Clinical Predictors and Risk Factors of Gleason Score Upgrade: A Retrospective Cohort Analysis

<b>Background:</b> In prostate cancer (PCa) patients, discrepancies between biopsy-assigned Gleason Scores and those determined from surgical specimens are frequently reported. This phenomenon, known as Gleason score upgrade (GSU), can have significant clinical implications. This work aims to understand the factors contributing to GSU for refining prostate cancer management strategies. <b>Methods:</b> Data from 779 patients diagnosed with histologically confirmed PCa who underwent robot-assisted radical prostatectomy at a single tertiary care institution between January 2005 and December 2020 were examined. <b>Results:</b> In the univariable setting, 5-alpha reductase inhibitor (5-ARI) use was associated with a higher percentage of upgrading (42.3% vs. 30.4% among non-users; <i>p</i> = 0.03942). A more advanced pathological T stage (<i>p</i> = 0.01114) and lymph node positivity (<i>p</i> < 0.00001) correlated significantly with GSU. In the logistic regression model, advanced pathological stage increased the odds more than twofold (OR = 2.807, <i>p</i> = 0.00135). 5-ARI use was associated with notably higher odds of upgrading (OR = 3.809, <i>p</i> = 0.00004). Younger age slightly increased the likelihood of GSU (OR = 0.951 per year increase in age, <i>p</i> = 0.01101). <b>Conclusions:</b> Younger age, advanced pathological stage, and the use of 5-alpha reductase inhibitors were identified as significant predictors of GSU.