Grade and stage misclassification in intermediate unfavorable-risk prostate cancer radiotherapy candidates.

Abstract

BACKGROUND:

We tested for upgrading (Gleason grade group [GGG] ≥ 4) and/or upstaging to non-organ-confined stage ([NOC] ≥ pT3/pN1) in intermediate unfavorable-risk (IU) prostate cancer (PCa) patients treated with radical prostatectomy, since both change the considerations for dose and/or type of radiotherapy (RT) and duration of androgen deprivation therapy (ADT).

METHODS:

We relied on Surveillance, Epidemiology, and End Results (2010-2015). Proportions of (a) upgrading, (b) upstaging, or (c) upgrading and/or upstaging were tabulated and tested in multivariable logistic regression models.

RESULTS:

We identified 7269 IU PCa patients. Upgrading was recorded in 479 (6.6%) and upstaging in 2398 (33.0%), for a total of 2616 (36.0%) upgraded and/or upstaged patients, who no longer fulfilled the IU grade and stage definition. Prostate-specific antigen, clinical stage, biopsy GGG, and percentage of positive cores, neither individually nor in multivariable logistic regression models, discriminated between upgraded and/or upstaged patients versus others.

CONCLUSIONS:

IU PCa patients showed very high (36%) upgrading and/or upstaging proportion. Interestingly, the overwhelming majority of those were upstaged to NOC. Conversely, very few were upgraded to GGG ≥ 4. In consequence, more than one-third of IU PCa patients treated with RT may be exposed to suboptimal dose and/or type of RT and to insufficient duration of ADT, since their true grade and stage corresponded to high-risk PCa definition, instead of IU PCa. Data about magnetic resonance imaging were not available but may potentially help with better stage discrimination.

• Authors: Gabriele Sorce, Rocco Simone Flammia, Benedikt Hoeh, Francesco Chierigo, Lukas Hohenhorst, Andrea Panunzio, Armando Stabile, Giorgio Gandaglia, Zhe Tian, Derya Tilki, Carlo Terrone, Michele Gallucci, Felix K H Chun, Alessandro Antonelli, Fred Saad, Shahrokh F Shariat, Francesco Montorsi, Alberto Briganti, Pierre I Karakiewicz
• Journal: The Prostate (Prostate) Vol. 82 Issue 10 Pg. 1040-1050 (06 2022) ISSN: 1097-0045 [Electronic] United States
• PMID: 35365851 (Publication Type: Journal Article)
• Copyright: © 2022 The Authors. The Prostate published by Wiley Periodicals LLC.

Chemical References

• Androgen Antagonists
• Prostate-Specific Antigen

Topics

• Androgen Antagonists (therapeutic use)
• Humans
• Male
• Neoplasm Grading
• Neoplasm Staging
• Prostate-Specific Antigen
• Prostatectomy (methods)
• Prostatic Neoplasms (pathology)