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Adverse Disease Features in Gleason Score 3 + 4 "Favorable Intermediate-Risk" Prostate Cancer: Implications for Active Surveillance.
- Source :
-
European urology [Eur Urol] 2017 Sep; Vol. 72 (3), pp. 442-447. Date of Electronic Publication: 2016 Aug 27. - Publication Year :
- 2017
-
Abstract
- Background: According to a recent National Comprehensive Cancer Network (NCCN) guidelines update, patients with Gleason score (GS) 3 + 4 prostate cancer (PCa) and "favorable intermediate-risk" (FIR) characteristics might be offered active surveillance (AS). However, the risk of unfavorable disease features and its prediction in this subset of patients is not completely understood.<br />Objective: To identify the risk of unfavorable disease and potential predictors of adverse outcomes among GS 3 + 4 FIR PCa patients.<br />Design, Setting, and Participants: The study included patients with biopsy GS 3 + 4 and otherwise fulfilling the NCCN low-risk definition (prostate-specific antigen [PSA] <10 ng/ml, cT2a or lower) undergoing radical prostatectomy (RP) from 2006 to 2014 at a single institution.<br />Outcome Measurements and Statistical Analysis: Complete information on PSA, PSA density (PSAD), clinical stage, percentage of positive cores, percentage of maximum surface specimen involvement, and RP pathology were available. GS upgrade and downgrade, non-organ-confined and non-specimen-confined disease, unfavorable disease (pT3-T4 and/or pN1 and/or a pGS ≥4 + 3) were the outcomes. Statistical analysis included descriptive statistics and multivariable logistic regression.<br />Results and Limitations: A total of 156 patients (13.1%) experienced GS upgrade; 201 (16.9%) were downgraded. Overall, 205 men (17.2%) harbored non-organ-confined disease, and 295 (24.8%) had unfavorable disease. Age (odds ratio [OR]: 1.06), percentage surface involvement (OR: 1.01), and PSAD (OR: 1.83) were the only significant predictors of upgrade. Age (OR: 1.05), clinical stage (OR: 1.74), percentage of positive cores >50% (OR 1.57), percentage of surface area (OR: 1.02), and perineural invasion (OR: 1.89) were significant predictors of unfavorable disease at RP. The retrospective design is a limitation.<br />Conclusions: AS is a possible option for a subset of men with FIR GS 3 + 4. However, clinical models alone have a limited role in GS upgrade prediction, and alternative tools warrant further investigation.<br />Patient Summary: Patients with Gleason score 3 + 4 at biopsy, low prostate-specific antigen, and low stage might consider the option of active surveillance, but the use of clinical information alone might be not adequate for thorough risk-adapted counseling.<br /> (Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Adult
Aged
Biopsy
Chi-Square Distribution
Clinical Decision-Making
Decision Support Techniques
Humans
Kallikreins blood
Logistic Models
Male
Middle Aged
Minnesota
Multivariate Analysis
Neoplasm Grading
Neoplasm Staging
Odds Ratio
Prostate-Specific Antigen blood
Prostatic Neoplasms blood
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Prostatectomy adverse effects
Prostatic Neoplasms pathology
Prostatic Neoplasms surgery
Watchful Waiting
Subjects
Details
- Language :
- English
- ISSN :
- 1873-7560
- Volume :
- 72
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- European urology
- Publication Type :
- Academic Journal
- Accession number :
- 27574819
- Full Text :
- https://doi.org/10.1016/j.eururo.2016.08.043