PROGNOSTIC FACTORS OF UPSTAGING, UPGRADING AND ADVERSE PATHOLOGICAL FEATURES IN FAVOURABLE GS 3+4

Giorgio Napodano1, Tommaso Realfonso1, Antonio Campitelli1, Olivier Intilla1, Umberto Di Mauro1, Giovanni Molisso1, Antonio Pistone1, Roberto Sanseverino1
  • 1 Ospedale Umberto I - ASL Salerno, U.O.C. Urologia (Nocera Inferiore)

Objective

Active surveillance (AS) is a valid option for the treatment of low risk prostate cancer. Whether or not AS could be offered also to patients with intermediate risk prostate cancer is a debated issue. Some AS protocols included selected patients (older) with Gleason score 3+4. In our study we evaluated the risk of upgrading and upstaging and predictive factors of adverse disease in patients with favourable Gleason score 3+4 and identified prognostic factors.

Materials and Methods

From database of our institution, we identified patients with favourable GS 3+4 (PSA ≤10 ng/ml, cT1c-T2a) undergone a laparoscopic pelvic lymphadenectomy (LAD) and radical prostatectomy; data on age, BMI, PSA, PSAD, positive cores percentage, clinical stage, Gleason score, lymphadenectomy template, prostate volume, number of removed nodes were available. We correlated these variables with upstaging (≥pT3), upgrading (≥GS4+3) and adverse pathological outcomes (non-organ confined disease or ≥GS4+3 or pN1) by logistic regression analysis (SPSS 24).

Results

Baseline characteristics of the 82 patients with favourable Gleason score 3+4 PCa are reported in table 1. Surgical and pathological outcomes are reported in table 2. Upstaging to ≥pT3 occurred in 9.7% of patients; no variables were associated to upstaging (table 3). Upgrading occurred in 24.4% of patients; PSA was the only factor associated to upgrading [OR 2.12, p 0.04] (tables 4A and 4B). Adverse pathological outcomes (non organ confined disease or primary GS4 or pN1) occurred in 31.7% of patients; PSA correlated with adverse pathological outcomes [OR 2.87, p 0.01] (tables 5A and 5B). Downgrading occurred in about 5% of patients.

Discussions

Active surveillance (AS) is a valid option for the treatment of low risk prostate cancer. Whether or not AS could be offered also to patients with intermediate risk prostate cancer is a debated issue. Some AS protocols included selected patients (older) with Gleason score 3+4. NCCN guidelines have considered AS as option for patients with favourable intermediate risk PCa (GS3+4, PSA ≤10 ng/ml, positive cores <50%). We have evaluated rates of upstaging, upgrading and adverse pathology in favourable intermediate risk patients undergone to laparoscopic RP. Upstaging, upgrading and adverse pathology occurred in 9.7%, 24.4% and 31.7%, respectively. Among all variables considered, PSA was the only factor associated to upgrading and adverse pathology.

Conclusion

In patients with favourable Gleason score 3+4, upstaging, upgrading and adverse pathological outcomes occurred in 10%, 24% and 32% of the patients. PSA was the only factor associated to upgrading and adverse pathological features.

Reference

Transl Androl Urol 2015; 4 (3): 342-54

Plos One 2014; 9 (9):
Urol Oncol 2015; 33: 7121-9

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