Clinical Factors Predicting Tumour Upgrading in Patients Under Active Surveillance and Elected to Active Treatment after Disease Reclassification or Progression

Urol Int. 2017;99(2):186-193. doi: 10.1159/000457966. Epub 2017 Feb 14.

Abstract

Objectives: To evaluate clinical factors associated with tumour upgrading (UPG) in low-intermediate risk patients who progressed while under active surveillance (AS) and underwent delayed radical prostatectomy.

Material and methods: The evaluated factors included prostate specific antigen (PSA), prostate volume, PSA density and number of biopsy positive cores (BPC). Multivariate logistic regression by the forward step Wald procedure was used.

Results: The study evaluated 24 patients who had UPG in 13 cases (54.2%). Independent factors associated with tumour UPG included PSA (OR 2.1; p = 0.047) and BPC (OR 2; p = 0.042).

Conclusions: Clinical factors associated with UPG were identified in patients who were under AS for with low-intermediate risk disease. Preoperative PSA levels and number of BPC were independent factors associated with UPG in a contemporary cohort of patients who progressed under AS and underwent delayed active treatment.

Keywords: Active surveillance; Active treatment; Disease progression; Low-risk; Prostate cancer; Radical prostatectomy; Tumour upgrading.

MeSH terms

  • Aged
  • Biopsy
  • Chi-Square Distribution
  • Disease Progression
  • Humans
  • Kallikreins / blood
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Grading
  • Odds Ratio
  • Predictive Value of Tests
  • Prostate-Specific Antigen / blood
  • Prostatectomy*
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / pathology*
  • Prostatic Neoplasms / therapy*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Time-to-Treatment
  • Treatment Outcome
  • Watchful Waiting*

Substances

  • KLK3 protein, human
  • Kallikreins
  • Prostate-Specific Antigen