Trends in distribution and prognostic significance of Gleason grades on radical retropubic prostatectomy specimens between 1989 and 2001

Sengupta, Shamik; Slezak, Jeffrey M.; Blute, Michael L.; Leibovich, Bradley C.; Sebo, Thomas J.; Myers, Robert P.; Cheville, John C.; Bergstralh, Eric J.; Zincke, Horst

doi:10.1002/cncr.21924

Cited by 29 publications

(25 citation statements)

References 25 publications

(43 reference statements)

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“…The comparisons between the results of the histological biopsy compared to the surgical specimen exhibited a correlation equal to ~50% (14)(15)(16)(17). The results of the prostate biopsy and the surgical specimen may differ for several reasons, such as incorrect evaluation by the pathologist, sampling errors and the presence of borderline grading.…”

Section: Discussionmentioning

confidence: 99%

Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy

D’Elia¹,

Cerruto²,

Cioffi³

et al. 2014

Molecular and Clinical Oncology

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Abstract. Prostate cancer (CaP) is the most common malignancy in men and the second cause of cancer-related mortality after lung cancer. Several studies have evaluated the correlation between bioptic and pathological Gleason score (GS), documenting a correlation ranging between 30 and 60%. The aim of this study was the evaluation of the association between bioptic and pathological GS in a series of patients undergoing prostate needle biopsy and subsequent radical prostatectomy. We also aimed to evaluate the possible prognostic factors of upgrading and upstaging. We prospectively collected and retrospectively reviewed data from 300 consecutive patients who underwent radical retropubic or robot-assisted prostatectomy at our Institution. Patients who underwent prostate needle biopsy, transrectal or transperineal, with a minimum of 5 samples, were included in this study. Upgrading and downgrading were defined as increase or decrease, respectively, from one prognostic grade group to another, similar to up-or downstaging. The mean age of the patients was 62.97 years and the mean prostate-spesific antigen (PSA) level was 7.83 ng/ml. A total of 51.3% of the population underwent a transperineal prostate biopsy. The most frequently represented bioptic GS was 3+3 (64.0%) followed by 3+4=7 (15.6%); the most frequent pathological Gleason score was 3+4 (44.3%), followed by 3+3 (31.0%). With reagard to the bioptic GS 4-5-6 group, approximately half of the specimens (46.7%) were subsequently upgraded to GS 3+4, and 5.3% to 4+3. With regards to the bioptic GS 3+4 group, 57.4% was confirmed in the surgical specimen. In the 4+3 group, 23.5% of the cases was downgraded to 3+4 and 35.3% was confirmed. With regards to stage, ~39.7% of the patients received an upstaging on the pathological specimen. We evaluated the correlations between preoperative serum PSA level, prostate volume, digital rectal examination and biopsy type and none of the variables considered exhibited a correlation with any upgrading (P>0.05). Moreover, we evaluated the correlations between the aforementioned variables and upstaging and, at the multivariate analysis, only a serum PSA <4 ng/ml was found to be an independent variable predictive of upstaging (P=0.017). Therefore, new tools are required to predict upgrading and upstaging of our patients, in order to ensure better counseling for optimal treatment planning.

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Section: Discussionmentioning

confidence: 99%

Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy

D’Elia¹,

Cerruto²,

Cioffi³

et al. 2014

Molecular and Clinical Oncology

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“…9 Furthermore, changes by pathologists in the interpretation of prostate biopsies have had a significant effect on the grade migration of prostate cancer. 7,10,11 If changing practice patterns can contribute to a grade migration of prostate cancer, then it is likely that these changes have had other influences as well. With this in mind, we hypothesized that the correlation between PSA and positive biopsy rate could have been altered by changes in prostate biopsy practice patterns.…”

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confidence: 99%

Negative influence of changing biopsy practice patterns on the predictive value of prostate‐specific antigen for cancer detection on prostate biopsy

