Introduction: Preoperative Gleason score is crucial, in combination with other preoperative parameters, in selecting the appropriate treatment for patients with clinically localized prostate cancer. The aim of the present study is to determine the clinical and pathological variables that can predict differences in Gleason score between biopsy and radical prostatectomy. Methods: We retrospectively analyzed the medical records of 302 patients who had a radical prostatectomy between January 2005 and September 2010. The association between grade changes and preoperative Gleason score, age, prostate volume, prostate-specific antigen (PSA), PSA density, number of biopsy cores, presence of prostatitis and high-grade prostatic intraepithelial neoplasia was analyzed. We also conducted a secondary analysis of the factors that influence upgrading in patients with preoperative Gleason score ≤6 (group 1) and downgrading in patients with Gleason score ≤7 (group 2). Results: No difference in Gleason score was noted in 44.3% of patients, while a downgrade was noted in 13.7% and upgrade in 42.1%. About 2/3 of patients with a Gleason score of ≤6 upgraded after radical prostatectomy. PSA density (p = 0.008) and prostate volume (p = 0.032) were significantly correlated with upgrade. No significant predictors were found for patients with Gleason score ≤7 who downgraded postoperatively. Conclusion: Smaller prostate volume and higher values of PSA density are predictors for upgrade in patients with biopsy Gleason score ≤6 and this should be considered when deferred treatment modalities are planned. IntroductionProstate cancer is the most common form of cancer and the second leading cause of cancer death among men.1 In 2010, there was an incidence of slightly less than 217 000 new cases and mortality of 32 000 in the United States. 1Gleason grading system is widely accepted to evaluate prostate adenocarcinoma grade.2 Biopsy Gleason score (GS), obtained by the histological examination of cores received during transrectal ultrasound, is an independent prognostic factor for progression.3 Gleason score is highly considered when we make decisions about the appropriate treatment selection or about the application of surgical modifications of the standard radical prostatectomy (RP) technique (lymph node and/or nerve sparing). It is also greatly correlated with the postoperative stage and the presence of adverse pathology.4,5 Since GS is highly associated with aggressiveness and progression of prostate cancer, its accurate determination is crucial in deciding the best treatment (active surveillance, watchful waiting, radical therapy, hormone therapy) for each patient. 6,7 Several investigators have studied the correlation between biopsy GS and GS obtained after RP by the pathological examination of the specimen. Interestingly, a very low positive correlation has been reported (some studies achieve 25% positive correlation). 8-10The aim of this study was to assess the impact of preoperative clinical and pathological variables in the pre...

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