format accepted as a poster presentation at the Southeastern Sectional Meeting of the American Urological Association in New Orleans, LA, on March 21, 2020INTRODUCTION: A proportion of prostate cancer (PCa) patients initially managed with active surveillance (AS) are upgraded to a higher Gleason score (GS) at the time of radical prostatectomy (RP). Our objective was to determine predictors of upgrading on RP specimens using a national database.
The Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting database was used to identify AS patients diagnosed with very low- or low-risk PCa who underwent delayed RP between 2010 and 2015. The primary outcome was upgrading to GS 7 disease or worse. Logistic regression analyses were used to evaluate demographic and oncological predictors of upgrading on final specimen.
A total of 3775 men underwent RP after a period of AS, 3541 (93.8%) of whom were cT2a; 792 (21.0%) patients were upgraded on RP specimen, with 85.4%, 10.6%, and 3.4% upgraded to GS 7(3+4), 7(4+3), and 8 diseases, respectively. On multivariable analysis, higher prostate-specific antigen (PSA) at diagnosis (5-10 vs. 0-2 ng/ml, odd ratio [OR] 2.59, p<0.001) and percent core involvement (80-100% vs. 0-20%, OR 2.52, p=0.003) were significant predictors of upgrading on final RP specimen, whereas higher socioeconomic status predicted lower odds of upgrading (highest vs. lowest quartile OR 0.75, p=0.013).
Higher baseline PSA and percent positive cores involvement are associated with significantly increased risk of upgrading on RP after AS, whereas higher socioeconomic status predicts lower odds of such events. These results may help identify patients at increased risk of adverse pathology on final specimen who may benefit from earlier definitive treatment.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2020 Dec 15 [Epub ahead of print]
Rashid K Sayyid, Brandon Wilson, John Z Benton, Atul Lodh, Eric F Thomas, Hanan Goldberg, Rabii Madi, Martha K Terris, Christopher J D Wallis, Zachary Klaassen
Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States., Medical College of Georgia, Augusta, GA, United States., Department of Urology, State University of New York Upstate, Syracuse, NY, United States., Department of Urology, Vanderbilt University, Nashville, TN, United States.