Extended Prostate Needle Biopsy Improves Concordance Of Gleason Grading Between Prostate Needle Biopsy And Radical Prostatectomy

Francisco, Ignacio F. San; DeWolf, William C.; Rosen, Seymour; Upton, Melissa P.; Olumi, Aria F.

doi:10.1016/s0022-5347(05)64053-0

Cited by 161 publications

(56 citation statements)

References 18 publications

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“…17,21 Although the appropriate number of cores that should be obtained during a prostate biopsy has not clarified, most studies contend that 10 or more biopsy cores increase the likelihood of correct GS prediction. 19,[22][23][24] However, this was not the case in our study. No association was found between the number of cores and tumour grade prediction.…”

contrasting

confidence: 77%

Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer

Sfoungaristos

Perimenis

2013

CUAJ

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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. Methods We retrospectively reviewed the medical records of 302 patients with clinically localized prostate cancer. A retro-pubic RP was performed in all patients between January 2005 and September 2010. Preoperative therapy for pros-tate cancer (active surveillance, hormone therapy, radiation therapy) was an exclusion criterion, as PSA and GS needed to be clear of any influences. Patients with incomplete medical records were also excluded. Patients who had previ-Positive 42 (75.0) 14 (25.0) Negative 49 (76.6) 15 (23.4) HGPIN, n (%) 0.335 § Positive 44 (72.1) 17 (27.9) Negative 47 (79.7) 12 (20.3) *statistical significance; †Student's t test; ‡Mann-Whitney U test; § Chi-square χ2 test; SD: standard deviation; IQR: interquartile range; GS: Gleason score; HGPIN: high-grade prostatic intraepithelial neoplasia; PSA: prostate-specific antigen.

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contrasting

confidence: 77%

Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer

Sfoungaristos

Perimenis

2013

CUAJ

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“…K values greater than 0.75 represent excellent agreement. 13 Moreover, these findings concurred with previous studies with 18G needles and an extended biopsy scheme 1,3 and in transperineal biopsy approach. 2 A discordant GS may be due to a sampling error; this does not mean that the needles were not large enough, but rather The last two patients were excluded from analysis to have an equal number to compare.…”

Section: Discussionsupporting

confidence: 82%

“…Smaller prostate volume was suggested by Sfoungaristos and colleagues 22 as a predictor for upgrading GS, but in our cohort the mean prostate volume size was 57 and 52 cm 3 for the both needle groups. We must acknowledge some important study limitations.…”

Section: Discussioncontrasting

confidence: 62%

“…In general, needle biopsy underestimates pathological Gleason grade in 30% of cases and overestimates it in 5% to 10% of cases. 1 Although a 16-gauge (16G) needle may also be used to perform prostate biopsy, studies [1][2][3][4] on GS concordance are based on 18G needles in combination with a biopsy gun, transrectal ultrasound guidance and the 12-core prostate biopsy template. 2,3 McCormack and colleagues have recently showed that the 16G needle for prostate biopsy is safe, but does not increase prostate cancer detection rate.…”

Section: Introductionmentioning

confidence: 99%

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Needle biopsy size and pathological Gleason Score diagnosis: No evidence for a link

Cicione

Cantiello

Nunzio³

et al. 2013

CUAJ

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Background: Biopsy Gleason score (GS), in combination with other clinical parameters, is important to take a therapeutic decision for patients with diagnosis of localized prostate cancer. However, preoperative GS is often upgraded after a radical prostatectomy. Increasing the amount of tissue in prostate biopsy may be a way to avoid this issue. We evaluate the influence of a larger biopsy needle size on the concordance between biopsy and pathological GS. Methods: We analyzed paired biopsies and prostatectomy specimens from 104 cases of men with clinically localized prostate cancer. At the time of prostate biopsy, the patients were prospectively randomized into two needle groups (16-Gauge [G] and 18G) using a 1:1 ratio. GS concordance was estimated performing kappa statistic testing, overall concordance rate and risk to under grade biopsy GS=6. A logistic regression analysis was performed to evaluate the patients' characteristics as possible risk factors. Results: The overall concordance between prostate biopsy and pathological GS was 76.9% and 75.6% (p = 0.875) and the k values were 0.821 and 0.811 (p = 0.424), respectively, for 16G and 18G needle study groups. The risk to undergrade a biopsy GS=6 was 21.1% and 15.4% (p = 0.709) using a 16G and 18G needle, respectively. Age, prostate-specific antigen, prostate volume and needle calibre were not independently associated with a higher risk of GS discordance. Conclusions: Needle size does not affect the concordance between biopsy and pathological GS. Although GS is not the only way to determine treatment, it is still an unresolved urological issue.

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“…8 The negative results concerning predictive power of biopsy core number match those reported by Pinthus and colleagues; however, it is common to find correlations between core number and accuracy. 17,18 This may be explained by considering the biopsy regimen at our centre. Only 59 men in our cohort (3.4%) underwent the traditional sextant biopsy and the mean core number in the 3 patient subgroups was about 11.6, a comparatively extended protocol.…”

Section: Differencementioning

confidence: 99%

Concordance between transrectal ultrasound guided biopsy results and radical prostatectomy final pathology: Are we getting better at predicting final pathology?

Walker

Lindner

Louis

et al. 2014

CUAJ

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Introduction: Inaccuracy in biopsy Gleason scoring poses a risk to men who may then receive inappropriate treatment. We assess whether there was a change in discordance rates between biopsyand radical prostatectomy at our institution in recent years, while considering the implementation of active surveillance and the shift in biopsy scores caused by the 2005 International Society of Urologic Pathology update to the Gleason scoring protocol.Methods: We reviewed patients who underwent radical prostatectomy at our institution between May 2004 and April 2011. We analyzed clinical and pathological correlates of upgrading in 3 subgroups: Gleason sum (GS) 6/6, GS6/7 and GS7/7, where the sum preceding the dash was determined from biopsy and the subsequent sum was determined from the radical prostatectomy specimen. We applied the log-rank test and Cox model to a Kaplan Meier analysis of biochemical recurrence in the subgroups, and also mapped GS6/7 discordance over time.Results: In total, 1717 patients met our inclusion criteria. The 3 subgroups had significantly different mean prostate-specific antigen, patient age, tumour volume, margin status, pathologic stage, prostate weight, transrectal ultrasound volume and rate of progression (p < 0.05). We noted a multiphasic trend with a fall indiscordance after 2005. However, there was no sustained trend over the study period taken as a whole (p = 0.06).Conclusions: Although no sustained trend was observed, the falling discordance after 2005 may reflect the accommodation to the Gleason scoring update, while the gradual adoption of active surveillance may have led to the otherwise increasing trends. However, our observations may also be spurious biopsy sampling errors.

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Extended Prostate Needle Biopsy Improves Concordance Of Gleason Grading Between Prostate Needle Biopsy And Radical Prostatectomy

Cited by 161 publications

References 18 publications

Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer

Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer

Needle biopsy size and pathological Gleason Score diagnosis: No evidence for a link

Concordance between transrectal ultrasound guided biopsy results and radical prostatectomy final pathology: Are we getting better at predicting final pathology?

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