Factors associated with Gleason score upgrading in biopsy-proven Gleason 6 prostate cancer: a retrospective cohort study.
5 affiliations
- 1Yangzhou University School of Medicine, Yangzhou, Jiangsu Province, China.
- 2Department of Urology, Ansteel General Hospital, Anshan, Liaoning Province, China.
- 3Department of Urology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu Province, China.
- 4Yangzhou University School of Medicine, Yangzhou, Jiangsu Province, China. [email protected].
- 5Department of Urology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu Province, China. [email protected].
Abstract
Objective
The present study aims to evaluate the incidence and risk factors of postoperative pathological upgrading in patients with biopsy Gleason score 6(bGS6), and to explore whether relevant clinical parameters can stratify patients at high risk of upgrading.Materials and methods
A total of 241 patients who were diagnosed with bGS6 and subsequently underwent RP at our center were included in this study. The clinical baseline parameters of the patients were collected, and the predictive factors for postoperative pathological upgrading were identified using logistic regression analysis.Results
A total of 96 patients (39.8%) with bGS6 experienced Gleason score upgrading after radical prostatectomy(RP). Multivariate logistic regression analysis indicated that prostate specific antigen density (PSAD) > 0.21 ng/ml² (p = 0.003, OR: 3.403) and Prostate Imaging-Reporting and Data System(PI-RADS) 4-5 (p < 0.001, OR: 3.887) were risk factors for the upgrading after RP. In the present cohort, when patients with bGS6 met both PI-RADS 4-5 and PSAD > 0.21 ng/ml², the probability of postoperative Gleason score upgrading was 78.7%; when at least one of the risk factors was fulfilled, the upgrading probability was 37.7%; if none of the risk factors were met by the patients, the probability of remaining Gleason score 6 of postoperative was 84.4%.Conclusion
For patients with bGS6 who are at intermediate or low risk, PSAD > 0.21 ng/ml2 and PI-RADS 4-5 are risk factors for the upgrading after RP. The risk stratification model constructed based on these two parameters allows for the preliminary differentiation of postoperative upgrading risk levels among patients in this cohort. This finding regarding the association between the model and upgrading risk provides a reference basis for future prospective validation studies.
Related
- From Biopsy to Pathology: A Retrospective Cohort Study of Predictors of Gleason Score Upgrading in Grade Group 1 Prostate Cancer.
- Histopathological Imaging and Artificial Intelligence for Cancer Diagnosis and Gleason Grading: A Brief Review of Prostate Cancer.
- TexTNet: a texture-guided hierarchical architecture for prostate cancer Gleason segmentation in whole slide images
- CORRELATION OF SERUM ZINC WITH GLEASON SCORE AS A MARKER FOR PROSTATE CANCER AGGRESSIVENESS IN JOS.
- Gleason Pattern 4 Burden and Adverse Pathology in ISUP Grade Group 2 Prostate Cancer: Implications for Active Surveillance Selection
BibTeX
@article{guo2026factors,
title = {{Factors associated with Gleason score upgrading in biopsy-proven Gleason 6 prostate cancer: a retrospective cohort study.}},
author = {Cheng-Hao Guo and Liang-Yong Zhu and Shu-Ping Chi and Xiao Tan and Yang Luan and Xue-Fei Ding},
journal = {BMC urology},
year = {2026},
month = aug,
doi = {10.1186/s12894-026-02292-1},
url = {https://europepmc.org/article/MED/42958541},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Factors associated with Gleason score upgrading in biopsy-proven Gleason 6 prostate cancer: a retrospective cohort study.
AU - Cheng-Hao Guo
AU - Liang-Yong Zhu
AU - Shu-Ping Chi
AU - Xiao Tan
AU - Yang Luan
AU - Xue-Fei Ding
PY - 2026
DA - 2026/08/03
JO - BMC urology
DO - 10.1186/s12894-026-02292-1
UR - https://europepmc.org/article/MED/42958541
AB - Objective The present study aims to evaluate the incidence and risk factors of postoperative pathological upgrading in patients with biopsy Gleason score 6(bGS6), and to explore whether relevant clinical parameters can stratify patients at high risk of upgrading.Materials and methods A total of 241 patients who were diagnosed with bGS6 and subsequently underwent RP at our center were included in this study. The clinical baseline parameters of the patients were collected, and the predictive factors for postoperative pathological upgrading were identified using logistic regression analysis.Results A total of 96 patients (39.8%) with bGS6 experienced Gleason score upgrading after radical prostatectomy(RP). Multivariate logistic regression analysis indicated that prostate specific antigen density (PSAD) > 0.21 ng/ml² (p = 0.003, OR: 3.403) and Prostate Imaging-Reporting and Data System(PI-RADS) 4-5 (p < 0.001, OR: 3.887) were risk factors for the upgrading after RP. In the present cohort, when patients with bGS6 met both PI-RADS 4-5 and PSAD > 0.21 ng/ml², the probability of postoperative Gleason score upgrading was 78.7%; when at least one of the risk factors was fulfilled, the upgrading probability was 37.7%; if none of the risk factors were met by the patients, the probability of remaining Gleason score 6 of postoperative was 84.4%.Conclusion For patients with bGS6 who are at intermediate or low risk, PSAD > 0.21 ng/ml2 and PI-RADS 4-5 are risk factors for the upgrading after RP. The risk stratification model constructed based on these two parameters allows for the preliminary differentiation of postoperative upgrading risk levels among patients in this cohort. This finding regarding the association between the model and upgrading risk provides a reference basis for future prospective validation studies.
SN - 1471-2490
ER -