PURPOSE: Approximately one-third of prostate cancer (PCa) cases with a Gleason score of 6 are upgraded at the time of radical prostatectomy (RP).
Our objective was to study trends and predictors of upgrading and upstaging among men with Gleason 6 PCa who are potential candidates for active surveillance in a population-based cohort.
MATERIALS AND METHODS: In 2007-2011, 13,159 men were diagnosed with Gleason 6, clinical stage T1c/T2 PCa in the National Prostate Cancer Register (NPCR) of Sweden. Of these men, 4,500 underwent RP, including 2,205 with data on extent of PCa in the biopsy cores. Logistic regression was used to examine variables associated with adverse pathology (defined as upgrading to Gleason ≥7 or upstaging to ≥pT3) in the full group and in potential candidates for active surveillance using 6 current published protocols.
RESULTS: Among Swedish men with clinically localized Gleason 6 PCa, ~50% had adverse pathology at RP. Of men who met inclusion criteria in 6 different active surveillance protocols, adverse pathology was present in 33- 45%. Predictors of adverse pathology were older age, higher PSA, PSA density >0.15 ng/mL/cm3, palpable disease, and extent of cancer >4 mm on biopsy. Larger prostate volume had an inverse relationship with adverse pathology.
CONCLUSIONS: More than 1/3 of men meeting the most stringent active surveillance criteria had adverse pathology at RP in this population-based population. Active surveillance programs should consider PSA density and extent of cancer on biopsy for patient selection.
Written by:
Vellekoop A, Loeb S, Folkvaljon Y, Stattin P. Are you the author?
Department of Urology, New York University and Manhattan Veterans Affairs Medical Center, NY, USA.
Reference: J Urol. 2013 Sep 23. pii: S0022-5347(13)05475-X.
doi: 10.1016/j.juro.2013.09.034
PubMed Abstract
PMID: 24071481
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