Gleason Grade 1 Prostate Cancer Volume at Biopsy is Associated with Upgrading, but Not Adverse Pathology or Recurrence after Radical Prostatectomy: Results from a Large Institutional Cohort.

Clinical guidelines suggest that for low-grade, clinically localized prostate cancer (PCa), patients with higher volume of disease at diagnosis may benefit from definitive therapy, although the data remain unclear. Our objective was to determine associations between low-grade PCa volume and outcomes in men managed with primary radical prostatectomy (RP).

Men with cT1-2N0/xM0/x PCa, prostate-specific antigen (PSA) at diagnosis <10ng/ml, and Gleason grade group (GG) 1 pathology on diagnostic biopsy managed with primary RP were included. Outcomes were pathologic upgrade at RP (≥GG2), UCSF adverse pathology at RP (≥GG3, pT3/4 or pN1), alternate adverse pathology at RP (≥GG3, ≥pT3b, or pN1), and recurrence (biochemical failure with two PSA ≥0.2ng/mL or salvage treatment). Multivariable logistic regression models were used to estimate associations between percentage of positive cores (PPC) and risk of upgrade and adverse pathology at RP. Multivariable Cox proportional hazards regression models were used to estimate associations between PPC and hazard of recurrence after RP.

1029 men met inclusion criteria. Multivariable logistic regression models demonstrated significant associations between PPC and pathologic upgrade (OR 1.31, 95% CI 1.1-1.57, p<0.01), but not UCSF adverse pathology at RP (p=0.84); PPC was negatively associated with alternate adverse pathology (OR 0.67, 95% CI 0.48-0.93, p=0.02). Multivariable Cox regression models demonstrated no association between PPC and hazard of recurrence after RP (p=0.11).

In men with GG1 PCa, tumor volume may be associated with upgrading at RP, but not more clinically significant outcomes of adverse pathology or recurrence.

The Journal of urology. 2022 Sep 06 [Epub ahead of print]

Kevin Shee, Samuel L Washington, Janet E Cowan, Claire M de la Calle, Avi S Baskin, Meera R Chappidi, Domenique Escobar, Hao G Nguyen, Matthew R Cooperberg, Peter R Carroll

Department of Urology, UCSF, San Francisco, California.