Predictors of Patients with Clinically Insignificant Prostate Cancer to Harbor Significant Cancer Open Access

Abstract

Introduction: The discrepancy of prostate cancer results between biopsy and prostatectomy is common. Our study aim was to identify factors that could help predict more advanced disease in patients with clinically insignificant prostate cancer.

Method: We identified 15,892 prostate cancer cases from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with clinically insignificant PCa between 2010 and 2011. Clinically insignificant prostate cancer was defined using the following criteria: locally confined prostate cancer based on clinical staging (clinical AJCC stage T1-T2) with a biopsy Gleason score of 3+3. Categorical variables were assessed using chi-square tests. Multivariate logistic regression modeling was used to assess predictors of more advanced disease following prostatectomy.

Results: Of the 15,489 patients eligible for the study, 8,010 patients (52%) experienced a shift from clinically insignificant PCa to significant PCa, including 1,228 patients (8%) shifting to AJCC stage T3-T4, 4,647 patients (30%) upgraded to GS>=7 (or any GS containing grade 4 or 5), and 2,135 (14%) patients experiencing both an upgraded GS and a shift in AJCC stage. Higher PSA and older age were the two strongest predictors. Race, SEER region and poverty were also independent predictors for selected groups.

Conclusions: Patients diagnosed with clinically insignificant prostate cancer may harbor significant cancer. Future work should look for ways to improve the accuracy of clinical measurements so that clinicians can minimize the probability of misclassification and more accurately classify patients prior to treatment so that more informed decision making can occur.

Key words: SEER, Biopsy, Prostatectomy, Prostate Cancer, Predictor, Insignificant, Significant

Table of Contents

Table of Contents

Background............................................... 1

Methods...................................................5

Results.....................................................9

Discussion................................................12

Conclusions............................................ .17

Future Directions.......................................18

References...............................................19

Tables and Figures.....................................24

Figure 1. Figure of Exclusion on Study Cohort....................24

Table 1. Biopsy Gleason Score of PCa Patients by Biopsy T Stage............25

Table 2. Results of Prostatectomy by Prostatectomy Gleason Score and AJCC T Stage............................25

Table 3. Demographic and Clinical Features of Study Population by Results of Prostatectomy...........................26

Table 4. Multivariate Logistic Regression Analysis of Predictors of Upgrade and Upstage After Prostatectomy...........................26

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Biopsy Insignificant Predictor
Committee Chair / Thesis Advisor	Ward, Kevin C., Emory University
Partnering Agencies	National or regional non-profit organization (e.g., American Cancer Society)

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