title: Clinical factors stratifying the risk of tumor upgrading to high-grade disease in low-risk prostate cancer.
abstract: OBJECTIVE
  To identify clinical factors stratifying the risk of tumor upgrading to increasing patterns of the tumor grading system in low-risk prostate cancer (PCa).
  
  
  METHODS
  We evaluated the records of 438 patients who underwent radical prostatectomy. Associations between clinical factors and tumor upgrading were assessed by the univariate and multivariate multinomial logistic regression model.
  
  
  RESULTS
  Low-risk PCa included 170 cases (38.8%) and tumor upgrading was detected in 111 patients (65.3%): 72 (42.4%) had pathology Gleason pattern (pGP) 3 + 4, 27 (15.9%) pGP 4 + 3, and 12 (7.1%) pGP 4 + 4. Prostate- specific antigen (PSA) and proportion of positive cores (P+) were independent predictors of upgrading to high-risk disease. These factors also stratified the risk of tumor upgrading to the increasing patterns of the tumor grading system. The model allowed the identification of pGP 4 + 4. The main difference between high-risk PCa and other upgraded tumors related to PSA load (odds ratio 2.4) that associated with high volume disease in the specimen.
  
  
  CONCLUSIONS
  Low-risk PCa is a heterogeneous population with significant rates of tumor upgrading. Significant clinical predictors stratifying the risk of tumor upgrading to increasing patterns of the grading system included PSA and P+. These factors allowed the identification of the subset hiding high-grade disease requiring further investigations before delivering active treatments.
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Antonio B
authors: AB
authors: Porcaro
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Salvatore
authors: S
authors: Siracusano
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Nicolò de
authors: N
authors: Luyk
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Paolo
authors: P
authors: Corsi
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Marco
authors: M
authors: Sebben
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Alessandro
authors: A
authors: Tafuri
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Tania
authors: T
authors: Processali
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Mattia
authors: M
authors: Cerasuolo
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Daniele
authors: D
authors: Mattevi
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Davide
authors: D
authors: Inverardi
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Maria A
authors: MA
authors: Cerruto
authors: 2 Department of Pathology, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Matteo
authors: M
authors: Brunelli
authors: 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors: Walter
authors: W
authors: Artibani
mesh_terms: D000368:Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods; D016017:Odds Ratio; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology*; D012307:Risk Factors
keywords: Gleason score system; Prostate cancer; Tumor grade; Tumor upgrading