PREDICTORS OF POSITIVE MARGIN AND UPSTAGING TO LOCALLY ADVANCED PROSTATE CANCER IN PATIENTS WITH UNILATERAL AND BILATERAL DISEASE AT BIOPSY

WANG DONGYA*, WU JIANHONG*, ZHANG HAOJIE*, ZHANG ZHONGYUN*, XIAO LI**, SUN ZHONGQUAN*, QIAN WEIQING*,#

*Department of Urology, HuaDong hospital, Fudan University, Shanghai 200040, China - **Department of pathology, HuaDong hospital, Fudan University, Shanghai 200040, China

Introduction: Whether the sexual nerve can be retained in radical surgery depends on the possibility of occult above T3 prostate cancer. But now, the predictors of upstaging to locally advanced prostate cance r(LAPCA) and positive margin in patients with unilateral and bilateral disease at biopsy were undetermined.

Materials and methods: We retrospectively studied 118 patients both diagnosed with clinically localized prostate cancer (cT1c/T2c) in 2010 to 2016 and treated with prostatectomy in our single center. We analyzed possible predictors such as age, prostate specific antigen (PSA), free prostate specific antigen (fPSA), prostate volume (PV), MRI scan results, biopsy cores counts ( BPx), clinic T stage, percent of positive core (PPC), percent of maximum core length (PMPC) and new grade of biopsy Gleason Score (bnGS) by logistic regression and ROC curve.

Results: At prostatectomy totally 39.8% (47cases), 31.4% (36cases) of cases were upstaging to LAPCA and Margin positive, there were26.9 % upstaging in the unilateral group,56.9% in the bilateral group. Multivariable analysis of 118 of margin positive were more than 38% PMPC (p< 0.001) and MRI results (p=0.023). Predictors of up staging to LAPCA were PSA greater than13ng/ml (p= 0.001) and more than 38% PMPC (p= 0.016) in unilateral positive group, and PSA greater than 13ng/ml (p=0.029), more than 30% PPC (p=0.012), more than 38% PMPC (p= 0.007) in bilateral positive group. We also analyzed ROC curve in each subgroup to get the cut-off point, which is PMPC>42.3%, MRI suspicious to predict margin positive, PSA>11.35ng/ml, PMPC>38.7% to predict upstaging to LAPCA in unilateral positive group, PSA>15.15 ng/ml, PMPC>34.8%, PPC>35.4% to predict upstaging to LAPCA in bilateral positive group. Tests in parallels increased the sensitivity and negative predictive value (NPV) in each subgroup, Tests in serials increased the specificity and positive predictive value (PPV) in each subgroup.

Conclusions: Nearly one third to one half of clinically supposed localized prostate cancer can be pathological up staging to locally advanced disease or positive margin with different occurrence in unilateral and bilateral positive biopsy groups .Clinic stage based on biopsy should be risk stratified by these factors before deciding on therapeutic strategies, but now larger, prospective and multi-center clinical trials are demanded.