The De Ritis Ratio (AST/ALT) and Its Diagnostic Relevance in ISUP Grade Reclassification After Prostatectomy

Aim: The prognostic value of the De Ritis ratio (AST/ALT) in localized prostate cancer remains uncertain. This study evaluated its predictive role in International Society of Urological Pathology (ISUP) grade upgrading and adverse pathological features following radical prostatectomy.Material and Methods: This retrospective study included 152 patients who underwent radical prostatectomy for prostate adenocarcinoma between 2012 and 2022. The De Ritis ratio was calculated using preoperative AST and ALT levels. Patients were grouped according to ISUP grade upgrading between biopsy and final pathology. Receiver operating characteristic (ROC) analysis and multivariate logistic regression were performed.Results: ISUP upgrading occurred in 46.3% of patients. Mean De Ritis ratios did not differ significantly between groups (p = 0.38). However, a ratio ≤1.22 was associated with higher upgrading rates (51.5% vs. 34.7%, p = 0.05). ROC analysis demonstrated limited discriminatory ability (AUC = 0.552; sensitivity 75%, specificity 39%). Multivariate analysis identified age (p = 0.02), prostate volume (p = 0.048), and biopsy ISUP grade (p = 0.001) as independent predictors, whereas the De Ritis ratio was not independently associated with upgrading.Conclusions: The De Ritis ratio was not an independent predictor of ISUP upgrading, although associations with adverse pathological features were observed. Its limited discriminatory performance suggests that it should not be used as a standalone predictor. Further prospective studies are warranted to clarify its potential supplementary clinical value.