Pathological upgrading in prostate cancer patients eligible for active surveillance: Does prostate-specific antigen density matter?
진병수, 강석현, 김덕윤, 오훈규, 김천일, 문기학, 권태균, 박재신,
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진병수 ( Jin Byung-Soo )
Catholic University of Daegu School of Medicine Department of Urology
강석현 ( Kang Seok-Hyun )
Catholic University of Daegu School of Medicine Department of Urology
김덕윤 ( Kim Duk-Yoon )
Catholic University of Daegu School of Medicine Department of Urology
오훈규 ( Oh Hoon-Gyu )
Catholic University of Daegu School of Medicine Department of Pathology
김천일 ( Kim Chun-Il )
Keimyung University School of Medicine Department of Urology
문기학 ( Moon Gi-Hak )
Yeungnam University School of Medicine Department of Urology
권태균 ( Kwon Tae-Gyun )
Kyungpook National University School of Medicine Department of Urology
박재신 ( Park Jae-Shin )
Catholic University of Daegu School of Medicine Department of Urology
KMID : 0358320150560090624
Abstract
Purpose: To evaluate prospectively the role of prostate-specific antigen (PSA) density in predicting Gleason score upgrading in prostate cancer patients eligible for active surveillance (T1/T2, biopsy Gleason score≤6, PSA≤10 ng/mL, and ≤2 positive biopsy cores).
Materials and Methods: Between January 2010 and November 2013, among patients who underwent greater than 10-core transrectal ultrasound-guided biopsy, 60 patients eligible for active surveillance underwent radical prostatectomy. By use of the modified Gleason criteria, the tumor grade of the surgical specimens was examined and compared with the biopsy results.
Results: Tumor upgrading occurred in 24 patients (40.0%). Extracapsular disease and positive surgical margins were found in 6 patients (10.0%) and 8 patients (17.30%), respectively. A statistically significant correlation between PSA density and postoperative upgrading was found (p=0.030); this was in contrast with the other studied parameters, which failed to reach significance, including PSA, prostate volume, number of biopsy cores, and number of positive cores. Tumor upgrading was also highly associated with extracapsular cancer extension (p=0.000). The estimated optimal cutoff value of PSA density was 0.13 ng/mL2, obtained by receiver operating characteristic analysis (area under the curve=0.66; p=0.020; 95% confidence interval, 0.53-0.78).
Conclusions: PSA density is a strong predictor of Gleason score upgrading after radical prostatectomy in patients eligible for active surveillance. Because tumor upgrading increases the potential for postoperative pathological adverse findings and prognosis, PSA density should be considered when treating and consulting patients eligible for active surveillance.
키워드
Neoplasm grading; Prostate specific antigen; Prostatectomy
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