Primary Gleason Pattern Upgrading in contemporary D'Amico low-risk prostate cancer patients: Implications for future biomarkers and imaging modalities

To retrospectively assess the rate of primary Gleason upgrading (HGPGU) to primary Gleason pattern 4 or 5 in a contemporary cohort of D'Amico low-risk prostate cancer (PCa) and PRIAS active surveillance (AS) patients and to develop a tool for HGPGU prediction. HGPGU is a contraindication in most AS and focal therapy protocols.

10,616 patients with localized PCa were treated at a high volume European tertiary care center from 2010 to 2015 with radical prostatectomy. Analyses were restricted to 1,819 D'Amico low-risk patients (17.1%) with PSA <10.0 ng/m, cT1c-cT2a and Gleason score ≤6, and were repeated within 772 men (7.3%), who fulfilled the PRIAS criteria for AS (PSA ≤10 ng/mL, T1c-T2, Gleason score ≤6, PSA density <0.2, ≤2 positive cores). Univariable and multivariable (MVA) logistic regression models (LRM) were fitted, testing predictors of HGPGU. The final LRM was based on the most informative variables.

HGPGU was observed in 88 (4.8%) D'Amico low-risk and in 32 (4.1%) PRIAS AS patients. MVA predicting HGPGU within D'Amico low-risk patients yielded three independent predictors: age, PSAD and clinical tumour stage (p 0.008, 0.005 and 0.021, respectively). Within the same patients, the model using all vs. the most informative variables resulted in AUCs of 69.2% and 68.3%, respectively. MVA within PRIAS AS candidates, yielded age and number of positive cores as independent predictors of HGPGU (p 0.002 and 0.049, AUC 64.9%).

The low accuracy (invariably less than 70%) for HGPGU prediction in both D'Amico low-risk and PRIAS AS candidates indicates that these variables have poor predictive ability in contemporary patients. Despite HGPGU being a rare phenomenon, it may have life threatening implications. In consequence, alternatives such as biomarkers, genetic markers or imaging modalities at re-biopsy are needed. This article is protected by copyright. All rights reserved.

BJU international. 2016 Jul 01 [Epub ahead of print]

Sami-Ramzi Leyh-Bannurah, Hiba Abou-Haidar, Paolo Dell'Oglio, Jonas Schiffmann, Zhe Tian, Hans Heinzer, Hartwig Huland, Markus Graefen, Lars Budäus, Pierre I Karakiewicz

Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada., Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada., Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe