Mp40-11 contribution of gleason pattern 4 prostate cancer tissue to pre-operative psa values in intermediate risk prostate cancer: results from 4 860 rp specimens

You have accessJournal of UrologyCME1 Apr 2023MP40-11 CONTRIBUTION OF GLEASON PATTERN 4 PROSTATE CANCER TISSUE TO PRE-OPERATIVE PSA VALUES IN INTERMEDIATE RISK PROSTATE CANCER: RESULTS FROM 4 860 RP SPECIMENS Fabian Falkenbach, Lukas Hohenhorst, Zhe Tian, Mykyta Kachanov, Tobias Maurer, Sophie Knipper, Markus Graefen, and Lars Budäus Fabian FalkenbachFabian Falkenbach More articles by this author , Lukas HohenhorstLukas Hohenhorst More articles by this author , Zhe TianZhe Tian More articles by this author , Mykyta KachanovMykyta Kachanov More articles by this author , Tobias MaurerTobias Maurer More articles by this author , Sophie KnipperSophie Knipper More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Lars BudäusLars Budäus More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite advances in imaging and genetic testing, blood PSA remains the cornerstone of prostate cancer (PCa) diagnosis and risk stratification. Especially in the management of intermediate-risk PCa, the PSA value has strong implications for clinical decision-making. It is known, that within this group Gleason pattern (GP) 4 drives biological aggressiveness. Aim of our study was to assess the relationship between pre-operative blood PSA values and volume of GP 4 compared to GP 3 and benign tissue in Radical Prostatectomy (RP) specimens. METHODS: Overall, 4860 patients with localized pT2pN0cM0, intermediate risk PCa without tertiary GP were assessed. Individual GPs were quantified at the whole-mount section analysis of RP specimen. For analysis, patients with biochemical recurrence after RP and a pre-operative PSA >50 ng/ml were further excluded for avoiding contamination of the cohort by occult metastasis. Moreover, patients with prior / neoadjuvant treatment, a gland size <10 cc after TUR-P or gland size >150 cc (associated risk of chronic inflammation) were excluded. Multivariable linear regression analysis addressed the relationship between volume of tissue types and PSA values. RESULTS: Of 4860 patients, in 4390 (90%) a Gleason Score of 3+4 and in 470 (10%) a Gleason Score of 4+3 was present. Median age at RP was 63 years (IQR: 58-68 years), median PSA was 6.4ng/ml (IQR: 4.8-8.7ng/ml) and median prostate volume was 30cc (IQR: 23-40cc). PSA as well as PSA-Density were associated with the quantitative GP 4 fraction above 50% (p-value: <0.001). GP 4 tissue contributed to the pre-operative PSA by 0.37 ng/ml per cc, GP 3 and benign prostate tissue combined contributed by 0.062 ng/ml per cc (p-value: <0.001). There was no significant difference in PSA contribution between GP 3 and benign tissue. CONCLUSIONS: The highest contribution to PSA prior RP originates from GP 4 PCa tumor foci. PSA expression of GP 3 and benign tissue were not significantly different. This confirms the discussed potential indolent nature of GP 3 PCa. Within intermediate risk PCa, PSA is a strong surrogate parameter for the amount of GP 4 PCa tissue. Further confirmatory studies including e.g. imaging data are needed for excluding potential selection bias. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e549 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabian Falkenbach More articles by this author Lukas Hohenhorst More articles by this author Zhe Tian More articles by this author Mykyta Kachanov More articles by this author Tobias Maurer More articles by this author Sophie Knipper More articles by this author Markus Graefen More articles by this author Lars Budäus More articles by this author Expand All Advertisement PDF downloadLoading ...