How Much Does Gleason Grade Of Follow-up Biopsy Differ From That Of Initial Biopsy In Untreated, Gleason Score 4 7, Clinically Prostate Cancer?

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Clinical Trials / Drug Trials
Article Date: 10 Dec 2007 - 0:00 PDT

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UroToday.com- Patients with prostate cancer (CaP) often elect active surveillance (AS) with potential delayed intervention. While protocols vary most patients undergo serial PSA testing and repeat prostate biopsies every 2 years. In the November issue of The Prostate, Dr. Choo and collaborators of Dr. Klotz report that no consistent change in Gleason grade is observed on serial follow-up biopsies.

In a prospective study of AS, 168 men were enrolled between 1995 and 2003. Of these, 105 underwent follow-up biopsies while the remainder had come off the protocol or declined biopsy. Disease progression was defined as a PSA doubling time of less than 2 years, clinical progression, and histologic upgrade on repeat prostate biopsy.

The median interval from initial prostate biopsy to follow-up biopsy was 22 months. From the initial biopsy, Gleason score was unchanged in 33 patients (31%), upgraded by 1 point or greater in 37 patients (35%), but upgraded by 2 Gleason points in 11 patients (10%), and decreased by 1 point or more in 34 men (32%). Regarding the primary Gleason grade, it was unchanged in 55 patients (52%), upgraded in 17 men (16%), and downgraded in 32 (30%). For secondary Gleason grade, it was unchanged in 37 (35%), upgraded in 34 (32%), and downgraded in 33 (31%). In multivariate analysis a larger tumor volume reduced the odds of observing a lower or same Gleason score after adjusting for the initial Gleason score. The authors suggest that a man with a lower Gleason score and higher tumor volume at the initial biopsy was more likely to have a higher Gleason score on the follow-up biopsy. The converse was also implied that a man with a higher Gleason score and lower tumor volume at the initial biopsy was more likely to have a same or lower Gleason score at the follow-up biopsy.

Choo R, Danjoux C, Morton G, Szumacher E, Sugar L, Gardner S, Kim M, Choo CM, Klotz L

Prostate. 67(15):1614-1620, November 2007
Doi: 10.1002/pros.20648

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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