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    This study aims to investigate the factors contributing to the discrepancy in between biopsy Gleason score (GS) and radical prostatectomy GS in patients diagnosed with prostate cancer.341 patients who underwent radical prostatectomy from 2011/04 to 2020/12 were identified. 102 Patients with initial GS of six after biopsy were enrolled. Preoperative clinical variables and pathological variables were also obtained and assessed. The optimal cut-off points for significant continuous variables were identified by the area under the receiver operating characteristic curve.Upgrading was observed in 63 patients and non-upgrading in 39 patients. In the multiple variables assessed, smaller prostate volume (PV) (p value = 0.0007), prostate specific antigen density (PSAD) (p value = 0.0055), positive surgical margins (p value = 0.0062) and pathological perineural invasion (p value = 0.0038) were significant predictors of GS upgrading. To further explore preclinical variables, a cut-off value for PV (≤ 38 ml, p value = 0.0017) and PSAD (≥ 0.26 ng/ml2, p value = 0.0013) were identified to be associated with GS upgrading.Smaller PV and elevated PSAD are associated with increased risk of GS upgrading, whereas lead-time bias is not. A cut-off value of PV < 38 ml and PSAD > 0.26 ng/ml2 were further identified to be associated with pathological GS upgrading.Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.


    Tzu-Heng Huang, Wei-Ming Li, Hung-Lung Ke, Ching-Chia Li, Wen-Jeng Wu, Hsin-Chih Yeh, Yen-Chun Wang, Hsiang-Ying Lee. The factors impacting on Gleason score upgrading in prostate cancer with initial low Gleason scores. Journal of the Formosan Medical Association = Taiwan yi zhi. 2024 Mar 29

    PMID: 38555188

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