Pathological upgrading in prostate cancer patients eligible for active surveillance: Does prostate-specific antigen density matter?

Authors
Byung-Soo JinSeok-Hyun KangDuk-Yoon KimHoon-Gyu OhChun-Il KimGi-Hak MoonTae-Gyun KwonJae-Shin Park
Department
Dept. of Urology (비뇨의학)
Issue Date
2015
Citation
Korean Journal of Urology, Vol.56(9) : 624-629, 2015
ISSN
2005-6737
Abstract
Purpose: To evaluate prospectively the role of prostate-specific antigen (PSA) density in predicting Gleason score upgrading in prostate cancer patients eligible for active surveillance (T1/T2, biopsy Gleason score≤6, PSA≤10 ng/mL, and ≤2 positive biopsy cores). Materials and Methods: Between January 2010 and November 2013, among patients who underwent greater than 10-core transrectal ultrasound-guided biopsy, 60 patients eligible for active surveillance underwent radical prostatectomy. By use of the modified Gleason criteria, the tumor grade of the surgical specimens was examined and compared with the biopsy results. Results: Tumor upgrading occurred in 24 patients (40.0%). Extracapsular disease and positive surgical margins were found in 6 patients (10.0%) and 8 patients (17.30%), respectively. A statistically significant correlation between PSA density and postoperative upgrading was found (p=0.030); this was in contrast with the other studied parameters, which failed to reach significance, including PSA, prostate volume, number of biopsy cores, and number of positive cores. Tumor upgrading was also highly associated with extracapsular cancer extension (p=0.000). The estimated optimal cutoff value of PSA density was 0.13 ng/mL2, obtained by receiver operating characteristic analysis (area under the curve=0.66; p=0.020; 95% confidence interval, 0.53–0.78). Conclusions: PSA density is a strong predictor of Gleason score upgrading after radical prostatectomy in patients eligible for active surveillance. Because tumor upgrading increases the potential for postoperative pathological adverse findings and prognosis, PSA density should be considered when treating and consulting patients eligible for active surveillance.
Keywords
Neoplasm gradingProstate specific antigenProstatectomy
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/33388
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Urology (비뇨의학)
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