Is preoperative staging reliable for low risk prostate cancer?

Abstract

Objective: To identify the risk factors of upgrading in patients with low risk prostate cancer who underwent radical prostatectomy. Patients and Methods: All eligible patients underwent RaLRP between January 2007 to December 2017 with, 1) low risk prostate cancer according to D'Amico risk stratification identified on diagnostic non‐targeted TRUS biopsy and 2) multiparametric MRI staging <= 2. Associated factors of upgrading were analysed using linear regression analysis. Results: 99 patients were identified as low risk cancer. In final histopathology, the rate of upgrading in Gleason score and upstaging in T stage was 40.2% and 61.7%. The preoperative PSA density was significant higher in the upgraded group (p = 0.049, OR 28.2, 95% CI 1.02 – 783), with an optimal cutoff at 0.102 ng/mL2 (sensitivity 97.3%, specificity 19.3%). Preoperative PSA, MRI T stage, PIRADS grading and digital rectal exam finding did not show a significant correlation (p = 0.223, p = 0.096, p = 0.428 and p = 0.889 respectively). Conclusion: The correct risk stratification with non‐targeted TRUS biopsy is poor with a high incidence of upgrading on final histopathology. Therefore, for patients who would like to consider active surveillance, a confirmation biopsy with transperineal systematic ± targeted biopsy should be considered.