The Accuracy of Prostate Biopsies for Predicting Gleason Score in Radical Prostatectomy Specimens. Nationwide trends 2000-2012

OBJECTIVES - To investigate how well the Gleason score in diagnostic needle biopsies predicted the Gleason score in a subsequent radical prostatectomy (RP) specimen before and after the 2005 International Society of Urological Pathology (ISUP) revision of Gleason grading, and if the recently proposed ISUP grades 1-5 (corresponding to Gleason score 6, 3+4, 4+3, 8, and 9-10) better predict the RP grade.

PATIENTS AND METHODS - All prostate cancers diagnosed in Sweden are reported to the National Prostate Cancer Register (NPCR). We analysed Gleason score and ISUP grades from the diagnostic biopsies and RP specimens from 15,598 men in the NPCR who were diagnosed between 2000 and 2012 with clinical stage T1-2 M0/X prostate cancer on needle biopsy at age ≤ 70 years, had serum PSA of

RESULTS - Prediction of RP Gleason score increased from 55% to 68% between 2000 and 2012. Most of the increase occurred before 2005 (9 percentage points) (p<0.001). However, when adjusting for Gleason score and year of diagnosis in a multivariable analysis the prediction of RP Gleason score decreased over time (OR 0.98, p<0.002). A change to ISUP grades would have led to a decreasing agreement between biopsy and RP grades over time, from 68% in 2000 to 57% in 2012, with an OR of 0.95 in multivariable analysis (p<0.001).

CONCLUSIONS - Agreement between biopsy and RP Gleason score improved from 2000 to 2012 with most of the improvement occurring before the 2005 ISUP grading revision. Had ISUP grades been used instead of Gleason score, the agreement between biopsy and RP grade would have decreased, likely because of its separation of Gleason score 7 into ISUP grades 2 and 3 (Gleason score 3+4 versus 4+3). This article is protected by copyright. All rights reserved.

BJU international. 2016 Feb 25 [Epub ahead of print]

Daniela Danneman, Linda Drevin, Brett Delahunt, Hemamali Samaratunga, David Robinson, Ola Bratt, Stacy Loeb, Pär Stattin, Lars Egevad

Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden., Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden., Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand., Aquesta Pathology, Brisbane, Queensland, Australia., Department of Urology, Ryhov County Hospital, Jönköping, Sweden., Department of Urology, Cambridge University Hospitals, Cambridge, United Kingdom., Department of Urology and Population Health, New York University and Manhattan, Veterans Affairs Medical Centre, NY, USA., Department of Surgical and Perioperative Sciences (PS), Urology and Andrology, Umeå University, Umeå, Sweden., Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.