Predictors Of Upgraded And Upstaged Prostate Cancer In Patients With Gleason Score≤7 At Biopsy

Objective:Retrospectively analyzed the 16-year clinical data and pathologic parameters postoperatively in prostate cancer patients with Gleason score≤7 at biopsy, with the experience of Urology Department of Shandong Provincial Hospital, to discover the independent risk factors of upstaging and upgrading,evaluate the true progression of initial disease by comparison of GS at biopsy and post-operative pathologic results and to treat the disease in advance.Materials and Methods:The retrospective study included data of a total of 105 patients received surgical treatment (Retro-pubic Radical Prostatectomy or Laparoscopic Radical Prostatectomy) and diagnosed as prostate cancer postoperatively, from January 1999 to December 2015. All the patients got GS≤7 at biopsy. Statistics in all cases related to general characteristics, preoperative blood data, biopsy parameters, imaging and postoperative pathologic parameters were be performed and statistical analysis was used to assess the independent risk factors of upstaging and upgrading.Results:In all patients, mean age:69.3 years (44-85), including the< 60 years old:15 cases, 60-69 years old:37 cases,70-80 years old:45 cases,> 80 years old:8 cases; The patients of age between 60 and 80 years old accounted for 78.1% of all cases. Patients with hypertension:10 cases (9.5%), smokers:13 cases (12.4%), drinkers:12 cases (11.4%).The rate of upstaging and upgrading was 27.6%(29) and 42.8%(45) respectively by comparison of biopsy data and postoperative pathologic parameters. The relationship between general characteristics of patients and upstaging:In the univariate analysis, age (P= 0.955), BMI (P= 0.079), smoking (P= 0.504), drinking (P= 1.000) and hypertension (P= 0.458) were not related to upstaging statistically,all P values> 0.05.The relationship between laboratory results and upstaging:TPSA and PS AD were related to upstaging statistically in the univariate analysis, all P values< 0.05.While prostate volume、FPSA and F/T were not related to upstaging statistically, all P values> 0.05.The relationship between biopsy results and upstaging:positive numbers(P=0.373)、percent of positive numbers (P=0.703) and clinical stage (P=0.064) were not related to upstaging statistically. In conclusion, TPSA and PSAD were the significant factors in the univariate analysis related to upstaging. The relationship between general characteristics of patients and upgrading: In the univariate analysis, age (P= 0.160), BMI (P= 0.323),smoking (P= 0.345), drinking (P= 0.551) and hypertension (P= 0.160) were not related to upgrading statistically,all P values> 0.05.The relationship between laboratory results and upgrading:TPSA and PSAD were related to upgrading statistically in the univariate analysis(P values= 0.004、0.001).While prostate volume、FPSA and F/T were not related to upgrading statistically, all P values> 0.05.The relationship between biopsy results and upgrading:positive numbers(P=0.003)、percent of positive numbers (P=0.003)and clinical stage (P=0.012)were related to upstaging statistically.In conclusion, TPSA、PSAD、positive numbers、percent of positive numbers and clinical stage were the significant factors in the univariate analysis related to upgrading. In multivariate analysis, we did not find the independent risk factors of upstaging due to P values of TPSA and PS AD>0.05. In multivariate analysis of upgrading, we found the independent risk factors of upgrading were percent of positive numbers and clinical stage. P values of TPSA、PSAD and positive numbers were all>0.05. In conclusion, we found the independent risk factors of upgrading were percent of positive numbers and clinical stage. The ROC figure of percent of positive numbers showed its ROC was 0.755>0.5, which shows diagnostic significance. We found the best cut-off value of percent of positive numbers was 29.17%, which meant Pca patients (GS≤7) with percent of positive numbers> 29.17% were ease to upgrade.Conclusion:Pca patients(GS≤7) with percent of positive numbers≥29.17% were ease to upgrade. When we choose the therapeutic methods, we should be cautious with respect to PSA and imaging result to prefer active surveillance (especially to the low-risk Pca to exclude the possibility of more progressive disease, re-biopsy or biopsy guided by MRI if necessary). We should tell the patients the risk of upgrading and then choose whether to active therapy.