Histological upgrading and upstaging in the UK population following radical prostatectomy and their implications for active surveillance

Summary 

Background

Upgrading of Gleason score at radical retropubic prostatectomy (RRP) is a recognised event; however there are few large, national, multicentre studies of upgrading. With the increasing utilisation of active surveillance as an option in the treatment of prostate cancer upgrading is an increasing concern to urologists.

Objective

To analyse the discordance between the biopsy Gleason score and the RRP Gleason score using the BAUS database from a non-screened UK population.

Methods and subjects

Data were obtained from the BAUS cancer registry which holds data on national complex operations. All patients who underwent RRP with pre and post-operative Gleason score were included in the study.

Results

1420 men were included in the study, mean age 62. Comparing Gleason score between the biopsy and the RRP specimen, 30% men were found to upgraded and 9% downgraded. Clinically significant upgrading was seen in 28%. Age and PSA were found to be higher in the upgraded cohort (p<0.02). Positive margins and seminal vesicle invasion were significantly higher in the upgraded group (p<0.02). Univariate analysis revealed PSA and age as significant predictors of upgrading at RRP (p<0.05).

Conclusions

This large study provides novel data from a non-screened UK population, nearly one-third of whom had clinically significant upgrading. We have also shown that adverse pathological events, positive margin and seminal vesicle invasion, are more common in the upgraded cohort. This evidence needs to be considered when managing men with localised prostate cancer especially when considering active surveillance.

Keywords: Prostate cancer, Gleason, Upgrading, Active surveillance