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01-10-2017 | Original Article

Postoperative upgrading of prostate cancer in men ≥75 years: a propensity score-matched analysis

Authors: Annika Herlemann, Alexander Buchner, Alexander Kretschmer, Maria Apfelbeck, Christian G. Stief, Christian Gratzke, Stefan Tritschler

Published in: World Journal of Urology | Issue 10/2017

Abstract

Purpose

Gleason score upgrading should be considered when indicating surgery in prostate cancer (PCa) patients. In elderly patients, definitive treatment of low-risk PCa must be weighed with the risks of overtreatment. Our aim was to evaluate rates of Gleason score upgrading in patients ≥75 years undergoing radical prostatectomy (RP) for localized PCa and to identify predictors associated with upgrading.

Methods

3296 patients undergoing RP were retrospectively evaluated and categorized into age groups: <70 years (n = 2971) vs. ≥75 years (n = 325). We analyzed prostate-specific antigen (PSA), biopsy counts, Gleason score, pathologic T- and N-stage, and surgical margin. Propensity score matching was performed to compare rates of up- and downgrading on surgical specimen using the new five-tier pathologic grading system. Logistic regression was used to identify independent predictors of upgrading.

Results

Preoperatively, patients ≥75 years had higher PSA (8.8 vs. 7.3 ng/mL) and lower proportion of grade group 1 (Gleason score 6) at biopsy (29.2 vs. 47.9%; both p < 0.001) compared to patients <70 years. At RP, patients ≥75 years were more likely to have extraprostatic disease (50 vs. 30%) and lower rates of grade group 1 (14.1 vs. 34.8%; both p < 0.001). Postoperative downgrading was similar (15.1 vs. 19.5%). However, patients ≥75 years had higher rates of postoperative upgrading (46.6 vs. 27.9%; p < 0.001). Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were associated with upgrading.

Conclusions

Patients ≥75 years not only demonstrated higher rates of advanced disease but more frequent upgrading on RP specimen. Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were predictive for upgrading. The increased risk of upgrading should be taken into consideration when discussing optimal treatment for this specific cohort.

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Title: Postoperative upgrading of prostate cancer in men ≥75 years: a propensity score-matched analysis
Authors: Annika Herlemann
Alexander Buchner
Alexander Kretschmer
Maria Apfelbeck
Christian G. Stief
Christian Gratzke
Stefan Tritschler
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 10/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-017-2045-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postoperative upgrading of prostate cancer in men ≥75 years: a propensity score-matched analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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