The Related Factors Analysis Of The Prostate Cancer Pathological Upgrading And PSA Recurrence Following Radical Prostatectomy

Objective:Needle biopsy Gleason scores often differs from the pathological examination of the prostate following radical prostatectomy.The retrospective study is held to estimate the impact of possibly related clinicopathological index on the incidence of tumor upgrading and biochemical free survival in this article. Methods:From January 2000 to October 2007,114 patients were diagnosed with prostate cancer by prostatic biopsy and underwent radical prostatectomy at our hospital.The reviewed medical records include patients' age,prostate specific antigen(PSA),prostate volume(PV)at diagnosis,PSA density(PSAD),whether or not receive the adjuvant hormornal therapy(AHT)before the operation,biopsy Gleason score,clinical stage,positive surgical margins,lymph node invasion and time to biochemical recurrence.The t-test and chi-square tests were used to compare variables among groups and the univariate and multivariate logistic regression analysis was used to determine predictors of Gleason score upgrading. 95 postoperative patients had been followed up.Biochemical recurrence(BCR)-free survival rate were estimated using the Kaplan-Meier method and the impact of various factors on it was analyzed using Cox proportional hazard regression models.Results:Median patient age was 67 years and median prostate specific antigen was 24.3 ng/ml.Median prostate volume on transrectal ultrasound was 33.1 ml.Transrectal ultrasound volume was categorized as 25 ml or less(in 25), 25 to 50 ml(in 59)and greater than 50 ml(in 11).GS at biopsy was categorized as 4-5(in 13),6(in 35),7(in 32)and 8-10(in 15).The incidence of tumor upgrading was significantly lower in patients with a large prostate volume(greater than 50 ml)compared to that in those with smaller prostate volume(≤25ml, 25-50ml)groups.The multivariate logistic regression analysis showed that PV and receiving the neoadjuvant therapy had significant negative association with the tumor upgrading(p＜0.05),while PSA was an independent indicator of tumor upgrading(p＜0.05).Cox proportion hazard model multiplicity showed that positive surgical margins,pathologica stage and the PSA level at diagnosis were independent prognosis affectoi of biochemical recurrence followed radical prostatectomy.The relative risk ratio were 6.945,3.202,1.553 respectively.Conclusion:Larger transrectal ultrasound volumes,higher GS at biopsy, receiving the neoadjuvant therapy and lower PSAD were at decreased risk for clinically significant upgrading after radical prostatectomy.This fact should be kept in urologists' minds when deciding on treatment decisions for men who diagnosed by prostate cancer on biopsy.Cox proportion hazard model multiplicity showed that lymph nodes positive surgical margins,pathologica stage and the PSA level at diagnosis were independent prognosis affectoi of biochemical recurrence followed radical prostatectomy.