Grand Journal of Urology
E-ISSN : 2757-7163

Frequency of ISUP 2014 Grade Group Upgrading in Radical Prostatectomy Patients and Associated Risk Factors: A Retrospective Study and Multivariate Analysis
Emre Salabas1, Huseyin Cihan Demirel2, Ozlem Ton Eryilmaz3
1Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
2Department of Urology, Aydin University Faculty of Medicine, VM Medical Park Florya Hospital, Istanbul, Turkey
3Department of Pathology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
DOI : 10.5505/GJU.2022.74755
Pages : 100-107
Objective: The primary aim of this study is the determination of International Society of Urological Pathology (ISUP) grade group (GG) upgrading prevalence and its risk factors in prostate cancer patients.

Materials and Methods: This study was conducted on 117 patients who all underwent open radical prostatectomy in our institution between 2011 and 2020. Patients who received neoadjuvant therapy prior to surgery and had metastasis in lymph nodes or bones were excluded from the study.

Results: In 28 (23.9%) cases ISUP GG had upgraded in final pathology. While grade group of 81 (69.2%) patients did not change, it was downgraded in the remaining 8 (6.8%) cases. In the univariate analysis for the predictors of ISUP GG upgrade, ISUP GG distribution in biopsy pathology (OR: 0.46, 95% CI: 0.26-0.82, p=0.009), positive core fraction (PCF) (OR: 0.07, 95% CI 0.01-0.85, p=0.037), greatest positive core percentage (GPC) (OR: 0.12, 95% CI: 0.02- 0.68, p=0.016) and extraprostatic invasion extended (EPI-extended) (OR: 2.95, 95% CI: 1.16- 7.49, p=0.023) were all identified as significant factors. When these significant factors were analyzed in multivariate logistic regression analysis, biopsy ISUP grade (OR: 0.38, 95% CI: 0.18-0.79, p=0.01), greatest percentage of cancer (GPC) (OR: 0.10, 95% CI 0.01-0.78, p=0.027) and EPI-extended (OR 14.9, 95% CI:3.1-71.9, p=0.01) were shown as independent predictors.

Conclusion: ISUP GGs of a significant number of patients upgrade in the final pathology. Initial biopsy ISUP score and greatest positive core percentage in the biopsy are independent predictors of ISUP GG upgrade risk. EPI-extended was also significantly higher in ISUP upgrade group. Tumor upgrade risk should be considered prior to prostate cancer treatment.

Keywords : prostate neoplasms, urologic surgical procedures, male, pathology
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