The predictive factor for pathological downgrading after prostatectomy in patients with biopsy Gleason score 4+3 or 4+4 prostate cancer

Tohi,Yoichiro; Matsuda,Iori; Fujiwara,Kengo; Harada,Satoshi; Ito,Ayako; Yamasaki,Mari; Miyauchi,Yasuyuki; Matsuoka,Yuki; Kato,Takuma; Taoka,Rikiya; Tsunemori,Hiroyuki; Ueda,Nobufumi; Sugimoto,Mikio

doi:10.3892/mco.2021.2218

March-2021 Volume 14 Issue 3

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March-2021 Volume 14 Issue 3

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Article Open Access

The predictive factor for pathological downgrading after prostatectomy in patients with biopsy Gleason score 4+3 or 4+4 prostate cancer

Authors:
- Yoichiro Tohi
- Iori Matsuda
- Kengo Fujiwara
- Satoshi Harada
- Ayako Ito
- Mari Yamasaki
- Yasuyuki Miyauchi
- Yuki Matsuoka
- Takuma Kato
- Rikiya Taoka
- Hiroyuki Tsunemori
- Nobufumi Ueda
- Mikio Sugimoto
View Affiliations / Copyright

Affiliations: Department of Urology, Faculty of Medicine, Kagawa University, Miki‑cho, Kita‑gun, Kagawa 761‑0793, Japan

Copyright: © Tohi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Article Number: 56
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Published online on: January 22, 2021

https://doi.org/10.3892/mco.2021.2218
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Abstract

The proportion of Gleason pattern (GP) 4 prostate cancers at prostate biopsy has a clinically significant impact on risk stratification for patients with prostate cancer. In pathological diagnosis including GP 4, a biopsy Gleason score (GS) of 3+4 has a more favorable prognosis than a GS of 4+3 and 4+4. However, the discrepancy between biopsy and prostatectomy specimens is well known. The current study investigated the clinical parameters and biopsy specimens associated with pathological downgrading after prostatectomy in biopsies with a GS of 4+3 or 4+4 prostate cancer. A total of 302 patients with prostate cancer who underwent robot‑assisted radical prostatectomy between August 2013 and May 2019 were retrospectively reviewed. A total of 103 patients had biopsies with GSs of 4+3 and GS 4+4 (unfavorable pathology). The proportion of patients who were downgraded from unfavorable disease to GS ≤3+4 (favorable pathology) in prostatectomy specimens was investigated. Logistic regression analysis was used to explore the association between clinical parameters and downgrading in prostatectomy specimens. A total of 43 patients (41.7%) were downgraded from biopsy GS to prostatectomy GS. The proportions of downgrade in biopsy GS 4+4 and 4+3 were 14.6 and 27.1%, respectively. The percentage of highest GS out of positive biopsy cores and the maximum percentage of cancer involvement within a positive core with the highest GS were lower in the downgrade group than in the no downgrade group (45 vs. 66.7%, P=0.025; 20 vs. 30%, P=0.048, respectively). When performing multivariate logistic regression analysis, the only significant predictor for downgrade was lower percentage of highest GS cores out of positive biopsy cores (odds ratio, 2.469; 95% confidence interval, 1.029‑5.925 P=0.043). In conclusion, patients with biopsy GS 4+4 and 4+3 often exhibit a downgrade to GS 3+4 or less in prostatectomy specimens. The lower percentage of highest GS cores out of positive biopsy cores was associated with downgrade.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

The predictive factor for pathological downgrading after prostatectomy in patients with biopsy Gleason score 4+3 or 4+4 prostate cancer

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