Original Article
Predictive risk factors for Gleason score upgrading of low-risk prostate cancer
Cheng Wanli, Pang Cheng, Song Xinda, Fu Chunlong, Hou Hunmin, Zhou Liqun, Ma Lulin, Gao Xu, He Dalin, Wang Jianye, Liu Ming
Published 2020-09-14
Cite as Chin J Geriatr, 2020,39(09): 1059-1062. DOI: 10.3760/cma.j.issn.0254-9026.2020.09.016
Abstract
ObjectiveTo investigate the risk factors for Gleason score upgrading after radical prostatectomy in clinical low-risk prostate cancer patients aged≥65 years.
MethodsA total of 485 clinical low-risk prostate cancer patients aged≥65 years at five centers of the national multi-center PC-follow database from January 2015 to March 2019 were retrospectively analyzed.Data including age at diagnosis, prostate-specific antigen(PSA), MRI prostate imaging, puncture Gleason score, operation method, puncture method, positive incision margin and capsule penetration were collected.Differences in Gleason scores before and after operation were compared, and the risk factors for Gleason score upgrading after radical resection were evaluated by univariate and multivariate Logistic regression analysis.
ResultsOf 485 patients with a puncture Gleason score of 3+ 3=6, 261(53.8%)cases had postoperative pathological upgrading, in whom 228(87.4%)cases had Gleason score upgrading of 7, 22(8.4%)had Gleason score upgrading of 8, and 11(4.2%)had Gleason score upgrading of 9 or more.The rate of Gleason score upgrading was elevated with increased preoperative PSA levels, positive pelvic MRI, and higher positive rates of puncture biopsy.The incidences of postoperative capsule penetration(27.2% vs.12.5%, P<0.001)and positive incision margin(25.2% vs.17.4%, P=0.036)had statistically significant differences between the pathologically upgraded group and the pathologically non-upgraded group.Multivariate analysis showed that preoperative PSA level, percentage of positive puncture biopsies, biopsy Gleason score and pelvic MRI were independent predictors of prostate cancer.
ConclusionsFor clinical low-risk prostate cancer patients aged≥65 years with high risk factors for Gleason score upgrading, repeated biopsies should be carried out when necessary and the treatment plan should be adjusted accordingly.
Key words:
Prostate neoplasms; Gleason score; Pathology; Risk faetors
Contributor Information
Cheng Wanli
Graduate School of Peking Union Medical College, Beijing 100730, China; Department of Urology, Beijing Hospital, National Geriatric Center, Institute of Geriatrics of Chinese Academy of Medical Sciences, Beijing 100730, China
Pang Cheng
Department of Urology, Beijing Hospital, National Geriatric Center, Institute of Geriatrics of Chinese Academy of Medical Sciences, Beijing 100730, China
Song Xinda
Graduate School of Peking Union Medical College, Beijing 100730, China
Fu Chunlong
Graduate School of Peking Union Medical College, Beijing 100730, China
Hou Hunmin
Department of Urology, Beijing Hospital, National Geriatric Center, Institute of Geriatrics of Chinese Academy of Medical Sciences, Beijing 100730, China
Zhou Liqun
Department of Urology, Peking University First Hospital, Beijing 100340, China
Ma Lulin
Department of Urology, Peking University Third Hospital, Beijing 100161, China
Gao Xu
Department of Urology, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
He Dalin
Department of Urology, the First Affiliated Hospital, Xi’an Medical University, Xi’an 710061, China
Wang Jianye
Department of Urology, Beijing Hospital, National Geriatric Center, Institute of Geriatrics of Chinese Academy of Medical Sciences, Beijing 100730, China
Liu Ming
Graduate School of Peking Union Medical College, Beijing 100730, China; Department of Urology, Beijing Hospital, National Geriatric Center, Institute of Geriatrics of Chinese Academy of Medical Sciences, Beijing 100730, China
