Pathological upgrading in prostate cancer patients eligible for active surveillance: Does prostate-specific antigen density matter?
- Affiliated Author(s)
- Alternative Author(s)
- Kim, Chun Il
- Journal Title
- Korean Journal of Urology
- Issued Date
- Neoplasm grading; Prostate specific antigen; Prostatectomy
- 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
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.
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