Correlation of Preoperative and Radical Prostatectomy Gleason Score: Examining the Predictors of Upgrade and Downgrade Results

  • Gholamreza Pourmand Department of Urology, Sina Hospital, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Shahram Gooran Mail Department of Urology, Sina Hospital, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Seyed Reza Hossieni Department of Urology, Sina Hospital, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Fateme Guitynavard Department of Urology, Sina Hospital, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Majid Safavi Department of Urology, Sina Hospital, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Amirsina Sharifi Department of Urology, Sina Hospital, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Ehsan Mokhtari Department of Urology, Sina Hospital, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Grade change, Prostate adenocarcinoma, Radical prostatectomy, Gleason score

Abstract

Preoperative Gleason score (GS) obtained from Trans Rectal Ultra Sonography (TRUS) is the most common grading system to evaluate the appropriate treatment for patients with clinically localized prostate cancer. But this method showed upgraded and downgraded results in comparison to Gleason score obtained from radical prostatectomy. The current study aimed to determine clinical or pathological variables to reduce the differences between biopsy and radical prostatectomy Gleason scores.Through retrospective review of 52 patients with radical prostatectomy, this study examined the correlations of preoperative Gleason score with age, prostate volume, PSA level, PSA density, digital rectal exam findings and percentage of positive core needle biopsies across two groups, including patients with preoperative GS≤6 (i.e. group one) and patients with preoperative GS≥7 (group two). The discordance between biopsy GS and radical prostatectomy GS was observed to be 52% in the current study. Among patients with preoperative GS≤6, prostate volume (P=0.026), PSA density (P=0.032) and percentage of positive core needle biopsies (P=0.042) were found to be significant predictors for upgrade. There was no significant predictor for downgrade in patients with preoperative GS≥7. Findings of this study revealed that in patients with preoperative GS≤6, smaller prostate volume, higher prostate density and higher positive results of core needle biopsies were associated with theupgrade of GS. Therefore, it should be considered when selecting treatment modalities among these patients.

References

Jemal A, Siegel R, Xu J, et al. Cancer statistics 2010. CA Cancer J Clin 2010; 60:277-300.

Epstein JI, Partin AW, Sauvageot J, Walsh PC. Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up. Am J Surg Pathol 1996; 20: 286–92

Hull GW, Rabbani F, Abbas F, et al. Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol 2002; 167:528-34.

Rubin MA, Bismar TA, Curtis S, et al. Prostate needle biopsy reporting: how are the surgical members of the Society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients? Am J Surg Pathol 2004; 28:946-52.

Makarov DV, Trock BJ, Humphreys EB, et al. Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, and biopsy Gleason score (Partin tables) based on cases from 2000 to 2005. Urology 2007; 69:1095-101.

Epstein JI, Partin AW, Sauvageot J, et al. Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up. Am J Surg Pathol 1996; 20:286-92.

Moussa AS, Li J, Soriano M, et al. Prostate biopsy clinical and pathological variables that predict significant grading changes in patients with intermediate and high grade prostate cancer. BJU Int 2009; 103:43-8.

Herman CM, Kattan MW, Ohori M, Scardino PT, Wheeler TM. Primary Gleason pattern as a predictor of disease progression in Gleason score 7 prostate cancer: a multivariate analysis of 823 men treated with radical prostatectomy. Am J Surg Pathol 2001; 25: 657–60

King CR, McNeal JE, Gill H, Presti JC Jr. Extended prostate biopsy scheme improves reliability of Gleason grading: implications for radiotherapy patients. Int J Radiat Oncol Biol Phys 2004; 59: 386–91

Altay B, Kefi A, Nazli O, Killi R, Semerci B, Akar I. Comparison of Gleason scores from sextant prostate biopsies and radical prostatectomy specimens. Urol Int 2001; 67: 14–8

Mosse CA, Magi-Galluzzi C, Tsuzuki T, Epstein JI. The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens. Am J Surg Pathol 2004; 28: 394–8

Kojima M, Troncoso P, Babaian RJ. Use of prostate-specific antigen and tumor volume in predicting needle biopsy grading error. Urology 1995; 45: 807–12

Cookson MS, Fleshner NE, Soloway SM, Fair WR. Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J Urol 1997; 157: 559–62

Schmid H, Oberpenning F, Pummer K. Diagnosis and staging of prostatic carcinoma: what is really necessary? Urol Int 1999; 63: 57–61

Partin AW, Kattan MW, Subong EN et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 1997; 277: 1445–51

Arellano L, Castillo O, Metrebian E. Concordance of Gleason histological scoring for prostatic cancer in needle biopsies and the surgical piece obtained during radical prostatectomy. Rev Med Chil 2004; 132: 971–8

Rubin MA, Bismar TA, Curtis S, Montie JE. Prostate needle biopsy reporting: how are the surgical members of the Society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients? Am J Surg Pathol 2004; 28: 946–52

Nayyar R, Singh P, Gupta NP, et al. Upgrading of Gleason score on radical prostatectomy specimen compared to the pre-operative needle core biopsy: An Indian experience. Indian J Urol 2010;26:56-9.

Carlson GD, Calvanese CB, Kahane H, et al. Accuracy of biopsy Gleason scores from a large uropathology laboratory: use of a diagnostic protocol to minimize observer variability. Urology 1998;51:525-9.

Wolff JM, Boeckmann W, Mattelaer P, et al. Determination of prostate gland volume by transrectal ultrasound: correlation with radical prostatectomy specimens. Eur Urol 1995;28:10-2

Hong SK, Han BK, Lee ST, et al. Prediction of Gleason score upgrading in low-risk prostate cancers diagnosed via mult (> or =12)-core prostate biopsy. World J Urol 2009;27:271-6.

Sved PD, Gomez P, Manoharan M, et al. Limitations of biopsy Gleason grade: implications for counseling patients with biopsy Gleason score 6 prostate cancer. J Urol 2004;172:98-102.

Fukagai T, Namiki T, Namiki H, Carlile RG, Shimada M, Yoshida H. Discrepancies between Gleason scores of needle biopsy and radical prostatectomy specimens. Pathol Int 2001; 51: 364–70

Stavros Sfoungaristos, Petros Perimenis, et al. Clinical and pathological variables that predict changes in tumor grade after radical prostatectomy in patients with prostate cancer. Can Urol Assoc J 2013;7:E93-E97.

Mian BM, Lehr DJ, Moore CK et al. Role of prostate biopsy schemes in accurate prediction of Gleason scores. Urology 2006; 67: 379–8

Published
2017-05-16
How to Cite
1.
Pourmand G, Gooran S, Hossieni SR, Guitynavard F, Safavi M, Sharifi A, Mokhtari E. Correlation of Preoperative and Radical Prostatectomy Gleason Score: Examining the Predictors of Upgrade and Downgrade Results. Acta Med Iran. 55(4):249-253.
Section
Articles