TY  - JOUR
A1  - Höh, Robert Benedikt
A1  - Flammia, Rocco Simone
A1  - Hohenhorst, Lukas
A1  - Sorce, Gabriele
A1  - Chierigo, Francesco
A1  - Tian, Zhe
A1  - Saad, Fred
A1  - Gallucci, Michele
A1  - Briganti, Alberto
A1  - Terrone, Carlo
A1  - Shariat, Shahrokh F.
A1  - Graefen, Markus
A1  - Tilki, Derya
A1  - Kluth, Luis
A1  - Mandel, Philipp
A1  - Becker, Andreas
A1  - Chun, Felix
A1  - Karakiewicz, Pierre I.
T1  - Non-organ confined stage and upgrading rates in exclusive PSA high-risk prostate cancer patients
T2  - The prostate
N2  - Background: The pathological stage of prostate cancer with high-risk prostate-specific antigen (PSA) levels, but otherwise favorable and/or intermediate risk characteristics (clinical T-stage, Gleason Grade group at biopsy [B-GGG]) is unknown. We hypothesized that a considerable proportion of such patients will exhibit clinically meaningful GGG upgrading or non-organ confined (NOC) stage at radical prostatectomy (RP).
Materials and methods: Within the Surveillance, Epidemiology, and End Results database (2010–2015) we identified RP-patients with cT1c-stage and B-GGG1, B-GGG2, or B-GGG3 and PSA 20–50 ng/ml. Rates of GGG4 or GGG5 and/or rates of NOC stage (≥ pT3 and/or pN1) were analyzed. Subsequently, separate univariable and multivariable logistic regression models tested for predictors of NOC stage and upgrading at RP.
Results: Of 486 assessable patients, 134 (28%) exhibited B-GGG1, 209 (43%) B-GGG2, and 143 (29%) B-GGG3, respectively. The overall upgrading and NOC rates were 11% and 51% for a combined rate of upgrading and/or NOC stage of 53%. In multivariable logistic regression models predicting upgrading, only B-GGG3 was an independent predictor (odds ratio [OR]: 5.29; 95% confidence interval [CI]: 2.21–14.19; p < 0.001). Conversely, 33%–66% (OR: 2.36; 95% CI: 1.42–3.95; p = 0.001) and >66% of positive biopsy cores (OR: 4.85; 95% CI: 2.84–8.42; p < 0.001), as well as B-GGG2 and B-GGG3 were independent predictors for NOC stage (all p ≤ 0.001).
Conclusions: In cT1c-stage patients with high-risk PSA baseline, but low- to intermediate risk B-GGG, the rate of upgrading to GGG4 or GGG5 is low (11%). However, NOC stage is found in the majority (51%) and can be independently predicted with percentage of positive cores at biopsy and B-GGG.
KW  - Gleason Grade group
KW  - non-organ confined stage
KW  - radical prostatectomy
KW  - upgrading
KW  - upstaging
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/75432
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-754327
SN  - 1097-0045
N1  - Open Access funding enabled and organized by Projekt DEAL.
VL  - 82
IS  - 6
SP  - 687
EP  - 694
PB  - Wiley-Liss
CY  - New York, NY
ER  -