Benedikt Hoeh1,2, Rocco S Flammia2,3, Lukas Hohenhorst2,4, Gabriele Sorce2,5, Francesco Chierigo2,6, Zhe Tian2, Fred Saad2, Michele Gallucci3, Alberto Briganti5, Carlo Terrone6, Shahrokh F Shariat7,8,9,10,11,12, Markus Graefen4, Derya Tilki4,13,14, Luis A Kluth1, Philipp Mandel1, Andreas Becker1, Felix K H Chun1, Pierre I Karakiewicz2. 1. Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany. 2. Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montréal Health Center, Montréal, Canada. 3. Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy. 4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 5. Unit of Urology, Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 6. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy. 7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 8. Department of Urology, Weill Cornell Medical College, New York City, New York, USA. 9. Department of Urology, University of Texas Southwestern, Dallas, Texas, USA. 10. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. 11. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 12. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan. 13. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 14. Department of Urology, Koc University Hospital, Istanbul, Turkey.
Abstract
BACKGROUND: The pathological stage of prostate cancer with high-risk prostate-specific antigen (PSA) levels, but otherwise favorable and/or intermediate risk characteristics (clinical T-stage, Gleason Grade group at biopsy [B-GGG]) is unknown. We hypothesized that a considerable proportion of such patients will exhibit clinically meaningful GGG upgrading or non-organ confined (NOC) stage at radical prostatectomy (RP). MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2010-2015) we identified RP-patients with cT1c-stage and B-GGG1, B-GGG2, or B-GGG3 and PSA 20-50 ng/ml. Rates of GGG4 or GGG5 and/or rates of NOC stage (≥ pT3 and/or pN1) were analyzed. Subsequently, separate univariable and multivariable logistic regression models tested for predictors of NOC stage and upgrading at RP. RESULTS: Of 486 assessable patients, 134 (28%) exhibited B-GGG1, 209 (43%) B-GGG2, and 143 (29%) B-GGG3, respectively. The overall upgrading and NOC rates were 11% and 51% for a combined rate of upgrading and/or NOC stage of 53%. In multivariable logistic regression models predicting upgrading, only B-GGG3 was an independent predictor (odds ratio [OR]: 5.29; 95% confidence interval [CI]: 2.21-14.19; p < 0.001). Conversely, 33%-66% (OR: 2.36; 95% CI: 1.42-3.95; p = 0.001) and >66% of positive biopsy cores (OR: 4.85; 95% CI: 2.84-8.42; p < 0.001), as well as B-GGG2 and B-GGG3 were independent predictors for NOC stage (all p ≤ 0.001). CONCLUSIONS: In cT1c-stage patients with high-risk PSA baseline, but low- to intermediate risk B-GGG, the rate of upgrading to GGG4 or GGG5 is low (11%). However, NOC stage is found in the majority (51%) and can be independently predicted with percentage of positive cores at biopsy and B-GGG.
BACKGROUND: The pathological stage of prostate cancer with high-risk prostate-specific antigen (PSA) levels, but otherwise favorable and/or intermediate risk characteristics (clinical T-stage, Gleason Grade group at biopsy [B-GGG]) is unknown. We hypothesized that a considerable proportion of such patients will exhibit clinically meaningful GGG upgrading or non-organ confined (NOC) stage at radical prostatectomy (RP). MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2010-2015) we identified RP-patients with cT1c-stage and B-GGG1, B-GGG2, or B-GGG3 and PSA 20-50 ng/ml. Rates of GGG4 or GGG5 and/or rates of NOC stage (≥ pT3 and/or pN1) were analyzed. Subsequently, separate univariable and multivariable logistic regression models tested for predictors of NOC stage and upgrading at RP. RESULTS: Of 486 assessable patients, 134 (28%) exhibited B-GGG1, 209 (43%) B-GGG2, and 143 (29%) B-GGG3, respectively. The overall upgrading and NOC rates were 11% and 51% for a combined rate of upgrading and/or NOC stage of 53%. In multivariable logistic regression models predicting upgrading, only B-GGG3 was an independent predictor (odds ratio [OR]: 5.29; 95% confidence interval [CI]: 2.21-14.19; p < 0.001). Conversely, 33%-66% (OR: 2.36; 95% CI: 1.42-3.95; p = 0.001) and >66% of positive biopsy cores (OR: 4.85; 95% CI: 2.84-8.42; p < 0.001), as well as B-GGG2 and B-GGG3 were independent predictors for NOC stage (all p ≤ 0.001). CONCLUSIONS: In cT1c-stage patients with high-risk PSA baseline, but low- to intermediate risk B-GGG, the rate of upgrading to GGG4 or GGG5 is low (11%). However, NOC stage is found in the majority (51%) and can be independently predicted with percentage of positive cores at biopsy and B-GGG.
Authors: Rocco S Flammia; Benedikt Hoeh; Gabriele Sorce; Francesco Chierigo; Lukas Hohenhorst; Zhen Tian; Jordan A Goyal; Costantino Leonardo; Alberto Briganti; Markus Graefen; Carlo Terrone; Fred Saad; Shahrokh F Shariat; Francesco Montorsi; Felix K H Chun; Michele Gallucci; Pierre I Karakiewicz Journal: Prostate Date: 2022-04-11 Impact factor: 4.012