Non-organ confined stage and upgrading rates in exclusive PSA high-risk prostate cancer patients
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Non-organ confined stage and upgrading rates in exclusive PSA high-risk prostate cancer patients. / Hoeh, Benedikt; Flammia, Rocco S; Hohenhorst, Lukas; Sorce, Gabriele; Chierigo, Francesco; Tian, Zhe; Saad, Fred; Gallucci, Michele; Briganti, Alberto; Terrone, Carlo; Shariat, Shahrokh F; Graefen, Markus; Tilki, Derya; Kluth, Luis A; Mandel, Philipp; Becker, Andreas; Chun, Felix K H; Karakiewicz, Pierre I.
in: PROSTATE, Jahrgang 82, Nr. 6, 05.2022, S. 687-694.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Non-organ confined stage and upgrading rates in exclusive PSA high-risk prostate cancer patients
AU - Hoeh, Benedikt
AU - Flammia, Rocco S
AU - Hohenhorst, Lukas
AU - Sorce, Gabriele
AU - Chierigo, Francesco
AU - Tian, Zhe
AU - Saad, Fred
AU - Gallucci, Michele
AU - Briganti, Alberto
AU - Terrone, Carlo
AU - Shariat, Shahrokh F
AU - Graefen, Markus
AU - Tilki, Derya
AU - Kluth, Luis A
AU - Mandel, Philipp
AU - Becker, Andreas
AU - Chun, Felix K H
AU - Karakiewicz, Pierre I
N1 - © 2022 The Authors. The Prostate published by Wiley Periodicals LLC.
PY - 2022/5
Y1 - 2022/5
N2 - BACKGROUND: The pathological stage of prostate cancer with high-risk prostate-specific antigen (PSA) levels, but otherwise favorable and/or intermediate risk characteristics (clinical T-stage, Gleason Grade group at biopsy [B-GGG]) is unknown. We hypothesized that a considerable proportion of such patients will exhibit clinically meaningful GGG upgrading or non-organ confined (NOC) stage at radical prostatectomy (RP).MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2010-2015) we identified RP-patients with cT1c-stage and B-GGG1, B-GGG2, or B-GGG3 and PSA 20-50 ng/ml. Rates of GGG4 or GGG5 and/or rates of NOC stage (≥ pT3 and/or pN1) were analyzed. Subsequently, separate univariable and multivariable logistic regression models tested for predictors of NOC stage and upgrading at RP.RESULTS: Of 486 assessable patients, 134 (28%) exhibited B-GGG1, 209 (43%) B-GGG2, and 143 (29%) B-GGG3, respectively. The overall upgrading and NOC rates were 11% and 51% for a combined rate of upgrading and/or NOC stage of 53%. In multivariable logistic regression models predicting upgrading, only B-GGG3 was an independent predictor (odds ratio [OR]: 5.29; 95% confidence interval [CI]: 2.21-14.19; p < 0.001). Conversely, 33%-66% (OR: 2.36; 95% CI: 1.42-3.95; p = 0.001) and >66% of positive biopsy cores (OR: 4.85; 95% CI: 2.84-8.42; p < 0.001), as well as B-GGG2 and B-GGG3 were independent predictors for NOC stage (all p ≤ 0.001).CONCLUSIONS: In cT1c-stage patients with high-risk PSA baseline, but low- to intermediate risk B-GGG, the rate of upgrading to GGG4 or GGG5 is low (11%). However, NOC stage is found in the majority (51%) and can be independently predicted with percentage of positive cores at biopsy and B-GGG.
AB - BACKGROUND: The pathological stage of prostate cancer with high-risk prostate-specific antigen (PSA) levels, but otherwise favorable and/or intermediate risk characteristics (clinical T-stage, Gleason Grade group at biopsy [B-GGG]) is unknown. We hypothesized that a considerable proportion of such patients will exhibit clinically meaningful GGG upgrading or non-organ confined (NOC) stage at radical prostatectomy (RP).MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2010-2015) we identified RP-patients with cT1c-stage and B-GGG1, B-GGG2, or B-GGG3 and PSA 20-50 ng/ml. Rates of GGG4 or GGG5 and/or rates of NOC stage (≥ pT3 and/or pN1) were analyzed. Subsequently, separate univariable and multivariable logistic regression models tested for predictors of NOC stage and upgrading at RP.RESULTS: Of 486 assessable patients, 134 (28%) exhibited B-GGG1, 209 (43%) B-GGG2, and 143 (29%) B-GGG3, respectively. The overall upgrading and NOC rates were 11% and 51% for a combined rate of upgrading and/or NOC stage of 53%. In multivariable logistic regression models predicting upgrading, only B-GGG3 was an independent predictor (odds ratio [OR]: 5.29; 95% confidence interval [CI]: 2.21-14.19; p < 0.001). Conversely, 33%-66% (OR: 2.36; 95% CI: 1.42-3.95; p = 0.001) and >66% of positive biopsy cores (OR: 4.85; 95% CI: 2.84-8.42; p < 0.001), as well as B-GGG2 and B-GGG3 were independent predictors for NOC stage (all p ≤ 0.001).CONCLUSIONS: In cT1c-stage patients with high-risk PSA baseline, but low- to intermediate risk B-GGG, the rate of upgrading to GGG4 or GGG5 is low (11%). However, NOC stage is found in the majority (51%) and can be independently predicted with percentage of positive cores at biopsy and B-GGG.
KW - Humans
KW - Male
KW - Neoplasm Grading
KW - Neoplasm Staging
KW - Prostate/pathology
KW - Prostate-Specific Antigen
KW - Prostatectomy/methods
KW - Prostatic Neoplasms/pathology
U2 - 10.1002/pros.24313
DO - 10.1002/pros.24313
M3 - SCORING: Journal article
C2 - 35188982
VL - 82
SP - 687
EP - 694
JO - PROSTATE
JF - PROSTATE
SN - 0270-4137
IS - 6
ER -
