Prognostic factors for identification of unfavorable pathomorphological signs and upgrade in patients with clinically localized prostate cancer and low or favorable intermediate risk

Abstract

Background. Prostate cancer is one of the most common oncological diseases in men and remains an important problem of modern oncological urology. One of the approaches to management of patients with clinically localized prostate cancer and low or favorable intermediate risk is active surveillance. Currently, there is a risk of underestimating tumor aggressiveness. The scale of this risk is unknown, and the factors affecting its significance are not sufficiently understood. Aim. To evaluate frequency and identification of prognostic factors of unfavorable pathomorphological signs through analysis of prostatectomy material from patients with clinically localized prostate cancer and low or favorable intermediate risk. Materials and methods. The retrospective study included 353 patients with clinically localized prostate cancer and low or favorable intermediate oncological risk who underwent radical prostatectomy in our center in 2016–2020. Primary endpoints were presence and frequency of unfavorable pathomorphological signs, upgrade. Additionally, frequency of upgrade of ISUP GG (International Society of Urological Pathology Grade Group) was evaluated depending on a number of prognostic factors. To determine independent effect of these factors, multivariable logistic regression was used with development of prognostic models. Results. Upgrade was reported in 35.4 % of patients. Evaluation of the factors associated with unfavorable pathomorphological signs showed that the following characteristics had statistical significance: ISUP GG per biopsy (p = 0.044), percentage of positive cores (p = 0.017), maximal tumor fraction in positive cores (p = 0.009). For predicting upgrade, 2 key factors were identified: maximal tumor fraction in positive cores (p = 0.033), tumor ISUP GG (p = 0.037). The proposed prognostic classifications confirmed their efficacy and reproducibility in this patient sample. Conclusion. Data analysis allowed to identify significant factors increasing probability of upgrade: presence of ISUP GG 2 and maximal tumor percentage in positive biopsy cores above 15 %. The main predictors associated with disease stage increase were ISUP GG 2 per biopsy, percentage of positive cores above 50 % and maximal tumor fraction in a core above 15 %. If any 2 of the factors are present, active surveillance should be performed with great care and be accompanied by scrutinous control.