title: Unfavorable Intermediate-Risk Prostate Cancer and the Odds of Upgrading to Gleason 8 or Higher at Prostatectomy.
abstract: Some men with unfavorable intermediate-risk prostate cancer (PC) have occult disease with a Gleason score of 8 or higher unrecognized on biopsy because of a sampling error that would change management to long from short course androgen-deprivation therapy in conjunction with radiotherapy. Identifying such men could improve outcomes.
  
  
  
  The study cohort consisted of 136 consecutive men with unfavorable intermediate-risk PC who underwent radical prostatectomy (RP) between 2005 and 2008. We performed logistic regression analysis to identify clinical factors associated with upgrading to a Gleason score of 8 or higher at RP.
  
  
  
  Fourteen percent of the men were upgraded to a Gleason score of 8 or higher PC at RP. Both increasing prostate-specific antigen (PSA) (adjusted odds ratio, 1.98; 95% confidence interval, 1.19, 3.30; P = .01) and greatest percentage core length (GPC) (adjusted odds ratio, 1.11; 95% confidence interval, 1.03, 1.19; P < .01) were significantly associated with upgrading. A significant interaction between PSA and GPC was observed (P = .01). Specifically, men with low PSA (< 5 ng/mL) and those with larger GPC (> 70%) were significantly more likely to have a Gleason score of 8 or higher at RP compared to men with low PSA and GPC of 70% or less (35% vs. 0%; P = .01), whereas the same was not true among men with PSA levels ≥ 5 ng/mL (16% vs. 9%; P = .36).
  
  
  
  In men with unfavorable intermediate-risk PC, a multiparametric magnetic resonance imaging could be considered when the PSA is low and the percentage core length high to identify occult Gleason score 8 or higher disease and change management from short to long course androgen-deprivation therapy and radiotherapy.
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA. Electronic address: nmartin@lroc.harvard.edu.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Department of Statistics, University of Connecticut, Storrs, CT.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Statistics, University of Connecticut, Storrs, CT.
authors.forename: Danjie
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Urology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA.
authors.forename: Jerome P
authors.initials: JP
authors.lastname: Richie
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
mesh_terms: D006801:Humans; D007610:Kallikreins / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: MRI; PSA; Pathology; Risk stratification; Staging