To examine the association between NCCN risk, number of positive biopsy cores, age, and early confirmatory test results on pathologic upgrading at prostatectomy; in order to better understand whether early confirmatory testing and better risk stratification is necessary for all men with Grade Group (GG) 1 cancers who are considering active surveillance.
We identified men in Michigan initially diagnosed with GG1 prostate cancer from 01/2012-11/2017 who had a prostatectomy within 1 year of diagnosis. Our endpoints were: 1) ≥GG2 cancer at RP; and 2) adverse pathology (≥GG3 and/or ≥pT3a). We compared upgrading according to NCCN risk, number of positive biopsy cores, and age. Last, we examined if confirmatory test results were associated with upgrading or adverse pathology at RP.
Among 1,966 patients with GG1 cancer at diagnosis, the rates of upgrading to ≥GG2 and adverse pathology were 40% and 59% (p<0.001), and 10% and 17% (p=0.003), for patients with very-low and low-risk cancers, respectively. Upgrading by volume ranged from 49%-67% for ≥GG2, and 16%-23% for adverse pathology. Generally, more patients ≥70 vs. <70 had adverse pathology. Non-reassuring confirmatory test results had a higher likelihood of adverse pathology than reassuring tests (35% vs. 18%, p=0.017).
Upgrading and adverse pathology is common among patients initially diagnosed with GG1 prostate cancer. Early use of confirmatory testing may facilitate the identification of patients with more aggressive disease ensuring improved risk classification and safer selection of patients for surveillance. This article is protected by copyright. All rights reserved.
BJU international. 2018 Sep 24 [Epub ahead of print]
Deborah R Kaye, Ji Qi, Todd M Morgan, Susan Linsell, Kevin B Ginsburg, Brian R Lane, James E Montie, Michael L Cher, David C Miller, Michigan Urological Surgery Improvement Collaborative
Dow Division of Health Services Research Department of Urology, University of Michigan, Ann Arbor, MI., Department of Urology, University of Michigan, Ann Arbor, MI., Department of Urology, Wayne State University, Detroit, MI., Spectrum Health Urology, Grand Rapids, MI.