To evaluate clinical factors associated with the risk of tumour upgrading patterns in low risk prostate cancer (PCA) patients undergoing radical prostatectomy.
In a period running from January 2013 to December 2016, 245 low risk patients underwent RP. Patients were classified into three groups, which included case with pathology grade group one (no upgrading pattern), two-three (intermediate upgrading pattern), and four-five (high upgrading pattern). The association of factors with the upgrading risk was evaluated by the multinomial logistic regression model. It was used a receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis to assess the efficacy of predictors.
Overall, tumor upgrading was detected in 158 patients (67.3%). Tumour upgrading patterns were absent in 80 patients (32.7%), intermediate in 152 cases (62%) and high in 13 subjects (5.3%). Median prostate specific (PSA) levels and proportion of biopsy positive core (BPC) were higher in patients with intermediate (PSA = 6 ng/mL; BPC = 0.28) and high (PSA = 8.9 ng/mL; BPC = 0.33) than those without (PSA = 5.7 ng/mL; BPC = 0.17) and the difference was significant (PSA: p = 0.002; BPC: p = 0.001). When compared to not upgraded cases, higher BPC proportions were independent predictors of intermediate upgrading patterns (odds ratio, OR = 36.711; p < 0.0001; AUC = 0.613) while higher PSA values were independent predictors of high upgrading patterns (OR=2.033, p < 0.0001; AUC = 0.779).
PSA and BPC were both independent predictors of tumour upgrading in low risk PCA. BPC associated with the risk of intermediate tumour upgrading patterns, but showed a low discrimination power. PSA associated with high upgrading patterns and showed a fair discrimination power in the model. Tumour upgrading risk patterns should be evaluated in low risk PCA patients before treatment.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2018 Oct 03 [Epub ahead of print]
Antonio B Porcaro, Davide Inverardi, Paolo Corsi, Marco Sebben, Giovanni Cacciamani, Alessandro Tafuri, Tania Processali, Marco Pirozzi, Daniele Mattevi, Davide De Marchi, Nelia Amigoni, Riccardo Rizzetto, Maria A Cerruto, Matteo Brunelli, Salvatore Siracusano, Walter Artibani
Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy - ., Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Department of Pathology, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.