Analysis Of The Related Factors Of Gleason Score Upgrading In Patients After Radical Prostatectomy

Objective:To explore the related factors of Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the patients with intermediate or low risk prostate cancer.Method:A total of 94 patients who were diagnosed with low or intermediate risk prostate cancer by prostate biopsy and underwent RP from June 2016 to January 2019 in The First Affiliated Hospital of Soochow University were included in the study.Each case underwent transperineal ultrasound guided systematic 12-core biopsy add magnetic resonance imaging/ultrasound(MRI/US)imaging fusion targeted biopsy.We collected clinical and pathological parameters of the patients,including age,BMI(body mass index),the period between prostate biopsy and RP(time interval),prebiopsy PSA(total prostate-specific antigen),PSAD(prostate-specific antigen density),ratio of positive needle number,prostate volume,biopsy GS,preoperative clinical stage.According to the difference between GS of biopsy and RP specimens,the patients were divided into two groups,namely GS upgrading group and GS not upgrading group.Univariable and multivariable logistic regression analysis were used to find related factors of GS upgrading after RP.In addition,We analyzed the puncture method in terms of postoperative GS upgrading.T or mann-whitneyU test was used for inter-group comparison,and X2 test was used for classification variable comparison.Results:Of the 94 patients,the pathological GS was upgraded in 37(39.4%),remained the same in 54(57.4%),and downgraded in 3(3.2%).There was a correlation between two groups in time interval,prostate volume(P<0.05),there was no correlation between two groups in age,BMI,PSA,PSAD,ratio of positive needle number,biopsy GS,preoperative clinical stage(P>0.05),For the univariate analysis,there were no significant differences in age(P=0.487),BMI(P=0.172),PSA(P=0.081),PSAD(P=0.333),ratio of positive needle number(P=0.910),biopsy GS(P=0.120),preoperative clinical stage(P=0.292).However,there were significant differences in time interval(P=0.048),prostate volume(P=0.026).For the multivariate logistic analysis,the prostate volume(P=0.042)is an independent predictor of GS upgrading after RP,the smaller the prostate volume is,the higher the possibility of postoperative GS upgrading is.Combined with targeted puncture,the percentage of GS upgrading guided by systematic 12-core biopsy can be reduced,with the statistically difference(P=0.031).Conclusion:Smaller prostate volume may suggest the possibility of postoperative GS upgrading in the patients with intermediate or low risk prostate cancer.Combined with targeted puncture,the percentage of GS upgrading guided by systematic 12-core biopsy can be reduced.