title: Preoperative predictors of pathologic stage T2a and pathologic Gleason score ≤ 6 in men with clinical low-risk prostate cancer treated with radical prostatectomy: reference for active surveillance.
abstract: To assess preoperative parameters that may be predictive of pathologic stage T2a (pT2a) and pathologic Gleason score (pGS) ≤ 6 disease in low-risk prostate cancer patients considering active surveillance. A cohort of 1,495 men with low-risk prostate cancer between 1993 and 2009 was utilized. Preoperative assessment focused on patient age, race, diagnostic PSA level, clinical stage, diagnostic biopsy Gleason score, and prostate cancer laterality. Kaplan-Meier curves and a Cox regression model were used for analysis of PSA recurrence. Preoperative parameters were analyzed by univariate and multivariate logistic regression methods. Of 1,495 patients, 187 (12.5 %) were identified with pT2a and pGS ≤ 6 disease. Of the 187 men with pT2a and pGS ≤ 6 disease, only 6 (3.2 %) cases had PSA recurrence. Kaplan-Meier PSA recurrence-free survival curves identified a difference between prostate cancers with pT2a and pGS ≤ 6 and prostate cancers with >pT2a or pGS ≥ 7 disease (p = 0.002). Only biopsy tumor unilaterality (OR, 10.452; p ≤ 0.001) and low diagnostic PSA levels (OR, 0.887; p = 0.003) were independent predictors of prostate cancers with pT2a and pGS ≤ 6 disease on univariate and multivariate logistic regression. Biopsy tumor unilaterality and low diagnostic PSA levels are the independent predictors of pT2a and pGS ≤ 6 disease in low-risk prostate cancer patients. Unilateral cancer by prostate biopsy and low diagnostic PSA level may be the reference to improving the selection of appropriate candidates for active surveillance within a low-risk prostate cancer cohort.
authors.affiliation: Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center (DUMC), Box 2804, Durham, NC 27710, USA.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fu
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.forename: Lionel
authors.initials: L
authors.lastname: Bañez
authors.forename: Leon
authors.initials: L
authors.lastname: Sun
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mouraviev
authors.forename: Donghua
authors.initials: D
authors.lastname: Xie
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012015:Reference Standards; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen