1207 BIOCHEMICAL FAILURE IN D'AMICO LOW RISK PATIENTS WITH GLEASON SUM UPGRADING FOLLOWING RADICAL PROSTATECTOMY: AN INTERNATIONAL, MULTI-INSTITUTIONAL STUDY (2011)

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20111207 BIOCHEMICAL FAILURE IN D'AMICO LOW RISK PATIENTS WITH GLEASON SUM UPGRADING FOLLOWING RADICAL PROSTATECTOMY: AN INTERNATIONAL, MULTI-INSTITUTIONAL STUDY Shahrokh F. Shariat, Sonal Grover, Abhishek Srivastava, Prasanna Sooriakumaran, Daniel Lee, Michael Rink, Felix K. Chun, Thomas F. Chromecki, Pierre I. Karakiewicz, Giacomo Novara, Francesco Montorsi, Kevin M. Slawin, Tommy Nyberg, Stefan Carlsson, Andreas Nilsson, Peter Wiklund, David I. Lee, and Ashutosh Tewari Shahrokh F. ShariatShahrokh F. Shariat New York, NY More articles by this author , Sonal GroverSonal Grover New York, NY More articles by this author , Abhishek SrivastavaAbhishek Srivastava New York, NY More articles by this author , Prasanna SooriakumaranPrasanna Sooriakumaran New York, NY More articles by this author , Daniel LeeDaniel Lee New York, NY More articles by this author , Michael RinkMichael Rink Hamburg, Germany More articles by this author , Felix K. ChunFelix K. Chun Hamburg, Germany More articles by this author , Thomas F. ChromeckiThomas F. Chromecki New York, NY More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz Montreal, Canada More articles by this author , Giacomo NovaraGiacomo Novara Padua, Italy More articles by this author , Francesco MontorsiFrancesco Montorsi Milano, Italy More articles by this author , Kevin M. SlawinKevin M. Slawin Houston, TX More articles by this author , Tommy NybergTommy Nyberg Stockholm, Sweden More articles by this author , Stefan CarlssonStefan Carlsson Stockholm, Sweden More articles by this author , Andreas NilssonAndreas Nilsson Stockholm, Sweden More articles by this author , Peter WiklundPeter Wiklund Stockholm, Sweden More articles by this author , David I. LeeDavid I. Lee Philadelphia, PA More articles by this author , and Ashutosh TewariAshutosh Tewari New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.842AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The accuracy of biopsy Gleason sum (GS) is important for proper clinical management. However, it is well documented that upgrading of GS can occur between preoperative biopsy and final histopathology. This may impact the oncologic outcomes following radical prostatectomy. We sought to evaluate the role of GS upgrading in predicting biochemical recurrence (BCR) in patients following radical prostatectomy. METHODS 13,567 patients with prostate cancer underwent radical prostatectomy from January 2005 to October 2010. Of these, 5,516 men were categorized as D'Amico low-risk. Kaplan-Meier survival analysis and Cox proportional hazard modeling were performed to identify predictors of BCR in patients with upgrading vs no upgrading. RESULTS GS upgrading was present in 2434/5516 (44.1%) men on final histopathology. 96.1% of men with no GS upgrading remained free of BCR at 60 months, compared to 91.1% of patients with GS upgrading (log rank p<0.001). Cox proportional hazard regression modeling for BCR identified LN+, PSM, ECE, SVI and GS upgrading as significant independent predictors of BCR (ORs 3.484, 4.637, 2.775, 2.660 and 1.869, respectively). We developed and validated a nomogram for prediction of BCR in D'Amico low-risk patients based on standard pathologic features and GS upgrading. CONCLUSIONS Patients classified as D'Amico low-risk are upgraded in over 40% of cases; upgrading at radical prostatectomy is associated with an increased risk of BCR. We developed a model that aids with the identification of patients at risk of upgrading despite being categorized as low risk based on the D'Amico stratification. This tool could help in patient counseling regarding treatment options such as active surveillance versus radical therapies. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e484 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shahrokh F. Shariat New York, NY More articles by this author Sonal Grover New York, NY More articles by this author Abhishek Srivastava New York, NY More articles by this author Prasanna Sooriakumaran New York, NY More articles by this author Daniel Lee New York, NY More articles by this author Michael Rink Hamburg, Germany More articles by this author Felix K. Chun Hamburg, Germany More articles by this author Thomas F. Chromecki New York, NY More articles by this author Pierre I. Karakiewicz Montreal, Canada More articles by this author Giacomo Novara Padua, Italy More articles by this author Francesco Montorsi Milano, Italy More articles by this author Kevin M. Slawin Houston, TX More articles by this author Tommy Nyberg Stockholm, Sweden More articles by this author Stefan Carlsson Stockholm, Sweden More articles by this author Andreas Nilsson Stockholm, Sweden More articles by this author Peter Wiklund Stockholm, Sweden More articles by this author David I. Lee Philadelphia, PA More articles by this author Ashutosh Tewari New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...