy, maximum percentage of cancer involvement per core (%CI), total number of biopsy cores, percentage of cancer positive biopsy cores (%PC), and sampling density were analyzed to detect potential risk factors of IGU. Biochemical recurrence (BCR) rates were calculated to analyze the effect of IGU on cancer prognosis. RESULTS: In univariate analysis, BMI was a positive predictor of IGU, while %CI, %PC, and sampling density were negative predictors of IGU. BMI and %PC were statistically significant predictors of IGU in multivariate analysis. For cases diagnosed as ISUP grade group 2 or higher at biopsy, there was a significant difference in BCR rates between cases with and without IGU. CONCLUSIONS: The results from our cohort showed that elements of both high-grade cancer risk (such as BMI) and sampling efficiency (such as %PC) contribute to IGU. Excluding cases diagnosed as ISUP grade group 1 at biopsy, BCR-free rates were significantly worse in cases with IGU, highlighting the need for more accurate pathological diagnosis at biopsy.
Authors: Judson D Davies; Monty A Aghazadeh; Sharon Phillips; Shady Salem; Sam S Chang; Peter E Clark; Michael S Cookson; Rodney Davis; S Duke Herrell; David F Penson; Joseph A Smith; Daniel A Barocas Journal: J Urol Date: 2011-10-19 Impact factor: 7.450
Authors: Niall M Corcoran; Matthew K H Hong; Rowan G Casey; Antonio Hurtado-Coll; Justin Peters; Laurence Harewood; S Larry Goldenberg; Chris M Hovens; Anthony J Costello; Martin E Gleave Journal: BJU Int Date: 2011-03-28 Impact factor: 5.588
Authors: Won Sik Jang; Dong Hoon Koh; Jongchan Kim; Jong Soo Lee; Doo Yong Chung; Won Sik Ham; Koon Ho Rha; Young Deuk Choi Journal: Prostate Date: 2019-09-04 Impact factor: 4.104
Authors: A V D'Amico; R Whittington; S B Malkowicz; D Schultz; K Blank; G A Broderick; J E Tomaszewski; A A Renshaw; I Kaplan; C J Beard; A Wein Journal: JAMA Date: 1998-09-16 Impact factor: 56.272
Authors: Daniel M Berney; Luis Beltran; Gabrielle Fisher; Bernard V North; David Greenberg; Henrik Møller; Geraldine Soosay; Peter Scardino; Jack Cuzick Journal: Br J Cancer Date: 2016-04-21 Impact factor: 7.640