Clinicopathological Analysis of the ISUP Grade Group And Other Parameters in Prostate Cancer: Elucidation of Mutual Impact of the Various Parameters

BackgroundProstate cancer has become increasingly common worldwide. Although Grade group (GG) is widely accepted as an indicator of prostate cancer grade, there are malignancies that cannot be defined by GG alone. Moreover, the relationship between GG and other parameters remains unclear. Herein, we aimed to explore the biological characteristics of prostate cancer.MethodsThis study included 299 radical prostatectomy cases. The Chi-square test and analysis of variance were used to analyze the association of GG with binary and continuous variables. We then conducted morphological analyses. Multivariate analyses were performed to extract the data on risk factors for biochemical recurrence (BCR) and lymph node metastasis.ResultsThe lymphatic, venous, perineural, and seminal vesicle invasion rates were 37/299 (12.4%), 25/299 (8.4%), 280/299 (93.6%), and 23/299 (7.7%), respectively. The extraprostatic extension (EPE), positive surgical margin, tertiary Gleason pattern 5, intraductal carcinoma of the prostate gland, and lymph node metastasis rates were 89/299 (29.8%), 106/299 (35.5%), 33/260 (12.7%), 56/299 (18.7%), and 23/299 (7.7%), respectively. As GG increased, various parameters became easier to visualize; however, there were differences between the parameters. Postoperative BCR was observed in 31/242 (12.8%) cases without preoperative hormone therapy; GG2, GG3, GG4, and GG5 accounted for 4, 7, 7, and 13 cases, respectively. Multivariate analyses revealed that GG and tumor diameter were significant risk factors for early BCR, whereas lymphatic invasion, EPE, and seminal vesicle invasion were significant risk factors for lymph node metastasis. For BCR, the odds ratios (ORs) for GG and tumor diameter were 2.253 (95% confidence interval (CI]): 1.297–3.912; P=0.004) and 1.074 (95% CI: 1.011–1.142; P=0.022), respectively. For lymph node metastasis, ORs for the presence of lymphatic invasion, EPE, and seminal vesicle invasion were 7.425 (95% CI: 1.688–22.583; P=0.004), 4.391 (95% CI: 1.037–18.589; P=0.044), and 5.755 (95% CI: 1.308–25.316; P=0.021), respectively.ConclusionsWe summarized various parameters correlating with each GG. Through multivariate analyses, we established the independent risk factors for early BCR and lymph node metastasis. In addition to GG, other important indices of malignancy were determined and weighted to provide a basis for future investigations.

Impact of Obesity on Adverse Pathological Characteristics After Radical Prostatectomy

Background: The effect of obesity on pathological features was different from country to country in other studies. To investigate whether obesity affected pathological characteristics of PCa after laparoscopic radical prostatectmy (LRP) in Chinese man.Methods: Medical record of 670 Chinese patients who underwent LRP between 2018 and 2020 were retrospectively reviewed. Patient height and weight were meaured before surgery to calculate the body mass index (BMI). They were categorized into three groups according to Chinese classification of obesity: normol weight (BMI＜24.0kg/m2),overweight (24.0 ≤ BMI ＜28.0kg/m2) and obese(BMI≥28.0kg/m2). The associations between BMI and operating age, preoperative prostate-specific antigen (PSA) level, were assessed with the Kruskal-Wallis test. The associations between BMI and pathological features were assessed with chi –square test.Results: Of the 670 patients, 31.5% patients were normal weight, 51.3% were overweight, 17.2% were obese. Operating age (P=0.029) tend to decrease as BMI increased. Seminal vesicle invasion differ significantly among BMI categoties (P=0.003), and other adverse pathologic characteristics , such as positive surgical margin (PSM) (P=0.851), International Society of Urological Pathology (ISUP) grade(P=0.194), extracapsular extension(P=0.460) were not associated with BMI categoties. In the Logistic regression model, higher BMI was an independent risk factors for seminal vesicle invasion after adjusting for multiple clinical preoperative characteristics.Conclusions: Overweight and obese Chinese PCa patients treated by LRP had lower operating age compared to normal weight patients. Seminal vesicle invasion was associated with higher BMI and other adverse pathologic characteristics are not significantly affected by BMI.