Department of Urology, Cho Ray Hospital, Ho Chi Minh, Viet Nam.
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Investig Clin Urol. 2020 Jul;61(4):405-410. doi: 10.4111/icu.2020.61.4.405. Epub 2020 May 25.
Whether active surveillance (AS) can be safely extended to patients with Gleason score (GS) 3+4 prostate cancer is highly debated. We examined the incidence and predictors of upgrading among patients with GS 3+4 disease.
The study involved 377 patients with biopsy GS 3+4 who underwent robot-assisted laparoscopic radical prostatectomy (RP) from 2014 to 2018 at a single institution. We analyzed the rate of GS upgrading and used logistic regression to determine the predictors of upgrading.
A total of 168 (44.6%) patients with GS 3+4 experienced an upgrade in GS. In multivariable analysis, advanced age, prostate-specific antigen (PSA) level, PSA density (PSAD) and Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2) score were significant predictors of GS upgrading. When structured into a predictive model that included age ≥65 years, PSA ≥7.7 ng/mL, PSAD ≥0.475 ng/mL and PI-RADS v2 score 4-5, the probability of GS upgrading ranged from 36.4% to 65.7% when one to four of these factors were included.
A substantial proportion of patients with GS 3+4 prostate cancer were upgraded after RP. However, according to our model combining clinical and imaging predictors, patients with a low risk of GS upgrading may be eligible candidates for AS.
是否可以安全地将主动监测（AS）扩展到 Gleason 评分（GS）为 3+4 的前列腺癌患者，这一问题存在广泛争议。本研究旨在探讨 GS 3+4 疾病患者中升级的发生率和预测因素。
本研究纳入了 2014 年至 2018 年期间在一家医疗机构接受机器人辅助腹腔镜根治性前列腺切除术（RP）的 377 例 GS 3+4 活检患者。我们分析了 GS 升级的发生率，并使用逻辑回归确定了升级的预测因素。
共有 168 例（44.6%）GS 3+4 患者的 GS 发生升级。多变量分析显示，高龄、前列腺特异性抗原（PSA）水平、PSA 密度（PSAD）和前列腺影像报告和数据系统版本 2（PI-RADS v2）评分是 GS 升级的显著预测因素。当将年龄≥65 岁、PSA≥7.7ng/ml、PSAD≥0.475ng/ml 和 PI-RADS v2 评分 4-5 等因素纳入预测模型时，当包含 1-4 个这些因素时，GS 升级的概率从 36.4%到 65.7%不等。
相当一部分 GS 3+4 前列腺癌患者在 RP 后发生升级。然而，根据我们的模型，将临床和影像学预测因素相结合，低 GS 升级风险的患者可能有资格接受 AS。
