Original Articles

Preoperative Factors Related to Stage and Grade Increase in D’Amico Low-Risk and Intermediate-Risk Group Patients


  • Serdar Çelik
  • Ozan Bozkurt
  • Ömer Demir
  • Burçin Tuna
  • Kutsal Yörükoğlu
  • Güven Aslan

Received Date: 29.08.2016 Accepted Date: 20.09.2016 Bull Urooncol 2016;15(4):148-153


In this study we searched preoperative factors that may cause upstaging and upgrading at D’Amico low-risk and intermediate-risk group patients who underwent radical prostatectomy (RRP) due to prostate adenocarcinoma.

Materials and Methods:

Among patients undergoing RRP retrospective evaluation, those who have PSA<10ng/mL, prostate needle biopsy (PNB) Gleason score (GS) ≤6 and clinical T1c-T2a were placed in the low-risk group. Patients with PSA 10-20 ng/mL and/or PNB GS=7 and/or clinical T2b were placed in the intermediate-risk group. In accordance with PNB GS and clinical stage, patients whose RRP GS and T stage increased or not with PNB GS 3+4=7 (7a) and RRP GS 4+3=7 (7b) were assessed as upgrade. The PSA data, PNB and RRP pathological data and biochemical recurrence rates of patients were investigated. Current data were used to separately assess and compare low-risk and intermediate-risk groups according to upstaging and upgrading.


Among the 151 patients in the low-risk group, it was identified that 21 had upstage and 63 had upgrade, while in the 187 patients in the intermediate-risk group 84 had upstage and 39 had upgrade. In the low-risk group, the PNB tumor percentage was identified to be high in the upgrade group (p<0.001). In the intermediate-risk group, PSA, PSA density, PNB perineural invasion (PNI) positivity, tumor percentage and positive core numbers were high in the upstage group. However, in the intermediate-risk group PSA, fPSA, PSA density, PNB GS and tumor percentage were high in the upgrade group (p<0.05). When postoperative factors were examined, tumor volume and surgical margin positivity were observed to be correlated with upstaging and upgrading.


In conclusion, in the low-risk group PNB tumor percentage was related to upgrading, in the intermediate-risk group, PSA, PSA density and PNB tumor percentage were correlated with both upstaging and upgrading, while PNB PNI positivity and positive core numbers were observed to be correlated with T stage increase only.

Keywords: D’Amico risk classification, low-risk and intermediate-risk prostate cancer, prostate needle biopsy, upgrading, upstaging

Full Text (Turkish)