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Predictors of Gleason score upgrading in a large African-American population

  • Urology - Original Paper
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Abstract

Purpose

Gleason score from biopsy specimens is important for prostate cancer (PCa) risk stratification and influences treatment decisions. Gleason score upgrading (GSU) between biopsy and surgical pathology specimens has been reported as high as 50 % and presents a challenge in counseling low-risk patients. While recent studies have investigated predictors of GSU, populations in these studies have been largely Caucasian. We report our analysis of predictors of GSU in a large urban African-American population.

Methods

A total of 959 patients with D’Amico low-risk prostate cancer underwent radical prostatectomy at Georgetown University or Washington Hospital Center between January 2005 and July 2012. Race, age, PSA, body mass index (BMI), cancer of the prostate risk assessment (CAPRA) score, and transrectal ultrasound (TRUS) biopsy characteristics (percent of biopsy cores showing adenocarcinoma, highest percent of biopsy core involved with cancer, and measured TRUS prostate volume) were analyzed with both univariate and multivariate analyses to identify significant predictors of GSU while controlling for clinical parameters.

Results

Of the 959 cases, 288 (30.0 %) were upgraded on final pathologic specimen with approximately 38 % (133/355) of African-American patients experiencing GSU. BMI (P = 0.02), percent positive biopsy cores (P < 0.01) and percent of core involved with cancer (P < 0.01), increasing CAPRA score, and serum PSA were independent predictors of GSU on both uni- and multivariate regression analyses. African Americans had a 73 % increase in the incidence of GSU over other races.

Conclusion

More than a quarter of low-risk prostate cancer patients were upgraded on final pathology in our series. Higher BMI, serum PSA, CAPRA score, percent of cores positive, and percent of cores involved were independent predictors of GSU. Individuals with those clinical parameters may harbor occult high-grade disease and should be carefully counseled on treatment decisions.

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Acknowledgments

I would like to acknowledge the mentorship and guidance of Drs. Jonathan Hwang, Mohan Verghese, and John Lynch during my clinical training and research endeavors. I appreciate the consideration of the editorial board of International Urology and Nephrology of this manuscript.

Conflict of interest

The authors of this manuscript have no financial disclosures or conflicts of interest.

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Authors and Affiliations

  1. Departments of Urology, Washington Hospital Center and Georgetown University Hospital, 3401 38th ST NW, Suite 915, Washington, DC, 20016, USA

    Anup Vora, Tim Large, Jenny Aronica, Sherod Haynes, Andrew Harbin, Daniel Marchalik, Hanaa Nissim, John Lynch, Gaurav Bandi, Kevin McGeagh, Keith Kowalczyk, Reza Ghasemian, Krishnan Venkatesan, Mohan Verghese & Jonathan Hwang

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  1. Anup Vora
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  2. Tim Large
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  3. Jenny Aronica
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  4. Sherod Haynes
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  6. Daniel Marchalik
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  7. Hanaa Nissim
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  8. John Lynch
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  9. Gaurav Bandi
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  11. Keith Kowalczyk
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  13. Krishnan Venkatesan
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  14. Mohan Verghese
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  15. Jonathan Hwang
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Correspondence to Anup Vora.

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Vora, A., Large, T., Aronica, J. et al. Predictors of Gleason score upgrading in a large African-American population. Int Urol Nephrol 45, 1257–1262 (2013). https://doi.org/10.1007/s11255-013-0495-y

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  • DOI: https://doi.org/10.1007/s11255-013-0495-y

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