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. 2020 Feb 4;56(2):61.
doi: 10.3390/medicina56020061.

The Impact of Prostate Cancer Upgrading and Upstaging on Biochemical Recurrence and Cancer-Specific Survival

Arnas Bakavičius  1   2   3 , Mingailė Drevinskaitė  4 , Kristina Daniūnaitė  3   5 , Marija Barisienė  1   2 , Sonata Jarmalaitė  3   5 , Feliksas Jankevičius  1   2
Affiliations

The Impact of Prostate Cancer Upgrading and Upstaging on Biochemical Recurrence and Cancer-Specific Survival

Arnas Bakavičius et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Significant numbers of prostate cancer (PCa) patients experience tumour upgrading and upstaging between prostate biopsy and radical prostatectomy (RP) specimens. The aim of our study was to investigate the role of grade and stage increase on surgical and oncological outcomes. Materials and Methods: Upgrading and upstaging rates were analysed in 676 treatment-naïve PCa patients who underwent RP with subsequent follow-up. Positive surgical margin (PSM), biochemical recurrence (BCR), metastasis-free survival (MFS), overall (OS) and cancer specific survival (CSS) were analysed according to upgrading and upstaging. Results: Upgrading was observed in 29% and upstaging in 22% of PCa patients. Patients undergoing upgrading or upstaging were 1.5 times more likely to have a PSM on RP pathology. Both upgrading and upstaging were associated with increased risk for BCR: 1.8 and 2.1 times, respectively. Mean time to BCR after RP was 2.1 years in upgraded cases and 2.7 years in patients with no upgrading (p <0.001), while mean time to BCR was 1.9 years in upstaged and 2.8 years in non-upstaged cases (p <0.001). Grade and stage increase after RP were associated with inferior MFS rates and ten-year CSS: 89% vs. 98% for upgrading (p = 0.039) and 87% vs. 98% for upstaging (p = 0.008). Conclusions: Currently used risk stratification models are associated with substantial misdiagnosis. Pathological upgrading and upstaging have been associated with inferior surgical results, substantial higher risk of BCR and inferior rates of important oncological outcomes, which should be considered when counselling PCa patients at the time of diagnosis or after definitive therapy.

Keywords: prostate cancer, upgrading, upstaging, biochemical recurrence, metastases, survival.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Prostate cancer biochemical disease-free survival rates after radical prostatectomy: (A) Biochemical disease-free survival according to upgrading (all clinical International Society of Urological Pathology (cISUP) grade groups); (B) Biochemical disease-free survival for patients with no upgrading (blue line), upgrading from cISUP grade group 1 (green line) and upgrading from cISUP grade group 2–4 (yellow line); (C) Biochemical disease-free survival according to upstaging.
Figure 2
Figure 2
Metastases-free survival after radical prostatectomy: (A) Metastases-free survival according to upgrading; (B) Metastases-free survival according to upstaging.
Figure 3
Figure 3
Prostate cancer overall survival rates after radical prostatectomy: (A) Overall survival according to upgrading; (B) Overall survival according to upstaging.
Figure 4
Figure 4
Prostate cancer-specific survival rates after radical prostatectomy: (A) Cancer-specific survival according to upgrading; (B) Cancer-specific survival according to upstaging.
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