From Biopsy to Pathology: A Retrospective Cohort Study of Predictors of Gleason Score Upgrading in Grade Group 1 Prostate Cancer.
4 affiliations
- 1Department of General Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
- 2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C.
- 3Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.
- 4Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.
Abstract
Background/aim
This study aimed to identify pre-treatment predictors of Gleason score (GS) upgrading in patients with biopsy-confirmed Grade Group 1 (GS 3+3) prostate cancer (PCa) - those typically considered candidates for active surveillance according to National Comprehensive Cancer Network guidelines - so as to refine risk stratification and avoid under-treatment.Patients and methods
A retrospective analysis was conducted on patients with biopsy-proven GS 3+3 PCa who underwent radical prostatectomy (RP) at a tertiary referral center between 2010 and 2023. Preoperative clinical, pathological, and biochemical data were collected, including prostate-specific antigen (PSA) levels, PSA density, prostate volume (PV). Multivariable logistic regression was used to identify independent predictors of GS upgrading. Collinearity among PSA, PV, and PSA density was assessed using variance inflation factors and correlation matrix analysis.Results
Among the 121 patients included in the study, 64.46% experienced GS upgrading at the final pathology. Patients with GS upgrading were older (median age 67.5 years), had higher PSA density (median 0.3 ng/ml/cm³ vs. 0.18 ng/ml/cm³, p=0.0033), and exhibited a smaller median PV (36.4 ml vs. 41 ml, p=0.0145) compared to those without upgrading. These findings highlight the limitations of biopsy-based grading in accurately assessing tumor aggressiveness.Conclusion
GS upgrading is common in patients initially diagnosed with GS 3+3 PCa and is associated with pre-treatment clinical factors, including PSA density and smaller PV. Identifying these predictors preoperatively may improve risk stratification and guide personalized treatment strategies. Future research should focus on integrating genomic and molecular markers to increase the predictive accuracy and optimize patient management.
Related
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- CORRELATION OF SERUM ZINC WITH GLEASON SCORE AS A MARKER FOR PROSTATE CANCER AGGRESSIVENESS IN JOS.
BibTeX
@article{su2026from,
title = {{From Biopsy to Pathology: A Retrospective Cohort Study of Predictors of Gleason Score Upgrading in Grade Group 1 Prostate Cancer.}},
author = {Hsiao-Chun Su and Yung-Chun Su and Hsiang-Ying Lee and Yung-Shun Juan and Wen-Jeng Wu and Kevin Lu},
journal = {Cancer diagnosis \& prognosis},
year = {2026},
month = nov,
doi = {10.21873/cdp.10603},
url = {https://europepmc.org/article/MED/42968951},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - From Biopsy to Pathology: A Retrospective Cohort Study of Predictors of Gleason Score Upgrading in Grade Group 1 Prostate Cancer.
AU - Hsiao-Chun Su
AU - Yung-Chun Su
AU - Hsiang-Ying Lee
AU - Yung-Shun Juan
AU - Wen-Jeng Wu
AU - Kevin Lu
PY - 2026
DA - 2026/11/01
JO - Cancer diagnosis & prognosis
DO - 10.21873/cdp.10603
UR - https://europepmc.org/article/MED/42968951
AB - Background/aim This study aimed to identify pre-treatment predictors of Gleason score (GS) upgrading in patients with biopsy-confirmed Grade Group 1 (GS 3+3) prostate cancer (PCa) - those typically considered candidates for active surveillance according to National Comprehensive Cancer Network guidelines - so as to refine risk stratification and avoid under-treatment.Patients and methods A retrospective analysis was conducted on patients with biopsy-proven GS 3+3 PCa who underwent radical prostatectomy (RP) at a tertiary referral center between 2010 and 2023. Preoperative clinical, pathological, and biochemical data were collected, including prostate-specific antigen (PSA) levels, PSA density, prostate volume (PV). Multivariable logistic regression was used to identify independent predictors of GS upgrading. Collinearity among PSA, PV, and PSA density was assessed using variance inflation factors and correlation matrix analysis.Results Among the 121 patients included in the study, 64.46% experienced GS upgrading at the final pathology. Patients with GS upgrading were older (median age 67.5 years), had higher PSA density (median 0.3 ng/ml/cm³ vs. 0.18 ng/ml/cm³, p=0.0033), and exhibited a smaller median PV (36.4 ml vs. 41 ml, p=0.0145) compared to those without upgrading. These findings highlight the limitations of biopsy-based grading in accurately assessing tumor aggressiveness.Conclusion GS upgrading is common in patients initially diagnosed with GS 3+3 PCa and is associated with pre-treatment clinical factors, including PSA density and smaller PV. Identifying these predictors preoperatively may improve risk stratification and guide personalized treatment strategies. Future research should focus on integrating genomic and molecular markers to increase the predictive accuracy and optimize patient management.
SN - 2732-7787
ER -