Prostate volume effect on Gleason score upgrading in active surveillance appropriate patients

Gleason Score (GS) upgrading rates in the literature are reported to be around 33-45%. The relationship between prostate volume and GS upgrading should be defined, aiming to reduce upgrading rates in patients with low risk groups who are eligible for active surveillance (AS) or minimally invasive treatment, by varying biopsy cores, or lengths of cores according to prostate volumes. In this regard, the aim of our study was to establish the relationship between prostate volume and GS upgrading.

We retrospectively analyzed the medical records of 78 patients, who were appropriate for AS between 2011-2016 at our hospital. Inclusion criteria were patient age under 65 years, PSA level under 10 ng/ml, GS (3 + 3) or (3 + 4), and 3 or less positive cores, clinical stages ≤ T2. GS increase in radical prostatectomy specimen was considered as 'upgrading' and in addition, score reported by biopsy as 3 + 4 but in surgical specimen as 4 + 3 were also considered as 'upgrading'. The effect of prostate volume on Gleason grade upgrading was examined by calculating upgrading rates separately for patients with prostate volume 30 ml or less, those with 30 to 60 ml, and those over 60 ml.

As a result of the analysis of the data, upgrading was seen in 35 (44.8%) of 78 patients included in the study. In the cohort mean prostate volume was 49.8 (± 26.3) ml. Twenty-two patients (28.2%) had prostate volume 30 ml or less, 34 (43.6%) 30 to 60 ml, and 22 (28.2%) 60 ml or more. The patients were divided into two groups as those with and without GS upgrading. Between the groups prostate volume and prostate volume range (0-30/31-60/> 60) were not significantly different (p value > 0.05).

Gleason grade upgrading causes patients to be classified in a lower risk group than they actually are, and may lead to inappropriate treatment. This condition has a direct effect on the decision of active surveillance. Therefore, it is important to define the factors that can predict GS upgrading in active surveillance appropriate patients. In this study, we found that prostate volume has no significant effect on upgrading in active surveillance appropriate patients.