Year: 2020
Type: letter
Abstract: We read the article by Shoag et al 1 with great interest.The authors have reported that prebiopsy prostate magnetic resonance imaging is associated with both oversampling of higher grade areas, which results in downgrading at prostatectomy, and the detection of otherwise occult higher grade lesions, which results in less upgrading at prostatectomy.We have some points of concern with this study.First, the median ages in the groups (68 and 71 years) and their numbers (10,531 and 494 patients) were not homogeneous.Patients older than 66 years were included in the study, and the authors did not clearly specify why patients 66 years old or younger were not included.Another point is upgrading in the radical prostatectomy specimens.Upgrading is associated with prostatespecific antigen (PSA) levels, prostate volume, number of biopsy cores, obesity, number of positive cores, and PSA density, which is calculated as the serum PSA level divided by the volume of the prostate gland. 2 The authors mentioned only the PSA level when they were comparing the groups.We have found that obesity is associated with upgrading in patients with prostate cancer.3 Moreover, low total and free testosterone levels have been positively associated with high-grade tumors.4 Low testosterone levels may disrupt the hormonal balance, and this can result in tumor cells that proliferate in an androgen-independent manner and that have a more aggressive phenotype.5 Finally, the time interval between biopsy and operation and the surgical techniques have not been reported.Time can affect upstaging, and surgical techniques affect patients' surgical margins.
Source: Cancer
DOI: 10.1002/cncr.33086
Institution: Weill Cornell Medicine
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3043339769