Clinicopathologic Profile of Filipino Men with Low-Risk Prostate Cancer and Predictors of Unfavorable Pathology at Radical Prostatectomy

Active surveillance (AS) is the preferred initial management for low-risk prostate cancer; however, a substantial proportion of patients are found to harbor more advanced disease at radical prostatectomy. This study evaluated the clinicopathologic features and surgical outcomes of Filipino men with low-risk prostate cancer and identified predictors of unfavorable pathology. This retrospective cohort study included 65 Filipino men with low-risk prostate cancer who underwent radical prostatectomy. Low-risk disease was defined as Grade Group 1 (GG1; Gleason score 3+3=6) and prostate-specific antigen (PSA) <10 ng/mL. Clinicopathologic features included age, PSA, biopsy characteristics, and measures of tumor volume such as number of positive cores and percent positive cores (PPC). Unfavorable pathology was defined as either upgrading to Grade Group ≥2 or GG1 with tertiary pattern 4, pathologic upstaging (pT3–pT4 or pN1), or both. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify predictors of unfavorable pathology and determine an optimal cutoff for PPC. Unfavorable pathology was observed in 56.92% of patients, predominantly due to upgrading, with fewer cases demonstrating upstaging. No cases of regional lymph node metastasis were identified. On multivariable analysis, PPC (per 10% increase) was a significant predictor of unfavorable pathology (OR 2.95, 95% CI 1.60–6.58; p=0.003), whereas age and PSA were not significant predictors. ROC analysis identified a cutoff value of 12.22% positive cores. A substantial proportion of Filipino patients with low-risk prostate cancer harbor more advanced disease at radical prostatectomy. Tumor volume, as measured by PPC, may help identify patients at risk for unfavorable pathology and aid in refining selection of candidates for AS.