Factors Associated with Upgrading of Pathological ISUP Grading Following Radical Prostatectomy: A Retrospective Cohort Study

Abstract

Background: Previous studies have reported discordance in Gleason scores (GSs) between needle biopsy results and radical prostatectomy (RP) specimens. Objectives: To identify factors associated with International Society for Urological Pathology (ISUP) grade upgrading in patients who underwent radical prostatectomy (RP). Methods: In this retrospective cohort study, 110 patients with prostate cancer who underwent RP between 2019 and 2024 were evaluated. Demographic data, laboratory results, pathological characteristics, and MRI findings (Prostate Imaging-Reporting and Data System [PI-RADS], intraprostatic cancerous lesions, extracapsular extension, and seminal vesicle invasion) were extracted from patient records. Patients were classified into two groups according to the presence or absence of ISUP grade upgrading. Upgrading was defined as any increase in ISUP grade in the RP specimen compared with that in the needle biopsy. Univariate and multivariate logistic regression analyses were performed to evaluate predictive factors for upgrading. Results: Among the 110 patients (mean age, 62.97 years), 47 (42.7%) had ISUP upgrading on RP compared with biopsy. In univariable analysis, age, PSA, PSA density (PSAD), the time interval between biopsy and RP, and MRI parameters were not significantly associated with ISUP upgrading (P > 0.05). In multivariate logistic regression analysis, both a free/total PSA (f/tPSA) ratio ≤ 10% (OR = 0.27, 95% CI, 0.11 - 0.65, P = 0.004) and an ISUP grade of 1 on biopsy (OR = 0.25, 95% CI, 0.11 - 0.57, P = 0.001) were independently associated with the risk of upgrading. Conclusions: An f/tPSA ratio of ≤ 10% and an ISUP grade of 1 on biopsy were associated with pathological upgrading. Prospective studies are required to validate these findings.