Is Low-risk Prostate Cancer Really Low-risk? Consider Factors Affecting Biochemical Recurrence and Tumour Upgrade.

OBJECTIVE

To evaluate the demographics, preoperative or pathological factors, and findings of magnetic resonance imaging (MRI) to predict the factors affecting biochemical recurrence and tumour upgrade in low-risk prostate cancer.

STUDY DESIGN

A descriptive study.

PLACE AND DURATION OF STUDY

Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey, from January 2017 to December 2021.

METHODOLOGY

The data of 135 patients, who underwent radical prostatectomy for low-risk prostate cancer according to prostate-specific antigen (PSA) level, biopsy result and clinical stage, were analysed. Preoperative clinicopathological factors, MRI findings, and the final pathological results were analysed. Prognostic factors affecting the biochemical recurrence in the follow-up and tumour upgrade in the final pathology according to the International Society of Urological Pathology (ISUP) were evaluated.

RESULTS

Mean age and preoperative PSA level were 61.37 ± 5.53 (46-74) years and 6.74 ± 1.97 (range 1.88-9.9) ng/dL, respectively. Multivariate analysis showed that the prostate volume and diameter of lesions were statistically significant in the patients with ISUP upgrade (p=0.006, p=0.025, respectively), and surgical margin positivity in the final pathology specimen was statistically significant for biochemical recurrence (p=0.016). Logistic regression analysis revealed that prostate volume and diameter of the lesion in MRI were independent predictors of ISUP score upgrade. Receiver operating characteristic (ROC) curve analysis showed that tumour size on the MRI had 49.4% sensitivity and 77.8% specificity at 10 mm (AUC:0.634, p=0.009 for predicting).

CONCLUSION

Lower prostate volume, higher diameter of lesions in multiparametric MRI and surgical margin positivity were associated factors affecting the ISUP score upgrade and biochemical recurrence. Therefore, patients should be evaluated preoperatively and patient-based factors should be considered in the choice of a treatment plan.

KEY WORDS

Prostate cancer, Cancer upgrade, Tumour size.