Predictors of Gleason Score Upgrading after Radical Prostatectomy in Low-Risk Prostate Cancer

ABSTRACT

PURPOSE: The Gleason score is an important predictor of outcome that is used in conjunction with clinical stage and prostate-specific antigen to guide clinical decision making. The prostate biopsy Gleason grade frequently differs from the radical prostatectomy grade. The aim of this study was to determine the risk factors of Gleason upgrading in patients with low-risk prostate cancer after radical prostatectomy. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 146 patients who underwent radical prostatectomy between 1998 and 2008 in two hospitals of Jeonbuk province in Korea. Pathological Gleason score upgrading was defined as an increase in the Gleason score from or =7 between the biopsy and radical prostatectomy specimen. Pretreatment clinical and pathological parameters were used to identify predictors of pathological upgrading. RESULTS: Of the total 146 patients, 51 (34.9%) were upgraded postoperatively. Small prostate volume (p=0.008), abnormality on the digital rectal examination, and positive surgical margin (p=0.001) were significantly and positively associated with upgrading after radical prostatectomy. A total of 17 of 65 patients with low-risk prostate cancer (26.2%) were upgraded postoperatively. Small prostate volume (<30 ml) was significantly (p=0.026) and positively associated with upgrading after radical prostatectomy in patients with low-risk prostate cancer. CONCLUSIONS: Overall, 26% of patients with low-risk disease were upgraded postoperatively. Small prostate volume was associated with an increased risk for pathological upgrading after radical prostatectomy. These conclusions should be kept in mind when making treatment decisions for men with low-risk prostate cancer.