title: Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System.
abstract: OBJECTIVE
  To identify clinical factors associated with prostate cancer (PCA) upgrading to higher patterns of the surgical specimen in low-risk PCA.
  
  
  METHODS
  We evaluated the records of 438 patients. The multinomial logistic regression model was used.
  
  
  RESULTS
  Low-risk PCA included 170 cases (38.8%) and tumor upgrading was detected in 111 patients (65.3%) of whom 72 (42.4%) had pathological Gleason patterns (pGP) = 3 + 4 and 39 (22.9%) pGP >3 + 4. Prostate-specific antigen (PSA) and proportion of positive cores (P+) were independent predictors of tumor upgrading to higher patterns. The main difference between upgraded cancers related to PSA and to P+ >0.20. The population was stratified into risk classes by PSA ≤5 μg/l and P+ ≤0.20 (class A), PSA >5 μg/l and P+ ≤0.20 (class B), PSA ≤5 μg/l and P+ >0.20 (class C) and PSA >5 μg/l and P+ 0.20 (class D). Upgrading rates to pGP >3 + 4 were extremely low in class A (5.1%), extremely high in D (53.8%).
  
  
  CONCLUSIONS
  Low-risk PCA is a heterogeneous population with significant rates of undetected high-grade disease. Significant clinical predictors of upgrading to higher patterns include PSA and P+, which identify a very high-risk class that needs repeat biopsies in order to reclassify tumor grade.
authors.affiliation: Urologic Clinic, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: Antonio Benito
authors.initials: AB
authors.lastname: Porcaro
authors.forename: Salvatore
authors.initials: S
authors.lastname: Siracusano
authors.forename: Nicolò
authors.initials: N
authors.lastname: De Luyk
authors.forename: Paolo
authors.initials: P
authors.lastname: Corsi
authors.forename: Marco
authors.initials: M
authors.lastname: Sebben
authors.forename: Alessandro
authors.initials: A
authors.lastname: Tafuri
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bizzotto
authors.forename: Irene
authors.initials: I
authors.lastname: Tamanini
authors.forename: Davide
authors.initials: D
authors.lastname: Inverardi
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Cerruto
authors.forename: Guido
authors.initials: G
authors.lastname: Martignoni
authors.forename: Matteo
authors.initials: M
authors.lastname: Brunelli
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors