Gleason Score Discrepancies Between Needle Biopsies and Radical Prostatectomy Specimens in an African Men: Clinical Implication
Keywords:Prostate adenocarcinoma, needle biopsy, radical prostatectomy, Gleason score correlation, prognostic significance.
Objective:Gleason scores, as determined by 18-gauge core needle biopsies (NB), were compared with both Gleason scores and the pathological staging of corresponding radical prostatectomy( RP) specimens. The goal was to evaluate the clinical implication and the prognostic impact of these discrepancies.
Methods: Records of 234 consecutive patients undergoing a radical retro pubic prostatectomy between 2001 and 2012 were reviewed. In total, all our patients were enrolled, al1 of whom had been diagnosed with adenocarcinoma by transrectal needle biopsies using an 18-gauge automated spring-loaded biopsy gun.
Results: Grading errors were greatest with wel1-differentiated tumors. The accuracy was 18 (23%) for Gleason scores of 2-4 on needle biopsy. Of the 108 evaluable patients with Gleason scores of 5-7 on needle biopsy, 84 (78%) were graded correctly. All of the Gleason scores of 8-10 on needle biopsy were graded correctly. 54 of 162 patients (33%), with a biopsy Gleason score of < 7 had their cancer upgraded to above 7. Tumors in 18 patients (60%) with both a Gleason score < 7 on the needle biopsy and a Gleason score of 7 for the prostatectomy specimen were confined to the prostate.
Conclusion: The potential for grading errors is greatest with well-differentiated tumors and in patients with a Gleason score of < 7 on the needle biopsy. Predictions using Gleason scores are sufficiently accurate to warrant its use with all needle biopsies, recognizing that the potential for grading errors is greatest with well-differentiated tumors.
Cookson MS, Fleshner NE, Soloway SM, Fair WR. Corre1ation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J Urol 1997; 157: 559-62. http://dx.doi.org/10.1016/S0022-5347(01)65201-7
Gonzalgo ML, Bastian PJ, Mangold LA, et al. Relationship between primary Gleason pattern on needle biopsy and clinicopathologic outcomes among men with Gleason score 7 adenocarcinoma of the prostate. Urology 2006; 49: 820-26.
Makhlouf AA, Krupski TL, Kunkle D, Theodorescu D. The effect of sampling more cores on the predictive accuracy of pathological grade and tumor distrubition in the prostate biopsy. BJU Int 2004; 93: 271-74. http://dx.doi.org/10.1111/j.1464-410X.2004.04600.x
King CR, Mc Neal JE, Gill H, Presti Jr JC. Extended prostate biopsy scheme improves reliability of Gleason grading: implication of radiotherapy patients. Int J Radiat Oncol Biol Phys 2004; 59: 386-61. http://dx.doi.org/10.1016/j.ijrobp.2003.10.014
Koksal T, Ozcan F, Kadiog1u TC, Esen T. Klcaslan J, Tunc M. Discrepancy between Gleason scores of biopsy and radical prostatectomy specimens. Eur Urol 2000; 37: 670-4. http://dx.doi.org/10.1159/000020216
Chun FK-H, Steuber T, Erbersdobler A. Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol 2006; 49: 820-26. http://dx.doi.org/10.1016/j.eururo.2005.11.007
King CR. Patterns of prostate cancer biopsy grading: trends and clinical implications. Int J cancer 2000. http://dx.doi.org/10.1002/1097-0215(20001220)90:6<305::AID-IJC1>3.0.CO;2-U
Epstein JI, Allsbrook Jr WC, Amin MB, Egevad LL. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of prostatic carcinoma. Am J Surg Pathol 2005; 29: 1228-42. http://dx.doi.org/10.1097/01.pas.0000173646.99337.b1
Mûntener M, Epstein JI, Hernandez DJ, Gonzalgo ML, et al. Prognostic significance of Gleason Score discrepancies between needle biopsy and radical prostatectomy. Eur Urol 2008; 53: 767-76. http://dx.doi.org/10.1016/j.eururo.2007.11.016
Stephen A, Boorjian R, Jeffrey Karnes R, et al. The impact of discordance between biopsy and pathological Gleason scores on survival after radical prostatectomy. J Urol 2009; 181: 95-104. http://dx.doi.org/10.1016/j.juro.2008.09.016
Rauf Taner D, Asken Erog L, Sahen A. Increasing the number of biopsies increases the concordance of Gleason scores of needle biopsies and prostatectomy specimens Urol Oncol 2007; 25: 276-82.
Yang CW, Lin TP, Huang YH. Does extended prostate needle biopsy improve the concordance of Gleason score between biopsy and prostatectomy in the Taiwanese population? J Chin Med Ass 2012; 75: 97-101. http://dx.doi.org/10.1016/j.jcma.2012.02.001
Davies JD, Aghazadeh MA, Phillips S, Salem S. Prostate size as a predictor of Gleason upgrading in patients with low risk prostate cancer. J Urol 2011; 186: 2221-27. http://dx.doi.org/10.1016/j.juro.2011.07.104
Audenet F, Comperat E, Seringe E, et al. Patient risk stratification using Gleason concordance and upgrading among men with prostate biopsy Gleason score 6 or 7. Urol Oncol 2011; 29: 602-607. http://dx.doi.org/10.1016/j.urolonc.2009.09.011
Isariyawongse BK, Sun L, Banez LL, Robertson C, et al. Significant discrepancies between biopsic and pathologic Gleason sums in prostate cancer. The predictive role of Age and prostate specific antigen. Urology 2008; 72: 882-86. http://dx.doi.org/10.1016/j.urology.2008.02.021
Kuroiwa K, Shiraishi T, Naito S. Gleason score correlation between biopsy and prostatectomy specimen and prediction of high grade Gleason patterns: significance of central pathologic review. Urology 2011; 77: 407-11. http://dx.doi.org/10.1016/j.urology.2010.05.030
Gershman B, Dahi DM, Olumi AF, et al. Smaller prostate gland size and older age predict Gleason score upgrading. Urol Oncol 2011; 28: 11-16.