PROSTATE BIOPSY CLINICAL AND PATHOLOGICAL VARIABLES THAT PREDICT SIGNIFICANT GRADING CHANGES IN THE CONTEMPORARY ERA

Czech version

Authors: S. Moussa; J. Li; M. Soriano; E. A. Klein; F. Dong; J. S. Jones
Authors‘ workplace: Cleveland Clinic Glickman Urological & Kidney Institute, Cleveland
Published in: Urol List 2010; 8(1): 23-28

Overview

Purpose:
A significant proportion of prostate cancer patients are upgraded or downgraded on interpretation of radical prostatectomy (RP) pathological specimens. Because biopsy GS plays a critical role in treatment decisions, we sought to identify the clinical and pathological parameters that predict pathological changes.

Materials & Methods:
We retrospectively evaluated a total of 1.397 patients who underwent RP following prostate biopsy at our institution from 2000–2007. We stratify patients according to biopsy Gleason sum into 2 groups, group one: 286 patients with biopsy GS 6. Group two: 1.129 patients with biopsy GS ≥ 7. Complete relevant clinical information was available for all. A multivariable logistic regression analysis was applied to identify predictors of pathological grading changes.

Results:
Following prostatectomy, over all the final pathological GS was found to be upgraded in 430 pa tients (30.8 %), downgraded in 210 (15 %), and unchanged in 757 (54.2%). In Group one (GS 6) 134 patients (50 %) were upgraded postoperatively to GS 7 or higher. In Group 2 (GS ≥ 7), the GS was upgraded in 296 patients (26.2 %), downgraded in 210 (18.6 %), and remained the same in 623 (55.2 %). Factors predicting surgical GS upgrade were higher PSA (p = 0.004), the number of cores positive for cancer (p < 0.001), the percentage of cancer in the extracted tissue (p = 0.002), and the maximum percentage of cancer in any core (p = 0.012). Also the presence of perineural invasion (p = 0.043), absence of inflammation (p < 0.0001), and absence of associated HGPIN (p = 0.0199) were predictors of upgrading. Large prostate volume (p = 0.0041) and low maximum percentage cancer in any core (p = 0.0014) were predictors of downgrading.

Conclusion:
Men with higher PSA, perineural invasion, and high volume cancer at biopsy are most likely to be upgraded while men with large prostate volume, and low volume cancer at biopsy are more likely to be downgraded. These findings carry implications for men with prostate cancer managed without prostatectomy confirmation of their true Gleason scores.

Key words:
biopsy, surgical specimen, prostate cancer, Gleason score, grade migration

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