The factors impacting on Gleason score upgrading in Prostate cancer

Abstract

Abstract Background: This study aims to investigate the factors contributing to the discrepancy in between biopsy Gleason score and radical prostatectomy Gleason score in patients diagnosed with prostate cancer. Methods: A total of 341 patients who underwent radical prostatectomy from 2011/04 to 2020/12 were identified. We only include patients with initial Gleason score of 6 after biopsy and enrolled 102 patients. Preoperative clinical variables and pathological variables were assessed to clarify the association with post-surgical Gleason score upgrading. The optimal cut-off points for significant continuous variables were then identified by obtaining the area under the receiver operating characteristic curve. Results: Upgrading was observed in 63 patients and non-upgrading in 39 patients. In the multiple variables assessed, smaller prostate volume (PV) (p value=0.0007), prostate specific antigen density (PSAD) (p value=0.0055), positive surgical margins (p value=0.0062) and pathological perineural invasion (p value=0.0038) were significant predictors of Gleason score upgrading. To further explore preclinical variables, a cut-off value for PV (38ml, p value=0.0017) and PSAD(0.26ng/ml2, p value=0.0013) were identified to be associated with Gleason score upgrading Conclusions: Smaller PV and elevated PSAD are associated with increased risk of Gleason score upgrading. The inverse relationship between PV and Gleason score upgrading might reflect the low androgenicity response of the prostate stroma.