Heterogeneity in D׳Amico classification-based low-risk prostate cancer: Differences in upgrading and upstaging according to active surveillance eligibility - Abstract

BACKGROUND: To date, no study has examined clinical, pathological, and surgical characteristics of D׳Amico low-risk patients according to active surveillance (AS) eligibility.

MATERIAL AND METHODS: We relied on patients with low-risk prostate cancer, who were classified based on the D׳Amico classification, treated with radical prostatectomy (RP) between 2008 and 2013 at the Martini-Clinic Prostate Cancer Center. We assessed differences in clinical, pathological, and surgical characteristics in D׳Amico low-risk patients according to AS eligibility (prostate-specific antigen [PSA]≤ 10ng/ml, Gleason score≤ 3+3, ≤ 2 positive cores,≤ 50% tumor content per core, and≤ cT1-2a). Multivariable logistic regression analyses targeted 2 end points: (1) presence of either intermediate- or high-risk characteristics (Gleason score ≥3+4 or ≥pT3 or pN1) or (2) exclusive presence of high-risk characteristics (Gleason score ≥4+4 or ≥pT3 or pN1) at RP.

RESULTS: Of 1,331 patients low-risk prostate cancer classified based on the D׳Amico classification, 825 (62%) men were eligible for AS. AS candidates were less frequently either upgraded (55% vs. 78%, P< 0.001) or upstaged (8% vs. 15%, P< 0.001). Similarly, at final pathology, AS candidates less frequently harbored either intermediate- or high-risk (56% vs. 78%, P< 0.001), or exclusive high-risk characteristics (9% vs. 16%, P< 0.001). Tumor involvement per core (>50%) (most powerful), number of positive cores, PSA values, and age were independent predictors for either intermediate- or high-risk characteristics at RP. Tumor involvement per core and PSA values were independent predictors for exclusive high-risk characteristics at RP.

CONCLUSIONS: D׳Amico low-risk patients did not have a homogeneous histology at RP. Especially, non-AS candidates were at a higher risk of either upgrading or upstaging at final pathology. Tumor involvement greater than 50% per core was the most powerful indicator of adverse pathology. Therefore, D'Amico low-risk criteria are not safe enough to identify AS candidates.

Written by:
Schiffmann J, Wenzel P, Salomon G, Budäus L, Schlomm T, Minner S, Wittmer C, Kraft S, Krech T, Steurer S, Sauter G, Beyer B, Boehm K, Tilki D, Michl U, Huland H, Graefen M, Karakiewicz PI.   Are you the author?
Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.  

Reference: Urol Oncol. 2015 Jul;33(7):329.e13-9.
doi: 10.1016/j.urolonc.2015.04.004


PubMed Abstract
PMID: 25960411

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