Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens
Background. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ≤6, 7, and ≥8; 94 patients (27.4%) had PSA recurrence...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Advances in Urology |
| Online Access: | http://dx.doi.org/10.1155/2013/710421 |
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| author | Leonardo Oliveira Reis Emerson Luis Zani Leandro L. L. Freitas Fernandes Denardi Athanase Billis |
| author_facet | Leonardo Oliveira Reis Emerson Luis Zani Leandro L. L. Freitas Fernandes Denardi Athanase Billis |
| author_sort | Leonardo Oliveira Reis |
| collection | DOAJ |
| description | Background. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ≤6, 7, and ≥8; 94 patients (27.4%) had PSA recurrence, mean followup 80.2 months (median 99). Independent predictors of Gleason upgrading (logistic regression) and disease-free survival (DFS) (Kaplan-Meier, log-rank) were determined. Results. Gleason discordance was 45.7% (37.32% upgrading and 8.45% downgrading). Upgrading risk decreased by 2.4% for each 1 g of prostate weight increment, while it increased by 10.2% for every 1 ng/mL of PSA, 72.0% for every 0.1 unity of PSA density and was 21 times higher for those with BGS 7. Gleason upgrading showed increased clinical stage (P=0.019), higher tumor extent (P=0.009), extraprostatic extension (P=0.04), positive surgical margins (P<0.001), seminal vesicle invasion (P=0.003), less “insignificant” tumors (P<0.001), and also worse DFS, χ2=4.28, df=1, P=0.039. However, when setting the final Gleason score (BGS ≤6 to PGS 7 versus BGS 7 to PGS 7), avoiding allocation bias, DFS impact is not confirmed, χ2=0.40, df=1, P=0.530.Conclusions. Gleason upgrading is substantial and confers worse outcomes. Prostate weight is inversely related to upgrading and its protective effect warrants further evaluation. |
| format | Article |
| id | doaj-art-e5a4213ee21d4b8291ea19b217630ea1 |
| institution | Kabale University |
| issn | 1687-6369 1687-6377 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Advances in Urology |
| spelling | doaj-art-e5a4213ee21d4b8291ea19b217630ea12025-02-03T05:48:29ZengWileyAdvances in Urology1687-63691687-63772013-01-01201310.1155/2013/710421710421Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy SpecimensLeonardo Oliveira Reis0Emerson Luis Zani1Leandro L. L. Freitas2Fernandes Denardi3Athanase Billis4Departments of Urology and Pathology, Faculty of Medical Sciences, University of Campinas (Unicamp), Rua Tessália Vieira de Camargo 126, Cidade Universitária “Zeferino Vaz,” 13083-887 Campinas-SP, BrazilDepartments of Urology and Pathology, Faculty of Medical Sciences, University of Campinas (Unicamp), Rua Tessália Vieira de Camargo 126, Cidade Universitária “Zeferino Vaz,” 13083-887 Campinas-SP, BrazilDepartments of Urology and Pathology, Faculty of Medical Sciences, University of Campinas (Unicamp), Rua Tessália Vieira de Camargo 126, Cidade Universitária “Zeferino Vaz,” 13083-887 Campinas-SP, BrazilDepartments of Urology and Pathology, Faculty of Medical Sciences, University of Campinas (Unicamp), Rua Tessália Vieira de Camargo 126, Cidade Universitária “Zeferino Vaz,” 13083-887 Campinas-SP, BrazilDepartments of Urology and Pathology, Faculty of Medical Sciences, University of Campinas (Unicamp), Rua Tessália Vieira de Camargo 126, Cidade Universitária “Zeferino Vaz,” 13083-887 Campinas-SP, BrazilBackground. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ≤6, 7, and ≥8; 94 patients (27.4%) had PSA recurrence, mean followup 80.2 months (median 99). Independent predictors of Gleason upgrading (logistic regression) and disease-free survival (DFS) (Kaplan-Meier, log-rank) were determined. Results. Gleason discordance was 45.7% (37.32% upgrading and 8.45% downgrading). Upgrading risk decreased by 2.4% for each 1 g of prostate weight increment, while it increased by 10.2% for every 1 ng/mL of PSA, 72.0% for every 0.1 unity of PSA density and was 21 times higher for those with BGS 7. Gleason upgrading showed increased clinical stage (P=0.019), higher tumor extent (P=0.009), extraprostatic extension (P=0.04), positive surgical margins (P<0.001), seminal vesicle invasion (P=0.003), less “insignificant” tumors (P<0.001), and also worse DFS, χ2=4.28, df=1, P=0.039. However, when setting the final Gleason score (BGS ≤6 to PGS 7 versus BGS 7 to PGS 7), avoiding allocation bias, DFS impact is not confirmed, χ2=0.40, df=1, P=0.530.Conclusions. Gleason upgrading is substantial and confers worse outcomes. Prostate weight is inversely related to upgrading and its protective effect warrants further evaluation.http://dx.doi.org/10.1155/2013/710421 |
| spellingShingle | Leonardo Oliveira Reis Emerson Luis Zani Leandro L. L. Freitas Fernandes Denardi Athanase Billis Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens Advances in Urology |
| title | Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens |
| title_full | Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens |
| title_fullStr | Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens |
| title_full_unstemmed | Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens |
| title_short | Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens |
| title_sort | higher prostate weight is inversely associated with gleason score upgrading in radical prostatectomy specimens |
| url | http://dx.doi.org/10.1155/2013/710421 |
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