KEY TAKEAWAYS
- The study aimed to investigate the predictive parameters associated with Gleason score 8 (4+4) downgrading in prostate biopsy following radical prostatectomy.
- Researchers noticed that PSMA PET/CT effectively predicts downgrading in patients with GS 4+4 PCa.
Gleason score 8 (4+4) prostate cancer (PCa) is often considered high-risk, but some patients may experience downgrading after radical prostatectomy, potentially altering their treatment and prognosis. Understanding the factors that predict this downgrading can help in more accurately assessing patient risk and tailoring treatment plans.
Ibrahim Can Aykanat and the team aimed to investigate the predictive parameters associated with Gleason score 8 (4+4) downgrading in prostate biopsy following radical prostatectomy.
They performed an inclusive analysis of 62 patients with a Gleason score of 4+4 on prostate biopsy who underwent robotic radical prostatectomy between 2017 and 2022.
About 38 of 62 (61.2%) patients were downgraded. In a multivariable logistic regression model, Ga-68 prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) SUVmax was an independent predictor of downgrading (OR 0.904; P = 0.011), and a Logistic Regression model was constructed using the following formula: Y = 1.465 – 0.95 (PSMA PET/CT SUVmax). This model correctly predicted downgrading in 72.6% of patients.
The AUC for PSMA PET/CT SUVmax was 0.709, with a cutoff of 8.8. A subgroup analysis was performed on 37 patients who had no other European Association of Urology (EAU) high-risk features. Of these, 25 out of 37 (67.5%) were downgraded, and 21 of these 25 had organ-confined disease. Low PSMA SUVmax (<8.1) and the percentage of GS 4+4 biopsy cores to cancer-bearing cores (45.0%) were independently associated with downgrading to GS 7.
The study concluded that PSMA PET/CT can be used to predict downgrading in patients with GS 4+4 PCa. Patients with GS 4+4 disease but no other EAU high-risk features, a low percentage of GS 4+4 biopsy cores relative to cancer-bearing cores, and a low PSMA PET/CT SUVmax are associated with a high likelihood of reclassification to an intermediate-risk group.
The study received open-access funding from the Scientific and Technological Research Council of Türkiye.
Source: https://pubmed.ncbi.nlm.nih.gov/38771329/
Aykanat IC, Kordan Y, Seymen H, et al. (2024). “The role of PSMA PET/CT in predicting downgrading in patients with Gleason score 4+4 prostate cancer in prostate biopsy.” World J Urol. 2024 May 21;42(1):341. doi: 10.1007/s00345-024-05012-2. PMID: 38771329; PMCID: PMC11108863.
