Amanda Black

PhD, MPH

NCI, DCEG, EBP

Staff Scientist

PLCO (Learn more about this study)

PLCO-93

Jun 23, 2014

Upgrading and upstaging of men with clinically low-risk prostate cancer in PLCO

The management of prostate cancer following diagnosis depends on several factors including stage, grade, and patient demographics and preference, amongst others. Although prostate cancer management remains controversial, radical prostatectomy and radiation therapy are both considered definitive therapies for localized disease, and active surveillance is often an appropriate alternative. However, previous studies have demonstrated upgrading and upstaging of disease at radical prostatectomy among men who were otherwise considered low-risk. This might be explained i) biologically by the natural history of disease or ii) mechanically by sampling error associated with biopsy that becomes apparent when the whole prostate is examined following radical prostatectomy. Therefore, differentiation of men diagnosed with low-risk disease who are more likely to be upstaged on radical prostatectomy from those whose grade and stage remains unchanged may help to identify suitable candidates for active surveillance and subsequently minimize the harms of overtreating low-risk prostate cancer.

We aim to estimate the proportion of men upstaged and upgraded at radical prostatectomy and to determine the impact of potential factors (such as race, age, BMI, smoking status) on the risk of upgrading and upstaging at radical prostatectomy among men with low clinical risk disease. We will also compare prostate cancer mortality among those who are upgraded/upstaged and those who are not.