Schwartz

Hwang

Hung

et al. 2008

Cancer

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BACKGROUND.A correlation between prostate specific antigen (PSA) level and positive prostate biopsy rate was established in an era when biopsy practice patterns were different from what they are today. We evaluated if changes in biopsy practice patterns have affected the ability of PSA to predict cancer detection on prostate biopsy in the current era.METHODS.Of 3634 prostate biopsies performed from 1993–2005, 1607 met criteria for analysis. Biopsy data were divided into 3 time‐cohorts (1993–1997, 1998–2001, and 2002–2005) to assess for practice patterns shifts and correlation between PSA and biopsy results.RESULTS.Significant changes in biopsy practice patterns included an increase in biopsy cores and more frequent use of PSA 2.5–3.99 ng/mL as a biopsy indication. In men with normal DRE, a moderate correlation between PSA and positive biopsy rate did exist from 1993–1997, but was subsequently lost. On multivariate analysis, PSA was not a significant predictor of biopsy result in men with normal DRE.CONCLUSIONS.Early in the PSA era, the predictive power of PSA depended on multiple factors: high prevalence of disease, higher prevalence of high‐grade disease, and low likelihood of prostate cancer diagnosis in men with low PSA. Now, beyond the culling effect of increased biopsy incidence and with shifted biopsy practice patterns, the correlation between PSA and biopsy result is lost in men with normal DRE. Diagnosing a higher proportion of tumors in men with a PSA between 2.0–4.0 ng/mL has negatively influenced the predictive value of PSA for cancer detection. Cancer 2008. © 2008 American Cancer Society.

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“…25 These trends have been attributed to changes in the approach to diagnosis of prostate cancer, an increase in expertise among pathologists, and redefinition of some of the criteria on which the scoring system is based. 21,26 As would be expected based on the differences between scoring systems, concordance between reviews was greatest at lower grades. Above score 6, interobserver variability is likely to have a greater role because the individual contributions of pattern 3 and pattern 4 are crucial in determining whether a tumor is grade 6 or 7.…”

Section: Commentmentioning

confidence: 57%

“…20 One study 21 confirmed a progressive increase in Gleason 3 and a decrease in Gleason 2 on radical retropubic prostatectomy specimens over time (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001), and other studies [22][23][24][25] have reported a decrease in the proportion of Gleason tumors scored 2 to 5 and an increase in Gleason 6 and 7 tumors. Correlation of Gleason score between biopsy and radical prostatectomy has been shown to increase over time, from 58% in 1992-1996 to 75% in [2002][2003][2004][2005][2006].…”

Section: Commentmentioning

confidence: 99%

Comparison of Classic and International Society of Urological Pathology 2005 Modified Gleason Grading Using Needle Biopsies From the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) Trial

Lucia

Bostwick

Somerville

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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Objective.-To compare scores derived using the 2 scoring systems.Design.-On-study and for-cause biopsies were centrally reviewed and assigned a classic Gleason score in the Reduction by Dutasteride of prostate Cancer Events trial. Positive biopsies were reviewed by an independent pathologist in a secondary review using the ISUP 2005 modified Gleason score. The independent pathologist also recorded a classic Gleason score.Results.-In total, 1482/1507 (98%) positive biopsy results were independently reviewed. Scores assigned by the 2 pathologists (classic versus modified) agreed in 83% (1230 of 1481) of cases; 99% (1471 of 1481) of cancers were within 61 of their previous score. Of discordant cases, similar numbers of biopsies were upgraded and downgraded in the secondary review, with minor differences in the score distributions. Interobserver agreement was good, with j values ranging from 0.62 (95% confidence interval [CI], 0.56-0.67) to 0.70 (95% CI, 0.65-0.76). The overall number of high-grade tumors (Gleason score 8-10; n ¼ 48) remained constant between reviews, with 3 fewer cases in the placebo group (n ¼ 16) and 3 more in the dutasteride group (n ¼ 32) in the secondary review. When comparing the independent pathologist's modified scores versus the classic, 17 of 1481 cancers (1.1%) were upgraded (including 9 of 17 upgrades [53%] to high-grade tumors).Conclusions.-This analysis showed similar score distributions between the classic and modified Gleason scoring systems. The differences seen between the 2 pathologists' scores likely reflect differences in interpretation rather than the scoring system chosen.

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Trends in distribution and prognostic significance of Gleason grades on radical retropubic prostatectomy specimens between 1989 and 2001

Cited by 29 publications

References 25 publications

Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy

Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy

Negative influence of changing biopsy practice patterns on the predictive value of prostate‐specific antigen for cancer detection on prostate biopsy

Comparison of Classic and International Society of Urological Pathology 2005 Modified Gleason Grading Using Needle Biopsies From the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) Trial

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