Well-differentiated prostate cancer in core biopsy specimens may be associated with extraprostatic disease

Abstract

CONTEXT AND OBJECTIVE: Accurate determination of the Gleason score in prostate core biopsy specimens is crucial in selecting the type of prostate cancer treatment, especially for patients with well-differentiated tumors (Gleason score 2 to 4). For such patients, an inaccurate biopsy score may result in a therapeutic intervention that is too conservative. We evaluate the role of Gleason score 2-4 in prostate core-needle biopsies for predicting the final pathological staging following radical prostatectomy. DESIGN AND SETTING: Retrospective study at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS: We analyzed the medical records of 120 consecutive patients who underwent radical retropubic prostatectomy to treat clinical localized prostate cancer at our institution between December 2001 and July 2006. Thirty-two of these patients presented well-differentiated tumors (Gleason score 2 to 4) in biopsy specimens and were included in the study. The Gleason scores of the core-needle biopsies were compared with the pathological staging of the surgical specimens. RESULTS: Sixteen of the 32 patients (50%) presented moderately differentiated tumors (Gleason score 5 to 7) in surgical specimens. Eighteen patients (56%) had tumors with involvement of the prostate capsule and ten (31%) had involvement of adjacent organs. Evaluating the 16 patients that maintained Gleason scores of 2 to 4 in the pathological staging of the surgical specimens, 11 (68.7%) had focal invasion of the prostate capsule and five (31.25%) had organ-confined disease. CONCLUSION: Well-differentiated tumors (Gleason score 2 to 4) seen in biopsies are not predictive of organ-confined disease.

Grading of prostatic adenocarcinoma: current state and prognostic implications

“…Gleason patterns 1 and 2 (Gleason scores 2–5) should no longer be assigned on needle core biopsy. This is because of poor reproducibility and poor correlation with radical prostatectomy grade [ 6 , 7 ]. In addition, a diagnosis of Gleason score of 2–5 is misleading for both clinicians and patients as nearly all cases show higher grade at resection [ 6 , 7 ].…”

“…This is because of poor reproducibility and poor correlation with radical prostatectomy grade [ 6 , 7 ]. In addition, a diagnosis of Gleason score of 2–5 is misleading for both clinicians and patients as nearly all cases show higher grade at resection [ 6 , 7 ]. The original study by Gleason did not benefit from the use of immunohistochemistry and it is likely that Gleason’s original 1 + 1 = 2 adenocarcinomas were in fact adenosis.…”

Changes in prostate cancer grading: Including a new patient‐centric grading system

“…One of the current authors (JIE) wrote an editorial in 2000 recommending that Gleason scores 2–4 should not be assigned to cancer on needle biopsy for several reasons: (i) poor reproducibility even amongst experts; (ii) poor correlation with radical prostatectomy grade with almost all cases showing higher grade at resection; and (iii) a diagnosis of Gleason score 2–4 may misguide clinicians and patients into believing that the patient has an indolent tumor . A Gleason score of 2–4 on needle biopsy was not infrequently associated with higher grade and high stage disease at radical prostatectomy . As a consequence, the incidence of Gleason scores 2–4 on needle biopsy decreased from 22% to 24% in the early 1990s to 1% and 2% in 2001–2003 to where it is almost never seen in current practice .…”

Efficacy of Supportive Histo-morphological Features in Prostate Cancer Diagnosis

“…Epstein's reports that a vast majority of tumors graded as Gleason score 2-4 on needle biopsy, when reviewed by experts in urologic pathology, are graded as Gleason scores 5-6 or higher [26]. Therefore inter-observer variations amongst various pathologists could account for the difference in incidence rates.…”