Downgrading of biopsy based Gleason score in prostatectomy specimens

Treurniet, Kilian M.; Trudel, Dominique; Sykes, Jenna; Evans, Andrew; Finelli, Antonio; Kwast, Theodorus H. van der

doi:10.1136/jclinpath-2012-201323

Cited by 18 publications

(14 citation statements)

References 22 publications

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“…Discrepancies mainly arise from the distinction of grade 3 from ill‐formed (Figure A–C) and small‐fused glands (Figure D). Downgrading a biopsy Gleason score 7 to a Gleason score 6 at prostatectomy could be attributed in most cases to these two patterns in the biopsy . The sizes of well‐defined Gleason grade 3 glands range from large‐size, difficult to separate from benign glands, to ever smaller‐sized glands, and there is no abrupt distinction from ill‐formed glands (Figure A).…”

Section: Isup 2014 Grading Of Prostate Cancermentioning

confidence: 99%

“…Downgrading a biopsy Gleason score 7 to a Gleason score 6 at prostatectomy could be attributed in most cases to these two patterns in the biopsy. 84 The sizes of well-defined Gleason grade 3 glands range from large-size, difficult to separate from benign glands, to ever smaller-sized glands, and there is no abrupt distinction from ill-formed glands ( Figure 5A). Based on an interobserver variation study, Zhou et al suggested that a minimum of 10 'ill-formed' glands constituting a separate tumour area in an otherwise Gleason grade 3 pattern tumour would be required to assign a grade 4 ( Figure 5B,C).…”

Section: Distinction Of Grade 3 Versus 4 Patternsmentioning

confidence: 99%

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Grading of prostate cancer: a work in progress

2018

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Grading of prostate cancer has evolved substantially over time, not least because of major changes in diagnostic approach and concomitant shifts from late‐ to early‐stage detection since the adoption of PSA testing from the late 1980s. After the conception of the architecture‐based nine‐tier Gleason grading system more than 50 years ago, several changes were made in order to increase its prognostic impact, to reduce interobserver variation and to improve concordance between prostate needle biopsy and radical prostatectomy grading. This eventually resulted in the current five‐tier grading system, with a much more detailed description of the individual architectural patterns constituting the remaining three Gleason patterns (i.e. grades 3–5). Nevertheless, there is room for improvement. For instance, distinction of common grade 4 subpatterns such as ill‐formed and fused glands from the grade 3 pattern is challenging, blurring the division between low‐risk patients who could be eligible for deferred therapy and those who need curative therapy. The last few years have witnessed the publication of several studies on the prognostic impact of individual architectural subpatterns showing that, in particular, the cribriform pattern exceeded the prognostic impact of other grade 4 subpatterns. This review provides an overview of the changes in prostate cancer grading over time and provides a thorough description of the various Gleason subpatterns, the current evidence of their prognostic impact and areas of contention. Potential practical ways for improvements of the current grading system are also put forward.

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Section: Isup 2014 Grading Of Prostate Cancermentioning

confidence: 99%

Section: Distinction Of Grade 3 Versus 4 Patternsmentioning

confidence: 99%

Grading of prostate cancer: a work in progress

2018

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“…However, the Gleason score of the biopsy sample, which remains the most powerful prognostic marker, is inaccurate in a large percentage of patients especially when only a small volume tumor is sampled during biopsy. The vast majority of biopsies are scored as either Gleason 6 or 7 and yet up grading or down grading occurs in 14–51% and 9%, respectively when comparing the Gleason score of the biopsy to that found in the prostatectomy specimen . Likewise, clinical stage poorly estimates final pathological stage , an important predictor of clinical outcome, second only to Gleason score .…”

Section: Introductionmentioning

confidence: 99%

A multicenter study shows PTEN deletion is strongly associated with seminal vesicle involvement and extracapsular extension in localized prostate cancer

