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Abstract
Purpose
Although biopsy Gleason score (GS) 6 prostate cancers are expected to demonstrate a more indolent clinical course than those with GS 7 or higher cancers, substantial proportion reveal upgrading or upstaging on final pathology. We investigated predictive factors of upstaging or upgrading after radical prostatectomy (RP) in biopsy GS 6 prostate cancers.
Materials and Methods
A total of 133 patients with biopsy GS 6 prostate cancer who underwent radical prostatectomy between March 2004 and March 2008 were reviewed. Patients were divided into 4 groups according to the number of positive biopsy core: single positive core (group 1, n=53), 2 (group 2, n=29), 3-5 (group 3, n=39) and 6 or more cores (group 4, n=12). We investigated the value of preoperative variables (age, PSA, Clinical stage, number and laterality of positive core, maximal core length, maximal core percentage) in predicting GS upgrading or upstaging in final pathology.
Results
Among all subjects, 70 (52.6%) were upgraded to GS 7 or higher and 29 (21.8%) were upstaged to pT3 at final pathology. Upgrading rates were 39.6%, 55.2%, 56.4% and 91.7%, and upstaging rates were 13.2%, 13.8%, 28.2% and 58.3% for groups 1, 2, 3 and 4, respectively. The upgrading and upstaging rates were similar among groups 1, 2 and 3, but were significantly higher in group 4 compared to the others. In multivariate analysis, number of positive cores 6 or more was the only factor significantly predictive of upgrading or upstaging following RP. No preoperative variables were observed to predict upgrading or upstaging following RP in patients with 5 or less positive biopsy cores.
Figures and Tables
Table 2
Preoperative characteristics of the patients with and without Gleason score upgrading on pathologic specimens
PSA: prostate-specific antigen, a: group 1 and 2 were not significantly different regarding number of positive cores. Also group 2 and 3, group 1 and 3 were not significantly different (p>0.05), b: Student's t-test, c: Pearson chi-square, d: group 1 - 1 core positive; group 2 - 2 cores positive; group 3 - 3-5 cores positive; group 4 - 6 or more cores positive
Table 3
Preoperative characteristics of the patients with and without upstaging on pathologic specimens
PSA: prostate-specific antigen, a: group 1 and 2 were not significantly different regarding number of positive cores. Also group 2 and 3, group 1 and 3 were not significantly different (p>0.05), b: Student's t-test, c: Pearson chi-square, d: group 1 - 1 core positive; group 2 - 2 cores positive; group 3 - 3-5 cores positive; group 4 - 6 or more cores positive
Table 4
Univariate and multivariate logistic regression of preoperative predictors for Gleason score upgrading after prostatectomy in patients with 5 or fewer positive biopsy cores
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