Division of Urology, Department of Surgery Saint Louis University, St Louis, Missouri, USA.
Advanced Health Data Institute, Department of Health and Clinical Outcomes Research Saint Louis University, St Louis, Missouri, USA.
Can J Urol. 2022 Apr;29(2):11059-11066.
Management of prostate cancer has seen an increasing predilection for active surveillance in low risk (LR) patients. We aimed to evaluate the rate of pathologic upgrading in patients with very low (VLR) or LR prostate cancer after prostatectomy.
The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) Database were queried for patients diagnosed with Gleason 6 prostate cancer and prostate specific antigen (PSA) < 10 ng/mL from 2010 to 2016. All patients underwent 12-core biopsy and a subsequent prostatectomy for final pathologic staging. Our primary outcome was rate of pathologic upgrading over the study period.
A total of 35,332 patients from the NCDB and 7,186 patients from the SEER database were collected. Patient population had an average age of about 59 years old and was over 80% white. Mean pre-biopsy PSA was higher for the upgraded cohorts in the NCDB and SEER populations (5.3 versus 4.9 and 5.5 versus 5.1 respectively, p < 0.001). Upgraded cohorts were more likely to have a higher percentage of positive cores at biopsy (p < 0.001). Multivariable analysis demonstrated that increasing age, increasing PSA and year of diagnosis were all predictors of upgrading (p < 0.05) in both databases. African American race was significantly associated with upgrading in the NCDB database only (p = 0.001). Over the studied time period, the rate of upgrading at prostatectomy increased from 41.2% to 56.7% in the NCDB population and from 41.9% to 45.4% in the SEER population.
The rate of pathologic upgrading of VLR and LR prostate cancer at prostatectomy has been increasing in recent years. Increasing age, pre-biopsy PSA and an increasing percentage of positive cores at biopsy are predictors of this outcome. This may relate to improved patient selection for active surveillance and definitive treatment.
在低危（LR）患者中，前列腺癌的治疗越来越倾向于主动监测。我们旨在评估前列腺切除术后极低危（VLR）或 LR 前列腺癌患者的病理升级率。
从 2010 年至 2016 年，国家癌症数据库（NCDB）和监测、流行病学和最终结果（SEER）数据库中检索诊断为 Gleason 6 前列腺癌和前列腺特异性抗原（PSA）<10ng/mL 的患者。所有患者均接受了 12 核活检，并随后进行了前列腺切除术以进行最终病理分期。我们的主要结局是研究期间病理升级的发生率。
从 NCDB 中收集了 35332 名患者，从 SEER 数据库中收集了 7186 名患者。患者人群的平均年龄约为 59 岁，超过 80%为白人。NCDB 和 SEER 人群中升级队列的平均术前 PSA 更高（分别为 5.3 与 4.9 和 5.5 与 5.1，p<0.001）。升级队列在活检时具有更高比例的阳性核心的可能性更大（p<0.001）。多变量分析表明，年龄增加、PSA 增加和诊断年份都是两个数据库中升级的预测因素（p<0.05）。在 NCDB 数据库中，非洲裔美国人种族与升级显著相关（p=0.001）。在研究期间，NCDB 人群中前列腺切除术的升级率从 41.2%增加到 56.7%，SEER 人群中从 41.9%增加到 45.4%。
近年来，前列腺切除术后 VLR 和 LR 前列腺癌的病理升级率一直在增加。年龄增加、术前 PSA 和活检时阳性核心比例增加是该结果的预测因素。这可能与主动监测和确定性治疗的患者选择改善有关。
