Extreme Gleason Upgrading From Biopsy to Radical Prostatectomy: A Population-Based Analysis

To examine the risk factors associated with the odds of extreme Gleason upgrading at RP (defined as a Gleason prognostic group score increase of ≥ 2), we utilized a large, population-based cancer registry.

The Surveillance, Epidemiologic, and End Results (SEER) database was queried (2010-2011) for all patients diagnosed with Gleason 3+3 or 3+4 on prostate needle biopsy (PNB). Available clinicopathologic factors and the odds of upgrading and extreme upgrading at RP were evaluated using multivariate logistic regression.

A total of 12,459 patients were identified with median age of 61 (IQR 56-65) years and diagnostic PSA 5.5 ng/mL (IQR 4.3-7.5). Upgrading was observed in 34% of men, including 44% of 7,402 patients with Gleason 3+3 and 19% of 5,057 patients with Gleason 3+4 disease. Age, clinical stage, diagnostic PSA, and %PNB cores positive were independently associated with odds of any upgrading at RP. In baseline 3+3 disease, extreme upgrading was observed in 6% with increasing age, diagnostic PSA, and >50% core positivity associated with increased odds. In baseline 3+4 disease, extreme upgrading was observed in 4% with diagnostic PSA and palpable disease remaining predictive. Positive surgical margins were significantly higher in patients with extreme upgrading at RP (p<0.001).

Gleason upgrading at RP is common in this large population-based cohort, including extreme upgrading in a clinically significant portion. Identifying men at greatest risk of extreme upgrading could improve patient counseling and surgical planning.

Urology. 2016 Jun 13 [Epub ahead of print]

Brian R Winters, Jonathan L Wright, Sarah K Holt, Daniel W Lin, William J Ellis, Bruce L Dalkin, George Schade

Department of Urology, University of Washington School of Medicine, Seattle, WA. Electronic address: ., Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA., Department of Urology, University of Washington School of Medicine, Seattle, WA., Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA., Department of Urology, University of Washington School of Medicine, Seattle, WA., Department of Urology, University of Washington School of Medicine, Seattle, WA., Department of Urology, University of Washington School of Medicine, Seattle, WA.

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