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World J Urol. 2009 Apr;27(2):271-6. doi: 10.1007/s00345-008-0343-3. Epub 2008 Nov 20.

Prediction of Gleason score upgrading in low-risk prostate cancers diagnosed via multi (> or = 12)-core prostate biopsy.

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  • 1Department of Urology, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam, Kyunggi-do, 463-707, South Korea.

Abstract

OBJECTIVES:

A paucity of data exists on actual pathology of the contemporary patients strictly categorized as having low-risk prostate cancer. We tried to identify useful preoperative predictors of Gleason score upgrading in patients who underwent radical retropubic prostatectomy (RRP) for low-risk prostate cancer diagnosed via multi-core prostate biopsy.

METHODS:

A total of 203 patients who underwent radical RRP for low-risk prostate cancer, as defined by D'Amico et al.'s classification (clinical stage < or = T2a, biopsy Gleason sum < or = 6, and PSA < or = 10 ng/ml), detected via multi (> or = 12)-core prostate biopsy were enrolled. We reviewed patients preoperative and pathological data.

RESULTS:

Among all subjects, 81 (39.9%) were upgraded to Gleason score > or = 7 after RRP, whereas no downgrading was observed. In multivariate analysis, only preoperative PSA level (P = 0.024) and number of positive cores (P = 0.027) were observed to be independent predictors of Gleason score upgrading following RRP. Also, Gleason core upgrading was observed to be significantly associated with extraprostatic extension of tumor (P < 0.001) and positive surgical margin (P = 0.002).

CONCLUSIONS:

A significant proportion of patients with low-risk prostate cancer as defined by D'Amico et al.'s classification diagnosed via multi-core prostate biopsy in contemporary period may have Gleason score upgrading following RRP. For patients with low-risk prostate cancer, preoperative PSA level and number of positive cores may be useful predictors of Gleason score upgrading, which was observed to significantly associated with other adverse pathologic features.

PMID:
19020885
[PubMed - indexed for MEDLINE]
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