The association between Gleason grade group, PSA levels, and prostatectomy outcomes for the optimized treatment of prostate cancer patients.

e17141 Background: Radical prostatectomy is a common approach for managing localized prostate cancer (PCa). Positive surgical margins (PSMs), upstaging or upgrading are associated with an increased risk of disease recurrence and warrant additional treatment such as radiation. This study aimed to assess the association between pre-operative PCa grade group and prostatectomy outcome based on PSMs, upstaging or upgrading, utilizing the specialized prostate cancer SEER database. Methods: Data for histologically confirmed PCa patients diagnosed between 2010-2020 were obtained from the SEER prostate cancer database, excluding cases with missing stage or Gleason scores, multiple primary tumors, or non-adenocarcinoma histology. Treatment was defined as the initial choice within a year of diagnosis. Results: A cohort of 278,877 patients met the inclusion criteria, where 123,640 selected prostatectomy for treatment. The median follow-up was 58 months. 34,748, 44,104, 22,061, 14,759 and 7,968 patients were in GG1-5, respectively. The percentage of PSMs increased with tumor grade being 8.6%, 8.7%, 9.1%, 9.2%, and 11%, in GG1-5, respectively. An increase in PSA levels was associated with a higher risk of PSMs, with odds ratios of 1.36 (95% CI: 1.25–1.47, p < 0.001) for PSA levels 4–10 ng/mL and 2.13 (95% CI: 1.95–2.32, p < 0.001) for levels >10 ng/mL after adjusting for clinical grade. Pre-operative grading predicts PSMs and/or upstaging in 15.7%, 23.1%, 28.9%, 33.2% or 41.8% for GG1-5 respectively (p<0.001). 44,788 patients who were diagnosed with GG3 or more, had a risk of PSMs/upstaging of 32.6%. Conclusions: Elevated PSA levels/grade group prior to prostatectomy is associated with an increased risk of PSMs and/or upstaging. It appears that patients with grade 3 PCa or higher may not be optimal candidates for prostatectomy, as subsequently approximately a third of patients may require further treatment.