994 GLEASON SCORE UPGRADING AFTER PROSTATECTOMY DEPENDS ON TUMOR FOCUS CHARACTERISTICS IN PATIENTS DIAGNOSED VIA STANDARDIZED 12-CORE PROSTATE BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 2011994 GLEASON SCORE UPGRADING AFTER PROSTATECTOMY DEPENDS ON TUMOR FOCUS CHARACTERISTICS IN PATIENTS DIAGNOSED VIA STANDARDIZED 12-CORE PROSTATE BIOPSY Michael Musch, Ulla Roggenbuck, Michael Sahm, Stephan Stoerkel, and Darko Kroepfl Michael MuschMichael Musch Essen, Germany More articles by this author , Ulla RoggenbuckUlla Roggenbuck Essen, Germany More articles by this author , Michael SahmMichael Sahm Essen, Germany More articles by this author , Stephan StoerkelStephan Stoerkel Wuppertal, Germany More articles by this author , and Darko KroepflDarko Kroepfl Essen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1027AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gleason grading heterogeneity has been observed in multifocal prostate cancer (PCA). We hypothesized that the existence of small secondary tumor foci representing the highest Gleason grade in the prostatectomy specimen contributes to Gleason score upgrading after prostatectomy. METHODS Between 12/00 and 10/06 a total of 931 PCA patients underwent radical retropubic prostatectomy. In 162 of these patients PCA was initially diagnosed via standardized 12-core transrectal prostate biopsy in our institution. Pathohistological examination of the prostatectomy specimen included determination of predominant Gleason grade and volume of all tumor foci. The correlation of biopsy and prostatectomy Gleason scores (2–6, 7, 8–10) was calculated. In addition, the influence of small secondary tumor foci representing the highest Gleason grade in the prostatectomy specimen on the incidence of Gleason score upgrading was examined. RESULTS Due to missing data 146 of the initial 162 patients were suitable for analysis. Based on the prostatectomy specimen Gleason scores 4–6 were assigned to 91 (62.3%) patients, Gleason score 7 to 42 (28.8%) and Gleason scores 8–10 to 13 (8.9%). Upgrading was observed in 24 (16.4%) and downgrading in 13 (8.9%) cases (kappa 0.49; 95% CI 0.35–0.63). In 76/146 (52.0%) patients a small secondary tumor focus showed the highest Gleason grade in the prostatectomy specimen. The Gleason grade of the largest tumor focus was consistent with the overall highest Gleason grade in 48.0% (70/146) of cases. The median volume of the 76 small secondary tumor foci was significantly smaller than the median volume of the 70 largest tumor foci (0.21cc [range 0.01–2.68] vs. 0.83cc [range 0.01–9.67]; p<0.0001). In the 76 patients with a small secondary tumor focus representing the highest Gleason grade upgrading was observed in 23 (30.3%) cases. In contrast, in the 70 patients in whom the largest tumor focus represented the highest Gleason grade upgrading was observed in only 1 (1.4%) case. In a multivariate logistic regression adjusting for PSA, total tumor volume and prostate volume existence of a small secondary tumor focus representing the highest Gleason grade in the prostatectomy specimen remained the only independent risk factor for Gleason score upgrading (p=0.0005). CONCLUSIONS In PCA patients diagnosed via standardized 12-core prostate biopsy Gleason score upgrading after prostatectomy is significantly more frequent when small secondary tumor foci represent the highest Gleason grade in the prostatectomy specimen. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e400-e401 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Musch Essen, Germany More articles by this author Ulla Roggenbuck Essen, Germany More articles by this author Michael Sahm Essen, Germany More articles by this author Stephan Stoerkel Wuppertal, Germany More articles by this author Darko Kroepfl Essen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...