Predictive Factors of Gleason Score Upgrading in Localized and Locally Advanced Prostate Cancer Diagnosed by Prostate Biopsy

Abstract

PurposeThe Gleason score (GS) is an important factor that is considered when making decisions about prostate cancer and its prognosis. However, upgrading of the GS can occur between transrectal ultrasonography (TRUS) biopsy and radical prostatectomy. This study analyzed the clinical factors predictive of upgrading of the GS after radical prostatectomy compared with that at the time of TRUS biopsy.Materials and MethodsWe analyzed the medical records of 107 patients who had undergone radical prostatectomy. Patients were divided into two groups. Group 1 consisted of patients in whom the GS was not upgraded, and group 2 consisted of patients in whom the GS was upgraded. Associations between preoperative clinical factors and upgrading of the GS were analyzed. Preoperative clinical factors included age, prostate-specific antigen (PSA), prostate volume, PSA density, GS of TRUS biopsy, maximum core percentage of cancer, percentage of positive cores, number of biopsies, location of positive core with maximum GS, high-grade prostatic intraepithelial neplasia (HGPIN), inflammation on biopsy, and clinical stage.ResultsAmong 85 patients, 42 (49%) patients had an upgraded GS after operation. TRUS biopsy core number of 12 or fewer (p=0.029) and prostate volume of 36.5 ml or less (p<0.001) were associated with upgrading of the GS. Preoperative clinical factors associated with nonupgrading of the GS were the detection of positive cores with a maximum GS at the apex (p=0.002) or in a hypoechoic lesion (p=0.002) in TRUS.ConclusionsIf the positive cores with maximum GS are located at the apex or in a hypoechoic lesion in TRUS, we can expect that the GS will not be upgraded. In patients with the clinical predictive factors of a prostate volume of 36.5 ml or less and TRUS biopsy core number of less than 12, we can expect upgrading of the GS after radical prostatectomy, and more aggressive treatment may be needed.

Impact of Gleason pattern up gradation after radical prostatectomy for carcinoma prostate patients with low biopsy score (≤ 6)

“…[13] Newer refinements in biopsy techniques and detailed pathological reporting of cancer (number of cores, length of each core, percentage of cancer in each core and total number of positive cores) and identification of tertiary score have shown salutary effect in predicting the upgradation of the b-GS. [14][15][16] The presence of prostatic intraepithelial neoplasia and perineural invasion were also found to be predictive of upgradation in one series. [10] The question whether it is necessary to predict upgradation of b-GS in low Gleason score setting is very crucial.…”

Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması

“…Gleason skoru prostatik adenokarsinomların prognozunda ve tedavi seçilmesinde etkili bir faktördür (16). Bu nedenle uygun tedavi yönteminin belirlenebilmesi için GS tam ve hatasız olarak tespit edilmelidir.…”

“…Ülkemizde yapılan bir çalışmada da 321 hastanın TRUS biyopsi ve RP GS karşılaştırılmış ve GS artış oranı %40.8 olarak saptanmıştır (29). Başka bir araştırmada 85 hastanın yaklaşık %50'sinde GS artışı rapor edilmiştir (16). Literatürle uyumlu olarak bizim çalışmamızda da 24 hastanın 8'inde (%33.3) GS artışı olduğu saptanmıştır.…”

“…Bazı araştırmacılar yüksek PSA değeri ile GS artışı arasında anlamlı ilişki saptasa da (17,20,21) bunun aksini belirten yayınlar da bulunmaktadır (16,31 …”

“…küçük prostat hacminin yüksek dereceli GS için bir belirteç olduğunu ileri sürmüşlerdir (32). Başka bir çalışmada da prostat hacmi 36.5 ml ve altında olan olgularda GS artış oranının daha yüksek olduğunu bildirilmiştir (16). Epstein ve ark.…”