Robert Benedikt Höh, Rocco Simone Flammia, Lukas Hohenhorst, Gabriele Sorce, Francesco Chierigo, Zhe Tian, Fred Saad, Michele Gallucci, Alberto Briganti, Carlo Terrone, Shahrokh F. Shariat, Markus Graefen, Derya Tilki, Luis Kluth, Philipp Mandel, Andreas Becker, Felix Chun, Pierre I. Karakiewicz
- 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.
MetadatenAuthor: | Robert Benedikt HöhORCiDGND, Rocco Simone FlammiaORCiD, Lukas HohenhorstORCiD, Gabriele SorceORCiD, Francesco ChierigoORCiD, Zhe Tian, Fred SaadORCiDGND, Michele GallucciORCiD, Alberto BrigantiORCiD, Carlo TerroneORCiDGND, Shahrokh F. ShariatORCiDGND, Markus GraefenORCiDGND, Derya TilkiORCiDGND, Luis KluthORCiDGND, Philipp MandelORCiDGND, Andreas BeckerGND, Felix ChunORCiDGND, Pierre I. Karakiewicz |
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URN: | urn:nbn:de:hebis:30:3-754327 |
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DOI: | https://doi.org/10.1002/pros.24313 |
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ISSN: | 1097-0045 |
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Parent Title (English): | The prostate |
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Publisher: | Wiley-Liss |
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Place of publication: | New York, NY |
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Document Type: | Article |
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Language: | English |
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Date of Publication (online): | 2022/02/21 |
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Date of first Publication: | 2022/02/21 |
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Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Release Date: | 2023/09/07 |
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Tag: | Gleason Grade group; non-organ confined stage; radical prostatectomy; upgrading; upstaging |
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Volume: | 82 |
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Issue: | 6 |
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Page Number: | 8 |
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First Page: | 687 |
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Last Page: | 694 |
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Note: | Open Access funding enabled and organized by Projekt DEAL. |
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HeBIS-PPN: | 514228652 |
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Institutes: | Medizin |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Licence (German): | Creative Commons - CC BY - Namensnennung 4.0 International |
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