Investig Clin Urol.  2017 Mar;58(2):90-97. 10.4111/icu.2017.58.2.90.

Prostate-specific antigen 10–20 ng/mL: A predictor of degree of upgrading to ≥8 among patients with biopsy Gleason score 6

• Santok GD
• Abdel Raheem A
• Kim LH
• Chang K
• Lum TG
• Chung BH
• Choi YD
• Rha KH

• KMID: 2368473
• DOI: http://doi.org/10.4111/icu.2017.58.2.90

Abstract

PURPOSE
This study aimed to identify the predictors of upgrading and degree of upgrading among patients who have initial Gleason score (GS) 6 treated with robot-assisted radical prostatectomy (RARP).
MATERIALS AND METHODS
A retrospective review of the data of 359 men with an initial biopsy GS 6, localized prostate cancer who underwent RARP between July 2005 to June 2010 was performed. They were grouped into group 1 (nonupgrade) and group 2 (upgraded) based on their prostatectomy specimen GS. Logistic regression analysis of studied cases identified significant predictors of upgrading and the degree of upgrading after RARP.
RESULTS
The mean age and prostate-specific antigen (PSA) was 63±7.5 years, 8.9±8.77 ng/mL, respectively. Median follow-up was 59 months (interquartile range, 47-70 months). On multivariable analysis, age, PSA, PSA density and ≥2 cores positive were predictors of upgrading with (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06; p=0.003; OR, 1.006; 95% CI, 1.01-1.11; p=0.018; OR, 0.65; 95% CI, 0.43-0.98, p=0.04), respectively. On subanalysis, only PSA level of 10-20 ng/mL is associated with upgrading into GS ≥8. They also had lower biochemical recurrence free survival, cancer specific survival, and overall survival (p≤0.001, p=0.003, and p=0.01, respectively).
CONCLUSIONS
Gleason score 6 patients with PSA (10-20 ng/mL) have an increased risk of upgrading to pathologic GS (≥8), subsequently poorer oncological outcome thus require a stricter follow-up. These patients should be carefully counseled in making an optimal treatment decision.

Keyword

Prognosis; Prostate-specific antigen; Prostatic neoplasms; Radical prostatectomy

MeSH Terms

Biopsy*
Follow-Up Studies
Humans
Logistic Models
Male
Neoplasm Grading*
Prognosis
Prostate-Specific Antigen*
Prostatectomy
Prostatic Neoplasms
Recurrence
Retrospective Studies
Prostate-Specific Antigen