The factors impacting on Gleason score upgrading in prostate cancer with initial low Gleason scores

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Discrepancies between biopsy and radical prostatectomy Gleason scores (GS) are common in prostate cancer management.
• Understanding factors influencing this score upgrading is crucial for accurate staging and treatment planning.

Purpose of the Study:

• To identify clinical and pathological factors associated with Gleason score upgrading from biopsy to radical prostatectomy.
• To determine specific cut-off values for key predictors of Gleason score upgrading.

Main Methods:

• Retrospective analysis of 102 prostate cancer patients with biopsy GS of six who underwent radical prostatectomy.
• Assessment of preoperative clinical and pathological variables.
• Identification of optimal cut-off points using receiver operating characteristic curve analysis.

Main Results:

• Gleason score upgrading occurred in 63 of 102 patients.
• Smaller prostate volume (PV), elevated prostate specific antigen density (PSAD), positive surgical margins, and perineural invasion were significant predictors of upgrading.
• Optimal cut-off values identified: PV ≤ 38 ml and PSAD ≥ 0.26 ng/ml².

Conclusions:

• Smaller prostate volume and elevated prostate specific antigen density are independently associated with an increased risk of Gleason score upgrading.
• These findings aid in predicting pathological Gleason score changes and refining treatment strategies for prostate cancer.