Extreme Gleason Upgrading From Biopsy to Radical Prostatectomy: A Population-based Analysis

Objective To examine the risk factors associated with the odds of extreme Gleason upgrading at radical prostatectomy (RP) (defined as a Gleason prognostic group score increase of ≥2), we utilized a large, population-based cancer registry. Materials and Methods The Surveillance, Epidemiologic, and En...

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Published in:Urology (Ridgewood, N.J.) N.J.), 2016-10, Vol.96, p.148-155
Main Authors: Winters, Brian R, Wright, Jonathan L, Holt, Sarah K, Lin, Daniel W, Ellis, William J, Dalkin, Bruce L, Schade, George R
Format: Article
Language:English
Subjects:
Aged
Biopsy
Humans
Male
Middle Aged
Neoplasm Grading
Prostatectomy - methods
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
Retrospective Studies
Risk Factors
Urology
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Summary:Objective To examine the risk factors associated with the odds of extreme Gleason upgrading at radical prostatectomy (RP) (defined as a Gleason prognostic group score increase of ≥2), we utilized a large, population-based cancer registry. Materials and Methods The Surveillance, Epidemiologic, and End Results database was queried (2010-2011) for all patients diagnosed with Gleason 3 + 3 or 3 + 4 on prostate needle biopsy. Available clinicopathologic factors and the odds of upgrading and extreme upgrading at RP were evaluated using multivariate logistic regression. Results A total of 12,459 patients were identified, with a median age of 61 (interquartile range: 56-65) and a diagnostic prostate-specific antigen (PSA) of 5.5 ng/mL (interquartile range: 4.3-7.5). Upgrading was observed in 34% of men, including 44% of 7402 patients with Gleason 3 + 3 and 19% of 5057 patients with Gleason 3 + 4 disease. Age, clinical stage, diagnostic PSA, and % prostate needle biopsy cores positive were independently associated with odds of any upgrading at RP. In baseline Gleason 3 + 3 disease, extreme upgrading was observed in 6%, with increasing age, diagnostic PSA, and >50% core positivity associated with increased odds. In baseline Gleason 3 + 4 disease, extreme upgrading was observed in 4%, with diagnostic PSA and palpable disease remaining predictive. Positive surgical margins were significantly higher in patients with extreme upgrading at RP ( P  
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2016.04.058