Prostate Cancers Scored as Gleason 6 on Prostate Biopsy are Frequently Gleason 7 Tumors at Radical Prostatectomy: Implication on Outcome
- 1 September 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 176 (3), 979-984
- https://doi.org/10.1016/j.juro.2006.04.102
Abstract
Differentiation between Gleason score 6 and 7 in prostate biopsy is important for treatment decision making. Nevertheless, under grading errors compared with the actual pathological grade at radical prostatectomy are common. We compared the characteristics and outcomes of tumors that were scored 6 on prostate biopsy but were 7 on subsequent radical prostatectomy pathological evaluation to those in tumors with a consistent rating of Gleason score 6 or 7 at biopsy and surgery. We performed a retrospective database analysis from our referral center (1989 to 2004). We compared pre-prostatectomy characteristics, radical prostatectomy pathological features and the post-radical prostatectomy prostate specific antigen failure rate, defined as any 2 consecutive detectable prostate specific antigen measurements, in 3 subgroups of patients, including 156 with matched Gleason score 6 in the prostate biopsy and radical prostatectomy, 205 with upgraded Gleason score 6/7, that is prostate biopsy Gleason score 6 and radical prostatectomy Gleason score 7, and 412 with matched Gleason score 7 in the prostate biopsy and radical prostatectomy. Radical prostatectomy Gleason score matched the prostate biopsy score in 38.2% of biopsy Gleason score 6 and 81.4% of biopsy Gleason score 7 cases. Higher prostate specific antigen was associated and an increased percent of cancer in the prostate biopsy was predictive of discordance between the prostate biopsy and radical prostatectomy Gleason scores (p <0.001). Margin (p = 0.0075) or seminal vesicle involvement (p = 0.0002), cancer volume (p <0.001) and the prostate specific antigen failures rate (p = 0.014) were significantly higher in under graded Gleason score 7 cancer compared to those in matched Gleason score 6 cases. However, they were comparable to those with a matched Gleason score 7 tumor grade (p = 0.66). Almost half of tumors graded Gleason score 6 at biopsy are Gleason score 7 at surgery. Upgraded Gleason score 6 to 7 tumors have outcomes similar to those of genuine Gleason score 7 cancer. For prostate biopsy Gleason score 6 tumors clinicians should consider the overall likelihood of tumor upgrading as well as specific patient characteristics, such as prostate specific antigen and the percent of tumor in the prostate biopsy, when contemplating treatments that are optimized for low grade tumors, including watchful waiting or brachytherapy.Keywords
This publication has 20 references indexed in Scilit:
- INCREASED ACCURACY OF BIOPSY GLEASON SCORE OBTAINED BY EXTENDED NEEDLE BIOPSYJournal of Urology, 2004
- LIMITATIONS OF BIOPSY GLEASON GRADE: IMPLICATIONS FOR COUNSELING PATIENTS WITH BIOPSY GLEASON SCORE 6 PROSTATE CANCERJournal of Urology, 2004
- Cancer-Specific Mortality After Surgery or Radiation for Patients With Clinically Localized Prostate Cancer Managed During the Prostate-Specific Antigen EraJournal of Clinical Oncology, 2003
- International Validation of a Preoperative Nomogram for Prostate Cancer Recurrence After Radical ProstatectomyJournal of Clinical Oncology, 2002
- EXPECTANT MANAGEMENT OF NONPALPABLE PROSTATE CANCER WITH CURATIVE INTENT: PRELIMINARY RESULTSJournal of Urology, 2002
- PROSPECTIVE VALIDATION OF AN ALGORITHM WITH SYSTEMATIC SEXTANT BIOPSY TO PREDICT PELVIC LYMPH NODE METASTASIS IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATIC CARCINOMAJournal of Urology, 2002
- INDICATORS OF PATHOLOGIC STAGE OF PROSTATE CANCER AND THEIR USE IN CLINICAL PRACTICEUrologic Clinics of North America, 2001
- Biochemical Outcome Following External Beam Radiation Therapy With or Without Androgen Suppression Therapy for Clinically Localized Prostate CancerJAMA, 2000
- American brachytherapy society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancerInternational Journal of Radiation Oncology*Biology*Physics, 1999
- Biochemical Outcome After Radical Prostatectomy, External Beam Radiation Therapy, or Interstitial Radiation Therapy for Clinically Localized Prostate CancerJAMA, 1998