Presentation Authors: Doo Yong Chung*, Jong Soo Lee, Won Sik Jang, Seoul, Korea, Republic of, In Rae Cho, Gimhae, Korea, Republic of, Young Sig Kim, Goyang, Korea, Republic of, Joong Shik Lee, Seoul, Korea, Republic of, Dong Hoon Lim, Gwangju, Korea, Republic of, Don Gu Lee, Jin Hyung Jeon, Won Sik Ham, Young deuk Choi, Seoul, Korea, Republic of
Introduction: Gleason score (GS) 8-10 is associated with adverse clinical outcomes in prostate cancer (PCa), however the biopsy GS (bGS) may be occured upgrades and downgrades after radical prostatectomy (RP). We investigated the predictive factors of decreasing to pathologic GS (pGS) 6-7 after RP in patients with bGS 8-10.
Methods: We retrospectively reviewed clinical data from patients with bGS 8-10 who underwent RP at our institution. Patients underwent neoadjuvant therapy or those without adequate medical records were excluded. To analyze pGS downgrade and biochemical recurrence (BCR) were performed univariate and multivariate cox regression analysis, logistic analysis, Kaplan-Meier curves.
Results: In a total of 860 patients, pathological findings showed that bGS8, bGSâ‰¥9 were present in 623 cases (72.4%), 237 cases (27.6%), respectively. 332 patients were downgraded to pGS 6-7 after RP. In these 332 patients, and bGS8, bGSâ‰¥9 were present in 284 cases (85.5%), 48 cases (14.5%), respectively. PSA, clinical stage on mpMRI, pathologic adverse features such as extracapsular extension, seminal vesicle invasion (SVI), positive surgical margin(PSM) were significant statistical difference between Downgrade group and No_downgrade group. In the univariate and multivariate logistic regression analyses, bGSâ‰¥9, PSA â‰¥10 ng/ml and above clinical T3b on multiparametric Magnetic Resonance Imaging (mpMRI) was a significant predictor of pGS downgrade (OR 0.349, p < 0.001 , OR 0.634, p=0.004, OR 0.400, p < 0.001). Also, pGS Downgrade was a significant positive predictor of BCR following RP in patients with high bGS (pGS8: HR 1.699, p < 0.001. pGSâ‰¥9: HR 1.765, p < 0.001). SVI, PSM were also statistically related to BCR (p < 0.001).
Conclusions: In patients with high bGS, bGS8, PSA < 10 ng/ml and without seminal vesicle invasion on mpMRI may show a downgrade in pGS. These patients may have few adverse pathologic features and show a good prognosis, so active treatment is needed.