Clinical and histopathological parameters in transrectal ultrasound‐guided biopsies associated with tumor upgrading after radical prostatectomy: A comparative analysis of risk groups

Background Thanks to technological advances, prostate cancer (PCa) can be diagnosed at a younger age. It is known that most of these patients are in the low‐intermediate risk group, and the histological grade of the tumor increases in half of those undergoing radical prostatectomy (Rp) compared to their diagnostic biopsies. This is especially important in terms of active surveillance (AS) and/or the timely evaluation of curative treatment options in patients diagnosed at an early age. Our aim was to investigate clinical and histopathological parameters that may be associated with an increase in the histological grade of the tumor in patients with acinar adenocarcinoma who were diagnosed by transrectal ultrasound‐guided biopsy (TRUS‐Bx) and underwent Rp. Methods A total of 205 patients with classical acinar adenocarcinoma diagnosed by TRUS‐Bx without metastasis and who underwent Rp were grouped according to the D'Amico risk classification. Age at diagnosis, serum prostate‐specific antigen (PSA), PSA density, prostate volume, Prostate Imaging Reporting and Data System (PI‐RADS) score, clinical stage, Gleason Grade Group (GGG), high‐grade intraepithelial neoplasia in tumor‐free cores (HGPIN) (single and ≥2 cores), perineural invasion (PNI), and lymphovascular invasion (LVI) was obtained. Additionally, GGG, pathological stage, lymph node metastasis, surgical margin positivity, and tumor volume obtained from Rp were evaluated. Comparisons were made between the case groups in which the tumor grade increased and remained the same, in terms of age, serum PSA, PSA density, HGPIN in tumor‐free cores (single and ≥2 cores), PNI, and LVI in all biopsies (with or without tumors), as well as risk groups. In addition, the relationships of HGPIN in tumor‐free cores (single and ≥2 cores), PNI, and LVI on TRUS‐Bx with age, serum PSA and PSA density, tumor volume, surgical margin positivity, pathological stage, lymph node metastasis, and risk groups were examined separately. Results Of the patients, 72 (35.1%) were in the low‐risk group, 95 (46.3%) in the intermediate‐risk group, and 38 (18.5%) in the high‐risk group. Most of the patients with an increased histological grade (n = 38, 48.1%) were in the low‐risk group (p