Up- and downgrading in single intermediate-risk positive biopsy core prostate cancer

Benedikt Hoeh; Rocco Flammia; Lukas Hohenhorst; Gabriele Sorce; Francesco Chierigo; Zhe Tian; Fred Saad; Michele Gallucci; Alberto Briganti; Carlo Terrone; Shahrokh F Shariat; Markus Graefen; Derya Tilki; Luis A Kluth; Philipp Mandel; Felix K H Chun; Pierre I Karakiewicz

doi:10.1016/j.prnil.2022.01.004

Up- and downgrading in single intermediate-risk positive biopsy core prostate cancer

Prostate Int. 2022 Mar;10(1):21-27. doi: 10.1016/j.prnil.2022.01.004. Epub 2022 Jan 26.

Authors

Benedikt Hoeh^{1

2}, Rocco Flammia^{2

3}, Lukas Hohenhorst^{2

4}, Gabriele Sorce^{2

5}, Francesco Chierigo^{2

6}, Zhe Tian², Fred Saad², Michele Gallucci³, Alberto Briganti⁵, Carlo Terrone⁶, Shahrokh F Shariat^{7

8

9

10

11

12}, Markus Graefen⁴, Derya Tilki^{4

13

14}, Luis A Kluth¹, Philipp Mandel¹, Felix K H Chun¹, Pierre I Karakiewicz²

Affiliations

¹ Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany.
² Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
³ Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy.
⁴ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁵ Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁶ Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
⁷ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
⁸ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
⁹ Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
¹⁰ Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
¹¹ Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
¹² Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹³ Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
¹⁴ Department of Urology, Koc University Hospital, Istanbul, Turkey.

Abstract

Background: Up- and/or downgrading rates in single intermediate-risk positive biopsy core are unknown.

Methods: We identified single intermediate-risk (Gleason grade group (GGG) 2/GGG3) positive biopsy core prostate cancer patients (≤ cT2c and PSA ≤ 20 ng/mL) within the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015). Subsequently, separate uni- and multivariable logistic regression models tested for independent predictors of up- and downgrading.

Results: Of 1,328 assessable patients with single core positive intermediate-risk prostate cancer at biopsy, 972 (73%) harbored GGG2 versus 356 (27%) harbored GGG3. Median PSA (5.5 vs 5.7; p = 0.3), median age (62 vs 63 years; p = 0.07) and cT1-stage (77 vs 75%; p = 0.3) did not differ between GGG2 and GGG3 patients. Of individuals with single GGG2 positive biopsy core, 191 (20%) showed downgrading to GGG1 versus 35 (4%) upgrading to GGG4 or GGG5 at RP. Of individuals with single GGG3 positive biopsy core, 36 (10%) showed downgrading to GGG1 versus 42 (12%) significant upgrading to GGG4 or GGG5 at RP. In multivariable logistic regression models, elevated PSA (10-20 ng/mL) was an independent predictor of upgrading to GGG4/GGG5 in single GGG3 positive biopsy core patients (OR:2.89; 95%-CI: 1.31-6.11; p = 0.007).

Conclusion: In single GGG2 positive biopsy core patients, downgrading was four times more often recorded compared to upgrading. Conversely, in single GGG3 positive biopsy core patients, up- and downgrading rates were comparable and should be expected in one out of ten patients.

Keywords: Downgrading; Intermediate-risk; Prostate cancer; Single positive core biopsy; Upgrading.