Evaluation of concordance of Gleason score between prostatectomy and biopsies that show more than two different Gleason scores in positive cores

Park, Hyoung Keun; Choe, Gheeyoung; Byun, Seok‐Soo; Lee, Hae Won; Lee, Sang Eun; Lee, Eunsik

doi:10.1016/j.urology.2005.07.018

Cited by 24 publications

(9 citation statements)

References 12 publications

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“…16 One of the main reasons for this consensus is that Gleason score at biopsy, often derived from a very small amount of tissue, poorly predicts Gleason score at RP. 17,18 Our data confirmed the low concordance between Gleason score from biopsy and from RP specimen and showed that it did not improve significantly with time. However, it is possible that in more recent years, subsequent to the VRPR registration period, concordance has increased more substantially particularly with the increasing number of cores taken at biopsy.…”

Section: Discussionsupporting

confidence: 76%

“…A likely explanation of this grade inflation is a growing consensus that Gleason score two to four tumours should rarely be diagnosed 16 . One of the main reasons for this consensus is that Gleason score at biopsy, often derived from a very small amount of tissue, poorly predicts Gleason score at RP 17,18 . Our data confirmed the low concordance between Gleason score from biopsy and from RP specimen and showed that it did not improve significantly with time.…”

Section: Discussionsupporting

confidence: 68%

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A whole of population‐based series of radical prostatectomy in Victoria, 1995 to 2000

Bolton

Severi

Millar

et al. 2009

Australian and New Zealand Journal of Public Health

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Objective: Radical prostatectomy (RP) as a first line treatment of prostate cancer was rare prior to the advent of prostate specific antigen (PSA) testing, yet little is known of its use and outcomes in a population setting. We described baseline characteristics of cases in the Victorian Radical Prostatectomy Register (VRPR), investigated possible associations between demographic characteristics and characteristics at diagnosis and at surgery and trends over time. Methods: The VRPR is a population‐based series of all RPs performed in Victoria from July 1995 to December 2000 (n=2,154). Results: On average, socio‐economic status for cases was higher than for the general Victorian population (34% vs 20% in the highest quintile respectively, p<0.0001). The proportion of PSA‐detected cases increased from 53% in 1995 to 79% in 2000 (p for linear trend=0.0004). Age at surgery and PSA levels at diagnosis decreased over time (p=0.006 and p=0.04 respectively). The proportion of cases with Gleason score ≤5 from RP decreased from 35% in 1995 to 14% in 2000, while cases with Gleason score 6‐7 increased from 60% to 79%. Similar trends were observed for Gleason score from biopsy. We found little evidence of significant trends over time in other pathological characteristics relevant to prognosis. Conclusion and Implications: The VRPR provides a unique whole of population based description of radical prostatectomy in Victoria, confirms findings previously reported in single institution clinical series overseas such as migration to younger age at surgery and to Gleason scores 6 to 7, and provides a resource for evaluating RP outcomes in the future.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 68%

A whole of population‐based series of radical prostatectomy in Victoria, 1995 to 2000

Bolton

Severi

Millar

et al. 2009

Australian and New Zealand Journal of Public Health

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“…This was surprising and contradicted general opinion based on previously published data using older grading systems. 3,[7][8][9] The proportion of downgrading we observed was higher than what was reported in a large series from Johns Hopkins. In that series, including all patients regardless of biopsy discordance, 49% had a prostatectomy Gleason score ≥8 when the highest biopsy core was Gleason 8.…”

Section: Discussioncontrasting

confidence: 80%

“…While it is generally believed that the core with the highest sum should be used when assigning cancer risk, controversy exists, and some may assign risk based on all of the biopsy tissue combined. 3,[7][8][9] Indeed, the assigned biopsy Gleason sum may vary depending on the interpreting clinician.…”

Section: Introductionmentioning

confidence: 99%

Predicting the Gleason sum of a patient with a prostate biopsy core Gleason ≤7 and a prostate biopsy core Gleason ≥8

