Harvard Medical School, Boston, MA
Kathryn Tindell Dinh , Brandon Arvin Virgil Mahal , David R. Ziehr , Vinayak Muralidhar , Yu-Wei Chen , Vidya Bhavani Viswanathan , Michelle Daniel Nezolosky , Clair Beard , Toni K. Choueiri , Neil E. Martin , Peter F. Orio , Christopher Sweeney , Quoc-Dien Trinh , Paul Linh Nguyen
Background: To inform decisions about active surveillance, we determined the incidence of upgrading and upstaging for a contemporary cohort of low-risk prostate cancer patients who received radical prostatectomy and identified clinical predictors of advanced disease. Methods: We studied 10,273 patients in the Surveillance, Epidemiology, and End Result (SEER) database diagnosed with low-risk prostate cancer (cT1c-T2a, PSA<10 ng/mL and Gleason 3+3=6) in 2010-2011. Upgrading was defined as pathologic Gleason score 7-10 and upstaging as pathologic T3-T4/N1 disease. Regression coefficients were used to evaluate the predictive value of clinical factors for upgrading or upstaging. Significant factors were used to develop a risk stratification table to evaluate individual patients. Results: At prostatectomy, 44% of patients were upgraded and 9.7% were upstaged. Multivariable analysis showed age, PSA, and percent total cores positive were associated with advanced disease (all p<0.001). When these variables were dichotomized by the median, age >60 (Adjusted Odds Ratio [AOR] 1.39), PSA>5.0 (AOR 1.28), and >25% total cores positive (AOR 1.76) were significantly associated with upgrading (all p<0.001). Similarly, age>60 (AOR 1.42), PSA>5.0 (AOR 1.44), and >25% total cores positive (AOR 2.26) were associated with upstaging (all p<0.001). Sixty percent of low-risk patients with PSA 7.5-9.9 and >25% total cores positive were upgraded. Conclusions: A significant proportion of low-risk patients eligible for active surveillance were harboring more aggressive or locally-advanced prostate cancer. Age, PSA and percent total cores positive should be used to assess risk of upgrading or upstaging and can guide decisions to pursue further evaluation or treatment.
Percent total cores positive | ≤12.5% | 12.6-25% | 25.1-50% | >50% |
---|---|---|---|---|
PSA | ||||
<2.5 | 13.6% | 20.4% | 35.8% | 31.3% |
2.6-5.0 | 33.3% | 40.6% | 45.9% | 51.9% |
5.1-7.5 | 32.4% | 47.1% | 51.8% | 59.9% |
7.6-9.9 | 34.2% | 43.0% | 59.8% | 61.8% |
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