Porcaro AB, et al. – Aim of this work was to distinguish significant clinical factors correlated with prostate cancer (PCa) upgrading the low–risk PCa patients graded according to the modified Gleason score system. The results of this study displayed that patients diagnosed with low–risk PCa at biopsy are a heterogeneous population because they include subsets with undetected high–grade disease. Significant clinical predictors of upgrading include the PSA value and P+. In low–risk prostate cancer, they distinguished a high–risk upgrading subgroup that required repeat biopsies in order to reclassify the tumor grade and to reassess the clinical risk category.

Methods

• Researchers applied logistic regression model to assess the records of 438 patients.

Results

• In this study, there were 170 cases (38.8%) of low–risk PCa and tumors were upgraded in 111 patients (65.3%).
• It was demonstrated that only prostate specific antigen (PSA) and the proportion of positive cores (P+) were independent predictors of tumor upgrading.
• They evaluated further exploration by categorizing and regressing PSA (≤5.0 vs. > 5.0 ng/ml) and P+ (≤ 0.20 vs. > 0.20). The odds ratio of PSA > 5 ng/ml was 1.32 and of P+ > 0.20 was 2.71.
• The population was stratified into very low–risk with PSA ≤ 5 ng/ml and P+ ≤ 0.20 (class A), low–risk with PSA > 5 ng/ml and P+ ≤ 0.20 (class B), intermediate risk with PSA ≤ 5 ng/ml and P+ > 0.20 (class C), and high risk with PSA > 5 ng/ml and P+ 0.20 (class D).
• They observed low upgrading rates in class A (9%), extremely high in D (50.5%), and moderate (20%) in B and C.