Jim Hu, MD, on upgrading of GG1 prostate cancer at radical prostatectomy

Rates of upstaging and upgrading of grade group 1 prostate cancer following radical prostatectomy have increased over time, according to data from 2 studies presented at the 2025 American Urological Association Annual Meeting in Las Vegas, Nevada.^1,2

The studies collected data from the National Cancer Database (NCDB)¹ and the Surveillance, Epidemiology, and End Results (SEER) database,² respectively. In both, approximately 53% of patients were upgraded at the time of radical prostatectomy, with 7.7% in the NCDB and 1.9% in the SEER database being upgraded to grade group 3 to 5.

In a recent interview with Urology Times®, senior author Jim C. Hu, MD, MPH, walked through key findings from both publications and discussed the implications of these findings for clinical practice. Hu is a urologic oncologist at Weill Cornell Medicine in New York, New York.

Overall, data showed that the likelihood of upgrading increased over time in both datasets.

Specifically, in the NCDB, the likelihood of upgrading was 43.5% in 2010, which increased to 69.0% in 2021 (P < .01). Likewise, in the SEER database, the likelihood of upgrading was 44.9% in 2010, which increased to 70.8% in 2021.

In the NCDB study, the investigators reported, “In adjusted analyses, older age, African American race, higher [prostate-specific antigen] PSA [and] higher clinical T stage, [and] treatment at an academic facility were independently associated with upgrading, while older age at diagnosis, higher PSA and clinical T stage, and treatment at academic facility were associated with upstaging.”

Hu did caution, however, that the investigators were unable to adjust for the use of biomarkers such as MRI prior to biopsy or genomic testing.

However, he concluded, “Our findings support that that we do not drop the label of cancer from grade group 1 nomenclature.”

REFERENCES

1. Wang S, Suzman E, Wahba BM, Strasser O, Hu JC. Should grade group 1 be designated as cancer? Results from the national cancer database on upgrading and upstaging at radical prostatectomy. J Urol. 2025;213(5S):e609. doi:10.1097/01.JU.0001109920.19321.ff.05

2. Suzman E, Wang S, Wahba BM, Hu JC. Upgrading of grade group 1 prostate cancer following radical prostatectomy using SEER. J Urol. 2025;213(5S):e256. doi:10.1097/01.JU.0001109792.00985.9d.09