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Abstract
Objective
Guidelines support considering selected men with ISUP grade group (GG) 2 prostate cancer for active surveillance (AS). We assessed the association of clinical variables with unfavorable pathology at radical prostatectomy in low-volume GG 2 prostate cancer on biopsy in a retrospective cohort.
Materials and methods
This was a retrospective analysis of 378 men with low-volume (≤ 2 cores) GG 2 localized prostate cancer who underwent prostatectomy at a single tertiary cancer center. Multivariable logistic regression of unfavorable pathology, upgrading to ≥ T3, or GG ≥ 3 was performed in relation to clinical factors, common variables used in AS in GG 1 and percentage Gleason 4 at biopsy. We compared the performance of potential variables with commonly used combined AS restrictions in GG 1 prostate cancer.
Results
In total, 128/378 (34%) men had unfavorable pathology at radical prostatectomy. On multivariable analysis, > 5% Gleason pattern 4 was independently associated with an increased risk of GG ≥ 3. A maximum percentage core involvement > 50% was independently associated with an increased risk of pT-stage ≥ 3 and unfavorable pathology. Restriction to patients with ≤ 5% Gleason 4 decreased the upgrading of both unfavorable pathology (OR = 0.62, p = 0.041) and GG ≥ 3 (OR = 0.17, p = 0.0007) compared to the full cohort, while restriction to those with ≤ 50% of max core involvement did not.
Conclusion
In low-volume GG 2, the percentage of Gleason 4 of ≤ 5% was the strongest predictor in reducing upgrading at final pathology. This easily available pathological descriptor could be used to guide urologists and patients when considering AS in this setting.
Ethical approval
Ethical approval was granted from Regional ethics board University of Toronto, RIB number 08-0472.
Author contributions
Funding: Johan Björklund.
Study design: Johan Björklund, Douglas C. Cheung, Lisa J. Martin, Maria Komisarenko, Antonio Finelli.
Statistical analysis: Johan Björklund, Katharine Lajkosz, Douglas C. Cheung, Lisa J. Martin, Maria Komisarenko.
Manuscript draft: Johan Björklund, Douglas C. Cheung, Lisa J. Martin, Maria Komisarenko.
Critical review: Johan Björklund, Douglas C. Cheung, Lisa J. Martin, Maria Komisarenko, Robert J. Hamilton, Alexandre R. Zlotta, Antonio Finelli.
Disclosure statement
No potential conflict of interest was reported by the author(s).