The 4Kscore predicts adverse pathology at radical prostatectomy in men diagnosed at biopsy with gleason 6
BAUS ePoster online library. Galvin D.
Jun 26, 2018; 211338
Dr. David Galvin
Dr. David Galvin
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Introduction: Men at biopsy (Bx) with Gleason 6 prostate cancer (PCa) would benefit from better understanding their risk for adverse pathology (Gleason score ≥7 or Gleason 6 with ≥pT3a). Our study objective was to determine if a preoperative 4Kscore from men with Gleason 6 could predict adverse pathology at radical prostatectomy (RP).

Methods: Serum samples from 177 men with Bx-detected Gleason 6 PCa who underwent RP at Martini Klinik (MK) from 2003 to 2013 were obtained from the MK bio-repository and the 4Kscore calculated. Bx and RP pathology were read by MK. Primary outcome was adverse RP pathology. 4Kscore and other clinical and pathologic characteristics were evaluated for their association with adverse RP pathology.

Results: 4Kscore, prostate volume, % positive cores, and total tumor length were significantly associated with adverse RP pathology (p ≤0.002). Total PSA, %fPSA ratio, DRE status and biopsy T stage were not associated (p ≥0.2). Age and no previous biopsy trended towards significance (p=0.08 and 0.07, respectively). On multivariate modeling, 4Kscore (OR=1.75 per 20% increase, 95% CI 1.19-2.57, p=0.004) and prostate volume (OR=0.67 per 20cc of volume, 95% CI 0.54-0.95, p=0.020) were independently associated. Comparing a 4Kscore cutoff of 7.5% with other risk indices (NCCN, D'Amico and CAPRA) demonstrated 4Kscore had 80% sensitivity, 40% specificity, 63% PPV, and 72% NPV. 4Kscore ≥7.5% did not miss detection of Gleason 8 PCa and missed 7% (1 of 14) pT3a/b.

Conclusions: The 4Kscore was significantly associated with adverse pathology at radical prostatectomy in men with Bx-proven Gleason 6 PCa.
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