Impact Of Discordance Between Biopsy And Pathological Gleason Scores On Survival After Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 14 Jan 2009 - 6:00 PDT

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UroToday.com - A group of investigators from the Mayo Clinic, Rochester MN evaluated the impact of discordance between prostate biopsy and radical prostatectomy (RP) Gleason score on survival after surgery. Their report appears in the online version of the Journal of Urology.

In general, prostate biopsy Gleason scores are upgraded in RP specimens in approximately 25% of cases. The authors investigated the impact of the Gleason score discordance on biochemical recurrence (BCR), systemic progression, and death from CaP. They also evaluated the additional prognostic value of incorporating biopsy Gleason score into the scoring algorithm incorporating Gleason score, PSA, and seminal vesicle and surgical margin status (GPSM).

Between 1987 and 2003, 8,054 patients in the Mayo Clinic database met the criteria for analysis. The incidence of Gleason score discordance was 481 of 1,259 patients (38.2%) for men undergoing RP between 1987 and 1992, 1,091 of 3,640 (30.0%) men treated between 1993 and 1998, and 847 of 3,155 men (26.9%) of patients treated between 1999 and 2003. Patients with a Gleason score discordance presented at an older age with greater preoperative PSA and increased clinical stage. Discordant Gleason score was associated with adverse pathological features, including advanced tumor stage, lymph node metastasis and positive surgical margins. Men with Gleason score discordance were more likely to undergo adjuvant radiotherapy and adjuvant hormonal therapy.

When patients were categorized by pathological Gleason score, increasing biopsy Gleason score was found to stratify the risk of BCR in men with pathological Gleason 6 or less and 3+4 CaP and remained associated with the risk of systemic progression. Increasing biopsy Gleason score predicted death from CaP in patients with pathological Gleason score of 3+4, but not in those with a Gleason score of 6 or less, 4+3, and 8 to 10. In multivariable analysis, increasing biopsy Gleason score independently predicted postoperative BCR across almost all strata in patients with pathological Gleason 6 or less and 3+4 CaP. Higher biopsy Gleason score also predicted systemic progression in patients with pathological Gleason 3+4 and 8 to 10 CaP and was associated with death from CaP after RP in patients with a pathological Gleason score of 3+4.

Thus, the authors surmise that a patient with a 3+4 RP Gleason score who had a biopsy Gleason score of 8 to 10 was 5.3 times more likely to die of CaP than a man with a RP Gleason score of 3+4 who had a biopsy Gleason score of 6 or less. The addition of biopsy Gleason score minimally improved the predictive ability of the GPSM model.

Boorjian SA, Karnes RJ, Crispen PL, Rangel LJ, Bergstralh EJ, Sebo TJ, Blute ML
J Urol. 2008 Nov 12. Epub ahead of print.
doi:10.1016/j.juro.2008.09.016

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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