Accurate grading at the time of diagnosis if fundamental to risk stratification and treatment decision making in patients with prostate cancer. Whilst previous studies have demonstrated significant pathological upgrading and downgrading following radical prostatectomy (RP), these were based on historical cohorts and do not reflect contemporary patient selection and management practices. The aim of this national, multicentre observational study was to characterise contemporary rates and risk factors for pathological upgrading after RP in the United Kingdom (UK). All RP entries on the British Association of Urological Surgeons (BAUS) Radical Prostatectomy Registry database of prospectively entered cases undertaken between January 2011 and December 2016 were extracted. Those patients with full preoperative PSA, clinical stage, needle biopsy and subsequent RP pathological grade information were included. Upgrade was defined as any increase in Gleason grade from initial needle biopsy to pathological assessment of the entire surgical specimen. Statistical analysis and multivariate logistic regression were undertaken using R version 3.5 (R Foundation for Statistical Computing, Vienna, Austria). A total of 17,598 patients met full inclusion criteria. Absolute concordance between initial biopsy and pathological grade was 58.9% (n = 10,364), whilst upgrade and downgrade rates were 25.5% (n = 4489) and 15.6% (n = 2745) respectively. Upgrade rate was highest in those with D’Amico low risk compared with intermediate and high-risk disease (55.7% versus 19.1 and 24.3% respectively, P < 0.001). Although rates varied between year of surgery and geographical regions, these differences were not significant after adjusting for other preoperative diagnostic variables using multivariate logistic regression. Pathological upgrading after RP in the UK is lower than expected when compared with other large contemporary series, despite operating on a generally higher risk patient cohort. As new diagnostic techniques that may reduce rates of pathological upgrading become more widely utilised, this study provides an important benchmark against which to measure future performance.

中文翻译：

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英国通过手术治疗的前列腺癌的病理升级：英国泌尿外科外科医生根治性前列腺切除术注册机构的趋势和危险因素

如果对前列腺癌患者的风险分层和治疗决策至关重要，则在诊断时进行准确的分级。尽管先前的研究表明根治性前列腺切除术（RP）后病理显着升级和降级，但这些是基于历史队列的研究，并未反映当代患者的选择和管理实践。这项全国性的，多中心的观察性研究的目的是表征英国（英国）RP发生后当代发生率和病理升级的危险因素。提取了英国泌尿外科医师协会（BAUS）根治性前列腺切除术注册数据库中所有2011年1月至2016年12月进行的前瞻性病例的RP条目。那些具有完整术前PSA，临床分期，包括穿刺活检和随后的RP病理分级信息。升级定义为从最初的穿刺活检到整个手术标本的病理评估，格里森评分的任何升高。使用R版本3.5（R统计学计算基金会，维也纳，奥地利）进行了统计分析和多元逻辑回归。共有17,598名患者符合完全纳入标准。初始活检与病理分级之间的绝对一致性为58.9％（n = 10,364），而升级和降级的比率分别为25.5％（n = 4489）和15.6％（n = 2745）。与中度和高危疾病相比，D'Amico低危人群的升级率最高（分别为55.7％，19.1和24.3％，P <0.001）。尽管发生率在手术年份和地理区域之间有所不同，使用多元逻辑回归对其他术前诊断变量进行校正后，这些差异并不显着。尽管在较高风险的患者队列中进行手术，但与其他大型当代医学期刊相比，英国进行RP后的病理学升级低于预期。随着可以降低病理升级率的新诊断技术得到越来越广泛的应用，本研究提供了衡量未来表现的重要基准。