Low-volume grade group 2 prostate cancer candidates for active surveillance: a radical prostatectomy retrospective analysis

Figures & data

Figure 1. Consort diagram.

Table 1. Clinical and pathological characteristics of patients (n = 378).

Variable		Missing data
Age at biopsy (years)		0/378
Median (IQR)	62.3 (56.9–66.6)
< 60	155 (41%)
60–69	186 (49%)
≥ 70	37 (10%)
cT stage		0/378
1	285 (75%)
2	93 (25%)
PSA at biopsy (ng/ml)		0/378
Median (IQR)	5.6 (4.2–7.3)
< 4	79 (21%)
4–10	262 (69%)
> 10 to < 20	37 (10%)
TRUS volume (cm^3)		1/378
Median (IQR)	38 (30–48)
PSA density at biopsy (ng/ml/cm^3)		1/378
Median (IQR)	0.1 (0.1–0.2)
≤ 0.15	198 (53%)
0.15–0.20	82 (22%)
> 0.20	97 (26%)
Diagnostic biopsy at academic center		0/378
Yes	210 (56%)
No	168 (44%)
Number of cores biopsied		1/378
Median (IQR)	12 (10,13)
Number of positive cores		1/378
Median (IQR)	3 (2,4)
% positive cores		1/378
Median (IQR)	25 (16.7–40)
> 33%	113 (30%)
Number of GG2 cores		0/378
Median (IQR)	2 (1–2)
1	160 (42%)
2	218 (58%)
Maximum Percentage Core Involvement		28/378^a
Median (IQR)	30 (15,60)
≤ 50%	252 (72%)
> 50%	98 (28%)
Percent cancer of total biopsy		72/378^a
Median (IQR)	7 (3,11.8)
Percent Gleason 4 in biopsy		77/378^a
Median (IQR)	10 (5,15)
≤ 5%	139 (46%)
> 5%	162 (54%)
pT stage after Radical Prostatectomy		0/378
2	275 (73%)
3	103 (27%)
4	0 (0%)
pN stage after Radical Prostatectomy		0/378
0/X	276 (99.5%)
1	2 (0.5%)
ISUP Grade Group after Radical Prostatectomy		0/378
1	53 (14%)
2	283 (75%)
3	35 (9%)
4	4 (1%)
5	3 (1%)

^aData primarily missing for patients biopsied outside our center.

Table 2. Complete case multivariable analysis.

	ISUP GG ≥ 3 (n = 42)		pT-stage ≥ 3 (n = 103)		Unfavorable pathology^a (n = 128)
	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Age at biopsy (years)
< 60	reference		reference		reference
60–69	0.91 (0.36–2.27)	0.83	1.64 (0.88–3.05)	0.12	1.39 (0.78–2.46)	0.27
≥ 70	1.02 (0.23–4.53)	0.98	1.45 (0.54–3.86)	0.46	1.18 (0.47–2.98)	0.72
PSA at biopsy (ng/ml)
< 4	reference		reference		reference
4–10	1.86 (0.45–7.68)	0.39	1.14 (0.53–2.49)	0.74	1.18 (0.56–2.47)	0.66
≥ 10	2.67 (0.43–16.51)	0.29	1.28 (0.37–4.41)	0.69	1.15 (0.36–3.67)	0.81
PSA density at biopsy (ng/ml/cm^3)
≤ 0.15	reference		reference		reference
0.15–0.20	1.56 (0.48–5.09)	0.46	0.66 (0.3–1.46)	0.31	0.94 (0.46–1.93)	0.87
> 0.20	2.72 (0.9–8.2)	0.075	1.31 (0.61–2.82)	0.49	1.8 (0.88–3.68)	0.11
Percent positive cores
≤ 33%	reference		reference		reference
> 33%	0.54 (0.16–1.81)	0.32	0.86 (0.45–1.65)	0.65	0.73 (0.39–1.36)	0.32
cT stage
1	reference		reference		reference
2	0.44 (0.14–1.4)	0.16	1.23 (0.67–2.28)	0.5	0.95 (0.52–1.72)	0.86
Biopsy at academic center
Yes	reference		reference		reference
No	0.98 (0.41–2.33)	0.96	0.76 (0.42–1.38)	0.37	0.71 (0.41–1.24)	0.23
Maximum Percentage Core Involvement
≤ 50%	reference		reference		reference
> 50%	0.56 (0.19–1.66)	0.3	2.61 (1.46–4.69)	0.0013	1.85 (1.05–3.25)	0.033
Percent Gleason 4 of cancer in biopsy
≤ 5%	Reference		reference		reference
> 5%	9.26 (2.58–33.2)	<0.001	1.2 (0.67–2.17)	0.54	1.66 (0.95–2.88)	0.075

^aDefined as pT ≥ 3, ISUP GG ≥ 3 and/or pN1.

Figure 2. Rate of upgrading on final pathology in respective cohort.

Table

	ISUP GG ≥ 3	pT-stage ≥ 3	Unfavorable pathology^a	N eligible for restriction (%)
Overall cohort
Rate of upgrading	11%	27%	33%	100%
≤ 5 % Gleason 4 of cancer in biopsy
Rate of upgrading	2%	22%	24%	46%
OR (95%CI)	0.17 (0.06–0.55)	0.73 (0.46–1.16)	0.62 (0.40–0.97)
p-value	0.0007	0.213	0.041
≤ 50% maximum core involvement
Rate of upgrading	12%	21%	29%	72%
OR (95% CI)	1.08 (0.66–1.77)	0.72 (0.48–1.04)	0.83 (0.58–1.17)
p-value	0.799	0.090	0.337
≤ 5% Gleason 4 and ≤ 50% maximum core involvement
Rate of upgrading	3%	17%	20%	34%
OR (95% CI)	0.24 (0.07–0.81)	0.54 (0.31–0.95)	0.49 (0.29–0.84)
p-value	0.021	0.034	0.0096
Royal Marsden
Rate of upgrading	12%	27%	34%	96%
OR (95% CI)	1.05 (0.67–1.70)	0.98 (0.70–1.36)	1.02 (0.74–1.39)
p-value	0.906	0.932	0.937
University of Toronto
Rate of upgrading	10%	25%	32%	86%
OR (95% CI)	0.87 (0.54–1.41)	0.87 (0.62–1.22)	0.90 (0.65–1.23)
p-value	0.623	0.437	0.519
PIRAS
Rate of upgrading	13%	27%	35%	32%
OR (95% CI)	1.23 (0.67–2.26)	0.97 (0.61–1.54)	1.07 (0.70–1.66)
p-value	0.515	1.00	0.740
MSKCC
Rate of upgrading	16%	23%	34%	42%
OR (95% CI)	1.54 (0.90–2.65)	0.79 (0.51–1.24)	1.05 (0.71–1.56)
p-value	0.142	0.377	0.838

^aDefined as ≥ ISUP GG 3, ≥ pT3 and/or N1