et al. 2015

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BACKGROUNDLoss of the phosphatase and tensin homolog (PTEN) tumor suppressor gene is a promising marker of aggressive prostate cancer. Active surveillance and watchful waiting are increasingly recommended to patients with small tumors felt to be low risk, highlighting the difficulties of Gleason scoring in this setting. There is an urgent need for predictive biomarkers that can be rapidly deployed to aid in clinical decision-making. Our objectives were to assess the incidence and ability of PTEN alterations to predict aggressive disease in a multicenter study.METHODSWe used recently developed probes optimized for sensitivity and specificity in a four-color FISH deletion assay to study the Canary Retrospective multicenter Prostate Cancer Tissue Microarray (TMA). This TMA was constructed specifically for biomarker validation from radical prostatectomy specimens, and is accompanied by detailed clinical information with long-term follow-up.RESULTSIn 612 prostate cancers, the overall rate of PTEN deletion was 112 (18.3%). Hemizygous PTEN losses were present in 55/612 (9.0%) of cancers, whereas homozygous PTEN deletion was observed in 57/612 (9.3%) of tumors. Significant associations were found between PTEN status and pathologic stage (P < 0.0001), seminal vesicle invasion (P = 0.0008), extracapsular extension (P < 0.0001), and Gleason score (P = 0.0002). In logistic regression analysis of clinical and pathological variables, PTEN deletion was significantly associated with extracapsular extension, seminal vesicle involvement, and higher Gleason score. In the 406 patients in which clinical information was available, PTEN homozygous (P = 0.009) deletion was associated with worse post-operative recurrence-free survival (number of events = 189), pre-operative prostate specific antigen (PSA) (P < 0.001), and pathologic stage (P = 0.03).CONCLUSIONPTEN status assessed by FISH is an independent predictor for recurrence-free survival in multivariate models, as were seminal vesicle invasion, extracapsular extension, and Gleason score, and preoperative PSA. Furthermore, these data demonstrate that the assay can be readily introduced at first diagnosis in a cost effective manner analogous to the use of FISH for analysis of HER2/neu status in breast cancer. Combined with published research beginning 17 years ago, both the data and tools now exist to implement a PTEN assay in the clinic. Prostate 75: 1206–1215, 2015. © 2015 The Authors. The Prostate, published by Wiley Periodicals, Inc.

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“… 2 3 Although an upgraded Gleason score after RP is most common, 7.4% to 30% of the Gleason score 7 (3 + 4) biopsies were shown to be downgraded to Gleason score 6 (3 + 3) or lower at RP. 17 In our study, when we compared the Gleason score between TRUSBX and RP, 11 (6%) cases were overestimated by TRUSBX. Freedland et al 18 described 123 (11%) downgrading cases (lower RP grade than biopsy grade) among 1113 men treated with RP.…”

Section: Discussionmentioning

confidence: 53%

Gleason score and tumor laterality in radical prostatectomy and transrectal ultrasound-guided biopsy of the prostate: a comparative study

et al. 2015

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We aimed to compare Gleason score and tumor laterality between transrectal ultrasound-guided biopsy of the prostate (TRUSBX) and radical prostatectomy (RP). Some factors that could cause a discrepancy in results between these two procedures were also evaluated. Among the 318 cases reviewed, 191 cases were selected for inclusion in this comparative study. We divided the patients into two groups using the Gleason score: an intermediate/high-grade group (≥7) and a low-grade group (<6). Exploratory analyses were conducted for comparisons between groups. We also performed comparisons between TRUSBX and RP for tumor laterality. TRUSBX overestimated 6% and underestimated 24% cases in comparison with RP for Gleason score, and overestimated 2.6% and underestimated 46% cases compared with RP for tumor laterality. Biopsy specimens were slightly smaller in TRUSBX cases with underestimated tumor laterality (P < 0.05), and no relationship between the biopsy specimen size and underestimated Gleason score in TRUSBX was found. Prostatic volume showed no statistical correlation with the likelihood of under or overestimation (P > 0.05). Thus, our study showed that TRUSBX has a high likelihood of underestimating both the Gleason score and tumor laterality in prostate cancer (PCa). The size of the fragment appears to be an important factor influencing the likelihood of laterality underestimation and Gleason score overestimation via TRUSBX. Due to the high likelihood of underestimation of the Gleason score and tumor laterality by 12-core prostate biopsy, we conclude that this type of biopsy should not be used alone to guide therapy in PCa.

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Downgrading of biopsy based Gleason score in prostatectomy specimens

Cited by 18 publications

References 22 publications

Grading of prostate cancer: a work in progress

Grading of prostate cancer: a work in progress

A multicenter study shows PTEN deletion is strongly associated with seminal vesicle involvement and extracapsular extension in localized prostate cancer

Gleason score and tumor laterality in radical prostatectomy and transrectal ultrasound-guided biopsy of the prostate: a comparative study

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