EAU 2019: Changes in Gleason Score Misclassification Between Diagnostic Biopsies and Radical Prostatectomy Specimens – A Nationwide Analysis

Barcelona, Spain (UroToday.com) Histological grading of prostate biopsies and radical prostatectomy specimens play an important role in the risk stratification and prognostication of patients with localized disease. To improve the prognostic value and increase the concordance between biopsy Gleason score and radical prostatectomy Gleason score, the Gleason grading system has been updated numerous times by the International Society of Urological Pathology (ISUP).

In this study, the authors investigated whether these ISUP updates have had an impact on the degree of down- and upgrading from the results of the biopsy Gleason score to the results of the radical prostatectomy Gleason scores.

The authors used the Danish Prostate Cancer Registry and included all men who underwent radical prostatectomy between 1997 and 2016. For each year the proportion of up- and downgrading were calculated and compared.

A total of 12,482 patients who underwent radical prostatectomy in the study time frame were included. Following exclusion of 2750 men, a total of 9737 men were included in the final analyses. The baseline characteristic of these men are shown in table 1, and the proportion of up- and downgrading- is demonstrated in figure 1.

Table 1- Baseline characteristics of the included patients:
EAU2019 article3 pic1


Figure 1- Proportion of up- and downgrading of the patients:

EAU2019 article3 pic2



From 2001 to 2007, the proportion of men that were upgraded on the final radical prostatectomy specimen increased from 26.9% to 42.3%, and then decreased to 24.5% in 2016, p<0.01. In contrast, the proportion of men who were downgraded remained stable at 5-10% until 2006 and thereafter increased to 15.5% in 2016, p<0.01.

The authors concluded that the degree of upgrading and downstaging from biopsy to final specimen remained high, despite implementing the revision of the grading system. During this time period, the use of multiparametric MRI targeted biopsies have been gradually increasing. It is still unknown how the usage of the MRI targeted biopsy, and the ISUP alterations have impacted the prognostic value of biopsy Gleason grade score and the correlation to the final radical prostatectomy specimen.


Presented by: John Thomas Helgstrand, Copenhagen University Hospital, Rigshospitalet, Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen, Denmark

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.




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