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KMID : 1011820200610040405
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Investigative and Clinical Urology
2020 Volume.61 No. 4 p.405 ~ p.410
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Prediction of pathologic upgrading in Gleason score 3+4 prostate cancer: Who is a candidate for active surveillance?
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Pham Duc Minh
Kim Jung-Kwon
Lee Sang-Chul
Hong Sung-Kyu
Byun Seok-Soo
Lee Sang-Eun
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Abstract
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Purpose: Whether active surveillance (AS) can be safely extended to patients with Gleason score (GS) 3+4 prostate cancer is highly debated. We examined the incidence and predictors of upgrading among patients with GS 3+4 disease.
Materials and Methods: The study involved 377 patients with biopsy GS 3+4 who underwent robot-assisted laparoscopic radical prostatectomy (RP) from 2014 to 2018 at a single institution. We analyzed the rate of GS upgrading and used logistic regression to determine the predictors of upgrading.
Results: A total of 168 (44.6%) patients with GS 3+4 experienced an upgrade in GS. In multivariable analysis, advanced age, prostate-specific antigen (PSA) level, PSA density (PSAD) and Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2) score were significant predictors of GS upgrading. When structured into a predictive model that included age ≥65 years, PSA ≥7.7 ng/mL, PSAD ≥0.475 ng/mL2 and PI-RADS v2 score 4?5, the probability of GS upgrading ranged from 36.4% to 65.7% when one to four of these factors were included.
Conclusions: A substantial proportion of patients with GS 3+4 prostate cancer were upgraded after RP. However, according to our model combining clinical and imaging predictors, patients with a low risk of GS upgrading may be eligible candidates for AS.
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KEYWORD
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Pathology, Prognosis, Prostate neoplasms, Prostatectomy
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