Influence of Tumor Burden on Serum Prostate-Specific Antigen in Prostate Cancer Patients Undergoing Radical Prostatectomy

Systematic Biopsy vs. Prostatectomy: Evaluating Correlations and Grading Discrepancies in Prostate Cancer

Background Prostate Cancer (PCa) represents a growing global health challenge. The main factor in predicting PCa prognosis is represented by the Gleason Score (GS) therefore, the accuracy of pathological features from preoperative biopsy is critical in the management of the patient. We aimed to investigate the correlation between prostate biopsy parameters and the prostatectomy specimen pathological features and to identify factors that lead to over- and under-grading tumors in biopsy samples. Materials and methods We performed a retrospective study that included 110 male patients with confirmed PCa, selected based on specific inclusion criteria. Biopsy and radical prostatectomy (RP) specimens were analyzed using standard histopathological techniques, and pathological features were assessed according to the latest guidelines. Statistical analysis was performed using IBM SPSS Statistics version 26.0.0 (IBM Corp., Armonk, NY). Results The study included 110 male patients with a median age of 67 years old, ranging from 48 to 79 years old. Correlations between biopsy parameters and RP outcomes were assessed and revealed several key findings. The tumoral length on biopsy was correlated with positive surgical margin (r=0.289, p<0.01) and with tumoral volume (r=0.526, p<0.001) on prostatectomy. Patients with higher grade groups (GG) on biopsy had an approximately four times higher chance of exhibiting extraprostatic extension. We demonstrated a significant correlation between Gleason Pattern 4 (%GP4) on biopsy and pT stage, with pT4 showing the highest %GP4, and a noticeable increase in %GP4 as the pT stage progressed from pT2b to pT4. The study found a significantly higher rate of undergrading at biopsy (30.90%) compared to overgrading (6.36%). Additionally, greater tumor length and higher tumor percentages in biopsies improved grading accuracy (p<0.001). Conclusion Our findings suggest that systemic biopsies play a key role in predicting pathological outcomes, especially through parameters that serve as key prognostic markers. However, due to the potential of the biopsy results to be under- or overgraded, urologists should take into consideration the advantages of using repeat biopsies or additional imaging techniques to achieve a more precise diagnosis and treatment strategy.

Non-organ confined stage and upgrading rates in exclusive PSA high-risk prostate cancer patients

BACKGROUND

The pathological stage of prostate cancer with high-risk prostate-specific antigen (PSA) levels, but otherwise favorable and/or intermediate risk characteristics (clinical T-stage, Gleason Grade group at biopsy [B-GGG]) is unknown. We hypothesized that a considerable proportion of such patients will exhibit clinically meaningful GGG upgrading or non-organ confined (NOC) stage at radical prostatectomy (RP).

MATERIALS AND METHODS

Within the Surveillance, Epidemiology, and End Results database (2010-2015) we identified RP-patients with cT1c-stage and B-GGG1, B-GGG2, or B-GGG3 and PSA 20-50 ng/ml. Rates of GGG4 or GGG5 and/or rates of NOC stage (≥ pT3 and/or pN1) were analyzed. Subsequently, separate univariable and multivariable logistic regression models tested for predictors of NOC stage and upgrading at RP.

RESULTS

Of 486 assessable patients, 134 (28%) exhibited B-GGG1, 209 (43%) B-GGG2, and 143 (29%) B-GGG3, respectively. The overall upgrading and NOC rates were 11% and 51% for a combined rate of upgrading and/or NOC stage of 53%. In multivariable logistic regression models predicting upgrading, only B-GGG3 was an independent predictor (odds ratio [OR]: 5.29; 95% confidence interval [CI]: 2.21-14.19; p < 0.001). Conversely, 33%-66% (OR: 2.36; 95% CI: 1.42-3.95; p = 0.001) and >66% of positive biopsy cores (OR: 4.85; 95% CI: 2.84-8.42; p < 0.001), as well as B-GGG2 and B-GGG3 were independent predictors for NOC stage (all p ≤ 0.001).

CONCLUSIONS

In cT1c-stage patients with high-risk PSA baseline, but low- to intermediate risk B-GGG, the rate of upgrading to GGG4 or GGG5 is low (11%). However, NOC stage is found in the majority (51%) and can be independently predicted with percentage of positive cores at biopsy and B-GGG.