Does extent of prostate-specific antigen fluctuation can predict Gleason score upgrading in low-risk prostate cancer patients?

Özet

Objective: To evaluate the effect of prostate-specific antigen (PSA) fluctuation on Gleason score (GS) upgrading, disease upstaging, oncological outcomes in low-risk prostate cancer (PCa) patients who underwentrobot-assisted laparoscopic radical prostatectomy (RARP) and met the inclusion criteria for active surveillance (AS).Material and methods: Data of 354 low-risk PCa patients who underwent RARP were retrospectivelyevaluated. Patients were divided into two groups: PSA fluctuation rate 9.5%/month (Group 2, n=162). Mainly compared parameters were GS upgrading, disease upstaging, biochemical recurrence (BCR) and surgical margin positivity (SMP) rates.Results: GS upgrading, disease upstaging and SMP were detected in 128 (36.2%), 56 (15.8%) and 42 (11.9%)patients, respectively. After a median follow-up of 46 months, BCR was observed in 40 (11.3%) patients.GS upgrading (41.1% vs. 30.2%, p=0.033), disease upstaging (19.8% vs. 11.1%, p=0.028), SMP (15.1% vs.8%, p=0.035) and BCR development (15.6% vs. 6.2%, p=0.005) rates were statistically significantly higherin Group 1 than Group 2. In multivariate analysis, digital rectal examination positivity, the presence of twopositive cores and low PSA fluctuation rate were found to be significant predictors of GS upgrading.Conclusion: Low PSA fluctuation rate is associated with higher GS upgrading.