BERKELEY, CA (UroToday.com) - Gleason score remains one of the strongest prognostic predictors of treatment outcome in patients with prostate cancer (CaP). The prostate biopsy is a sampling and may not accurately reflect the Gleason score in the final radical prostatectomy (RP) specimen. The biopsy Gleason score can impact treatment decisions and outcomes if it does not accurately reflect the true Gleason score and biology of the prostate tumor. For example, some treatments such as brachytherapy are best suited for men with Gleason score 6 or less CaP. In the online version of Urology, Dr. Rajinikanth and the group of Dr. Mark Soloway at the University of Miami report the trends in Gleason score concordance between biopsy and RP over a 15 year period.

A total of 1,363 men who underwent RP by Dr. Soloway between 1992 and 2006 were assessed in three groups; group 1 was 1992-1996, group 2 was 1997-2001, and group 3 was 2002-2006. The same pathologist was not reviewing the specimens in all cases. The number of RPs performed increased 2.5 fold from group 1 to group 3. Overall, biopsy and RP Gleason score correlated exactly in 59% of patients. The biopsy Gleason score was undergraded in 32% and overgraded in 9%. The Gleason score concordance between biopsy and RP was 39%, 55%, and 70% in groups 1, 2, and 3, respectively. Undergrading of the biopsy sample was the most common discordant finding. The rate of undergrading decreased from 53% in group 1 to 20% in group 3. The percentage of overgrading did not differ greatly over the 3 time periods and was about 5%. The data is reassuring to patients that the biopsy is a more accurate reflection of their tumor than it may have been 10 to 15 years previously.

Rajinikanth A, Manoharan M, Soloway CT, Civantos FJ, Soloway MS

Urology. 2008 Feb 14 [Epub ahead of print]
doi: 10.1016/j.urology.2007.10.022

PubMed Abstract
PMID: 18279938

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Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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