Grade and stage misclassification in intermediate unfavorable-risk prostate cancer radiotherapy candidates
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Grade and stage misclassification in intermediate unfavorable-risk prostate cancer radiotherapy candidates. / Sorce, Gabriele; Flammia, Rocco Simone; Hoeh, Benedikt; Chierigo, Francesco; Hohenhorst, Lukas; Panunzio, Andrea; Stabile, Armando; Gandaglia, Giorgio; Tian, Zhe; Tilki, Derya; Terrone, Carlo; Gallucci, Michele; Chun, Felix K H; Antonelli, Alessandro; Saad, Fred; Shariat, Shahrokh F; Montorsi, Francesco; Briganti, Alberto; Karakiewicz, Pierre I.
in: PROSTATE, Jahrgang 82, Nr. 10, 06.2022, S. 1040-1050.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Grade and stage misclassification in intermediate unfavorable-risk prostate cancer radiotherapy candidates
AU - Sorce, Gabriele
AU - Flammia, Rocco Simone
AU - Hoeh, Benedikt
AU - Chierigo, Francesco
AU - Hohenhorst, Lukas
AU - Panunzio, Andrea
AU - Stabile, Armando
AU - Gandaglia, Giorgio
AU - Tian, Zhe
AU - Tilki, Derya
AU - Terrone, Carlo
AU - Gallucci, Michele
AU - Chun, Felix K H
AU - Antonelli, Alessandro
AU - Saad, Fred
AU - Shariat, Shahrokh F
AU - Montorsi, Francesco
AU - Briganti, Alberto
AU - Karakiewicz, Pierre I
N1 - © 2022 The Authors. The Prostate published by Wiley Periodicals LLC.
PY - 2022/6
Y1 - 2022/6
N2 - BACKGROUND: We tested for upgrading (Gleason grade group [GGG] ≥ 4) and/or upstaging to non-organ-confined stage ([NOC] ≥ pT3/pN1) in intermediate unfavorable-risk (IU) prostate cancer (PCa) patients treated with radical prostatectomy, since both change the considerations for dose and/or type of radiotherapy (RT) and duration of androgen deprivation therapy (ADT).METHODS: We relied on Surveillance, Epidemiology, and End Results (2010-2015). Proportions of (a) upgrading, (b) upstaging, or (c) upgrading and/or upstaging were tabulated and tested in multivariable logistic regression models.RESULTS: We identified 7269 IU PCa patients. Upgrading was recorded in 479 (6.6%) and upstaging in 2398 (33.0%), for a total of 2616 (36.0%) upgraded and/or upstaged patients, who no longer fulfilled the IU grade and stage definition. Prostate-specific antigen, clinical stage, biopsy GGG, and percentage of positive cores, neither individually nor in multivariable logistic regression models, discriminated between upgraded and/or upstaged patients versus others.CONCLUSIONS: IU PCa patients showed very high (36%) upgrading and/or upstaging proportion. Interestingly, the overwhelming majority of those were upstaged to NOC. Conversely, very few were upgraded to GGG ≥ 4. In consequence, more than one-third of IU PCa patients treated with RT may be exposed to suboptimal dose and/or type of RT and to insufficient duration of ADT, since their true grade and stage corresponded to high-risk PCa definition, instead of IU PCa. Data about magnetic resonance imaging were not available but may potentially help with better stage discrimination.
AB - BACKGROUND: We tested for upgrading (Gleason grade group [GGG] ≥ 4) and/or upstaging to non-organ-confined stage ([NOC] ≥ pT3/pN1) in intermediate unfavorable-risk (IU) prostate cancer (PCa) patients treated with radical prostatectomy, since both change the considerations for dose and/or type of radiotherapy (RT) and duration of androgen deprivation therapy (ADT).METHODS: We relied on Surveillance, Epidemiology, and End Results (2010-2015). Proportions of (a) upgrading, (b) upstaging, or (c) upgrading and/or upstaging were tabulated and tested in multivariable logistic regression models.RESULTS: We identified 7269 IU PCa patients. Upgrading was recorded in 479 (6.6%) and upstaging in 2398 (33.0%), for a total of 2616 (36.0%) upgraded and/or upstaged patients, who no longer fulfilled the IU grade and stage definition. Prostate-specific antigen, clinical stage, biopsy GGG, and percentage of positive cores, neither individually nor in multivariable logistic regression models, discriminated between upgraded and/or upstaged patients versus others.CONCLUSIONS: IU PCa patients showed very high (36%) upgrading and/or upstaging proportion. Interestingly, the overwhelming majority of those were upstaged to NOC. Conversely, very few were upgraded to GGG ≥ 4. In consequence, more than one-third of IU PCa patients treated with RT may be exposed to suboptimal dose and/or type of RT and to insufficient duration of ADT, since their true grade and stage corresponded to high-risk PCa definition, instead of IU PCa. Data about magnetic resonance imaging were not available but may potentially help with better stage discrimination.
KW - Androgen Antagonists/therapeutic use
KW - Humans
KW - Male
KW - Neoplasm Grading
KW - Neoplasm Staging
KW - Prostate-Specific Antigen
KW - Prostatectomy/methods
KW - Prostatic Neoplasms/pathology
U2 - 10.1002/pros.24349
DO - 10.1002/pros.24349
M3 - SCORING: Journal article
C2 - 35365851
VL - 82
SP - 1040
EP - 1050
JO - PROSTATE
JF - PROSTATE
SN - 0270-4137
IS - 10
ER -