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RESEARCH PRODUCT

Predictors for clinically relevant Gleason score upgrade in patients undergoing radical prostatectomy

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Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Clinically relevant GSU in the prostatectomy specimen is a common phenomenon. Clinically relevant GSU occurs in one of three patients with clinically ‘very’ low-risk PCa, and a low number of biopsy cores is the key negative predictor. OBJECTIVE • To evaluate clinical predictors for Gleason score upgrade (GSU) in radical prostatectomy (RP) specimen, especially in patients with ‘very’ low risk PCA (T1c and biopsy Gleason score ≤6 and PSA <10 ng/ml and ≤2 positive biopsy cores and PSA density <0.15). Patients and Methods • 402 consecutive patients undergoing RP between 2004 and 2006, including a subgroup of 62 patients with ‘very’ low risk PCA, were examined. • Patients were categorized for clinically relevant GSU (defined as upgrade into a higher PCA risk category). • Parameters including number of biopsy cores obtained, positive biopsy cores, prostate weight, PSA, DRE and pathology department were evaluated for their role as predictors. • Furthermore, GSU in RP specimen was analyzed for its impact on pT-stage. RESULTS • Clinically relevant GSU occurred in 38.1% in the whole cohort and in 32.3% in the ‘very’ low risk PCA subgroup. Gleason score downgrade (GSD) occurred in 4.7%. • Number of biopsy cores obtained and prostate weight were independent negative predictors of GSU in all 402 patients (P = 0.02 and P = 0.03, respectively). • In the ‘very’ low risk group, only number of biopsy cores obtained revealed as an independent negative predictor of GSU (P = 0.02). • PSA, DRE, number of positive cores or pathology department were not associated to GSU. • In the ‘very’ low risk group, GSU was related with extracapsular tumor extension (P = 0.05). Conclusions • Clinically relevant GSU in RP specimen is still a challenging problem. • Increasing the number of biopsy cores lower this risk significantly. GSD is rare and thus of minor importance for treatment decisions.