MP58-11: Gleason grade group 1 prostate cancer volume at biopsy is associated with unfavorable pathology but not upgrading after radical prostatectomy
Sunday, May 5, 2024 1:00 PM to 3:00 PM · 2 hr. (US/Central)
221C
Abstract
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Full Abstract and Figures
Author Block
TAE HEON KIM*, Tae Ho Hwang, Young Dong Yu, Seung Ryeol Lee, Young Kwon Hong, Dong Soo Park, Seongnam, Korea, Republic of
Introduction
A significant proportion of patients with Gleason grade group 1 (GG1) prostate cancer at biopsy is upgraded to GG2 or higher after radical prostatectomy, increasing the risk of adverse pathological findings. We examined the implications of volume of GG1 disease at prostate biopsy with respect to unfavorable pathological findings after radical prostatectomy.
Methods
Patients with biopsy Gleason grade group 1 prostate cancer and prostate specific antigen (PSA) <20 ng/mL who underwent robot-assisted radical prostatectomy (RARP) between May 2014 and May 2023 at out institution were included in the study. Patients missing any clinical or pathological variables and patients with the interval of more than 6 months between prostate biopsy and RARP were excluded. Patients who received neoadjuvant therapy or underwent salvage RARP were also excluded. All patients had a systematic biopsy in addition to targeted biopsies if suspicious lesions were noted on transrectal ultrasound and/or multiparametric prostate magnetic resonance imaging (mpMRI). Percent of biopsy cores positive (PPC), defined as the number of positive cores divided by the total number of cores at biopsy. Outcomes were surgical Gleason upgrade (=GG2) and unfavorable pathology (=GG3, pT3/4, or pN1) at radical prostatectomy. Multivariable logistic regression models were used to estimate associations between PPC and risk of upgrade and unfavorable pathology at radical prostatectomy.
Results
A total of 213 patients were included in the analysis. Median age at RARP was 67 years (IQR 62-73). Median PSA at diagnosis was 6.52 ng/mL (IQR 4.79-9.46), and median PSAD at diagnosis was 0.19 ng/mL2 (IQR 0.12-0.30). Clinical T stage based on mpMRI findings was T1/T2 in 60.6% patients and T3 in 39.4% patients. Median number of cores obtained at diagnosis was 12 (IQR 11-12), median PPC at diagnosis was 17.0 (IQR 8.0-33.0), and maximum percent of cancer in any core at diagnosis was 10.0 (5.0-20.0). Multivariable logistic regression models demonstrated significant associations between PPC and unfavorable pathology (OR 1.02, 95% CI 1.00-1.04, p=0.030), but not surgical Gleason upgrade at radical prostatectomy (p=0.189). During median follow-up of 34.0 months (IQR 12.0-60.5), there were 5 (2.3%) biochemical recurrence. The 5-year biochemical recurrence-free survival was 98.2% and 97.8% in patients with <17% PPC and =17% PPC, respectively (log-rank p =0.417).
Conclusions
PPC at diagnosis was associated with adverse pathology, but not pathological upgrading in patients with GG1 prostate cancer who underwent RARP.
Source Of Funding
I have nothing to disclose.
Author Block
TAE HEON KIM*, Tae Ho Hwang, Young Dong Yu, Seung Ryeol Lee, Young Kwon Hong, Dong Soo Park, Seongnam, Korea, Republic of
Introduction
A significant proportion of patients with Gleason grade group 1 (GG1) prostate cancer at biopsy is upgraded to GG2 or higher after radical prostatectomy, increasing the risk of adverse pathological findings. We examined the implications of volume of GG1 disease at prostate biopsy with respect to unfavorable pathological findings after radical prostatectomy.
Methods
Patients with biopsy Gleason grade group 1 prostate cancer and prostate specific antigen (PSA) <20 ng/mL who underwent robot-assisted radical prostatectomy (RARP) between May 2014 and May 2023 at out institution were included in the study. Patients missing any clinical or pathological variables and patients with the interval of more than 6 months between prostate biopsy and RARP were excluded. Patients who received neoadjuvant therapy or underwent salvage RARP were also excluded. All patients had a systematic biopsy in addition to targeted biopsies if suspicious lesions were noted on transrectal ultrasound and/or multiparametric prostate magnetic resonance imaging (mpMRI). Percent of biopsy cores positive (PPC), defined as the number of positive cores divided by the total number of cores at biopsy. Outcomes were surgical Gleason upgrade (=GG2) and unfavorable pathology (=GG3, pT3/4, or pN1) at radical prostatectomy. Multivariable logistic regression models were used to estimate associations between PPC and risk of upgrade and unfavorable pathology at radical prostatectomy.
Results
A total of 213 patients were included in the analysis. Median age at RARP was 67 years (IQR 62-73). Median PSA at diagnosis was 6.52 ng/mL (IQR 4.79-9.46), and median PSAD at diagnosis was 0.19 ng/mL2 (IQR 0.12-0.30). Clinical T stage based on mpMRI findings was T1/T2 in 60.6% patients and T3 in 39.4% patients. Median number of cores obtained at diagnosis was 12 (IQR 11-12), median PPC at diagnosis was 17.0 (IQR 8.0-33.0), and maximum percent of cancer in any core at diagnosis was 10.0 (5.0-20.0). Multivariable logistic regression models demonstrated significant associations between PPC and unfavorable pathology (OR 1.02, 95% CI 1.00-1.04, p=0.030), but not surgical Gleason upgrade at radical prostatectomy (p=0.189). During median follow-up of 34.0 months (IQR 12.0-60.5), there were 5 (2.3%) biochemical recurrence. The 5-year biochemical recurrence-free survival was 98.2% and 97.8% in patients with <17% PPC and =17% PPC, respectively (log-rank p =0.417).
Conclusions
PPC at diagnosis was associated with adverse pathology, but not pathological upgrading in patients with GG1 prostate cancer who underwent RARP.
Source Of Funding
I have nothing to disclose.