MP53-04: Rates of upgrading and upstaging in prostate cancer patients with single GGG1 positive biopsy core

Benedikt Hoeh*, Frankfurt am Main, Germany, Rocco Flammia, Rome, Italy, Mike Wenzel, Frankfurt am Main, Germany, Sorce Gabriele, Milan, Italy, Francesco Chierigo, Genova, Italy, Zhe Tian, Fred Saad, Montreal, Canada, Markus Graefen, Hamburg, Germany, Michele Gallucci, Rome, Italy, Alberto Briganti, Milan, Italy, Carlo Terrone, Genova, Italy, Shahrokh Shariat, Vienna, Austria, Derya Tilki, Luis Kluth, Hamburg, Germany, Philipp Mandel, Felix Chun, Frankfurt am Main, Germany, Pierre Karakiewicz, Montreal, Canada

Introduction: Not infrequently patients are diagnosed with clinically localized prostate based on a single positive biopsy core exhibiting Gleason grade group 1 (GGG1) with variable prostate-specific antigen (PSA) levels. We hypothesized that regardless of PSA in cT1 to cT2 patients, presence of GGG3/GGG4/GGG5 and/or non-organ confined (NOC) stage will rarely be identified.

Methods: Within the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), of all clinically localized PCa patients, we included those with PSA =50ng/ml and a single positive biopsy core for GGG1. Rates of upgrading (GGG3/GGG4/GGG5) and/or upstaging (=pT3 and/or pN1) were tabulated in radical prostatectomy (RP) patients. Overall treatment rates were examined. Subsequently, treatment trends were examined, relying on estimated annual percentage changes analyses.

Results: Of all clinically localized PCa patients (n=77,088), 12,061 (15.6%) harbored single GGG1 positive biopsy core at diagnosis. In cT1-patients (n=2,074), 132 (6.4%) and 135 (6.5%) were upgraded and upstaged vs 38 (6.5%) and 29 (4.9%) in cT2 patients (n=587). In cT1 patients, 235 (11.0%) patients exhibited upgrading and/or upstaging combined vs 58 (9.9%) in cT2 patients. No local treatment was recorded in 5,235 (53.0%) cT1 vs in 1,039 (49%) cT2 patients. No local treatment rates increased over time from 35.0 to 67.0% vs 34.0 to 63.0% in cT1 vs cT2 patients.

Conclusions: In single GGG1 positive biopsy core PCa patients, the combined proportion of upgrading and upstaging should be expected in one tenth. In consequence, the overwhelming majority harbors favorable grade and stage that is compatible with no local treatment.

Source of Funding: The research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.