Heimrath

Kos

Belanger

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(7-8):e476-80. http://dx.doi.org/10.5489/cuaj.1737 Published online July 18, 2014. AbstractIntroduction: We review a subset of men who had discordant prostate biopsy sums and were treated with radical prostatectomy. Methods: Consecutive patients treated with radical prostatectomy at The Ottawa Hospital between 2000 and 2012 were reviewed. Those with at least 1 prostate biopsy core of Gleason sum ≥8 and at least 1 prostate biopsy core of Gleason sum ≤7 cancer were included. Results: Of the 764 radical prostatectomies, 661 (87%) were eligible for the study and 35 (5%) met inclusion criteria. Of these, only 16 (46%) had prostatectomy Gleason sum of ≥8. When the highest biopsy core was Gleason sum 8 (n = 24), only 7 (29%) had a prostatectomy Gleason sum ≥8. When the highest biopsy core was Gleason 9 (n = 11), 9 (82%) had a prostatectomy Gleason sum ≥8 (relative risk [RR] 2.8; p = 0.004). Patients with clinical T3 tumours were at higher risk of Gleason sum ≥8 compared to cT1 patients (RR 3.7; p = 0.008). Patient age (p = 0.89), preoperative prostate-specific antigen (p = 0.34), prostate volume (p = 0.86), number of biopsy cores (p = 0.18), and proportion of biopsy cores with cancer (p = 0.96) were not strongly associated with risk of prostatectomy Gleason sum ≥8. Conclusion: These data should be considered when assigning patients into prognostic risk categories based on prostate biopsy information. Further study to verify our findings using larger samples is warranted.

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“…Despite that the role of amount of cancer in predicting GS upgrading remains controversial. In some studies it is not a predictive parameter; however, the results of other recent studies confirm the predictive role of cancer volume on GS upgrading [5, 19, 22, 25–28]. Discrepancies in these results may be related to patient's characteristics or statistical power.…”

Section: Discussionmentioning

confidence: 98%

UROLOGICAL ONCOLOGY Factors predicting Gleason score 6 upgrading after radical prostatectomy

et al. 2011

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ObjectivesProstate cancer Gleason score 6 is the most common score detected on prostatic biopsy. We analyzed the clinical parameters that predict the likelihood of Gleason score upgrading after radical prostatectomy.MethodsThe study population consisted of 241 patients who underwent radical retropubic prostatectomy between Feb 2002 and Dec 2007 for Gleason score 6 adenocarcinoma. The influence of preoperative parameters on the probability of a Gleason score upgrading after surgery was evaluated using multivariate logistic regression and ROC curves.ResultsGleason score upgrade was found in 92 of 241 patients (38.2%). Multivariate logistic regression analysis showed that only percentage of cancer in dominant lobe and prostate weight were significant predictors for Gleason score upgrading (p = 0.043 and p = 0.006, respectively). ROC curves showed that prostate weight and PSA density were only two independent significant parameters for prediction of upgrade (AUC – 0.634, p <0.0001 and 0.604, p = 0.006, respectively). Gleason score upgrading was observed to be accompanied by significantly higher rates of extra prostatic extension (p <0.001) and seminal vesicle invasion (p = 0.002).ConclusionsAlmost forty percent of tumors graded Gleason 6 at biopsy are Gleason 7 at surgery. Upgraded tumors significantly associated with adverse pathological features. The probability of Gleason score upgrade can be predicted using prostate weight and PSA density as independent parameters.

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Evaluation of concordance of Gleason score between prostatectomy and biopsies that show more than two different Gleason scores in positive cores

Cited by 24 publications

References 12 publications

A whole of population‐based series of radical prostatectomy in Victoria, 1995 to 2000

A whole of population‐based series of radical prostatectomy in Victoria, 1995 to 2000

Predicting the Gleason sum of a patient with a prostate biopsy core Gleason ≤7 and a prostate biopsy core Gleason ≥8

UROLOGICAL ONCOLOGY Factors predicting Gleason score 6 upgrading after radical prostatectomy

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