Incidence and Predictors of Upgrading and Up Staging among 10,000 Contemporary Patients with Low Risk Prostate Cancer

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Active surveillance is a management option for clinically low-risk prostate cancer.
• Accurate risk stratification is crucial for selecting appropriate candidates for active surveillance.

Purpose of the Study:

• To determine the incidence of pathological upgrading and upstaging in clinically low-risk prostate cancer patients.
• To identify predictors of occult advanced disease to refine patient selection for active surveillance.

Main Methods:

• Analysis of 10,273 patients from the SEER database diagnosed with clinically low-risk prostate cancer (2010-2011) and treated with prostatectomy.
• Multivariable logistic regression of 5,581 patients with complete biopsy data to identify predictors of upgrading or upstaging.
• Development of a risk stratification table based on significant predictors.

Main Results:

• 44% of patients experienced pathological upgrading (Gleason score 7-10), and 9.7% were upstaged (pathological T3-T4/N1).
• Age (>60 years), prostate-specific antigen (>5.0 ng/ml), and percent positive cores (>25%) were significant predictors of both upgrading and upstaging.
• 60% of low-risk cases with PSA 7.5-9.9 ng/ml and >25% positive cores were upgraded.

Conclusions:

• A significant proportion of clinically low-risk prostate cancer patients have higher-grade or advanced-stage disease at prostatectomy.
• Risk stratification using prostate-specific antigen and percent positive cores is essential for guiding further testing and active surveillance decisions.