Abstract
BackgroundIn this population-based study, we investigated the degree of concordance between Gleason scores obtained from prostate biopsies and those obtained from prostatectomy specimens, as well as the determinants of biopsy understaging.MethodsWe considered for this study all 371 prostate cancer patients recorded at the Geneva Cancer Registry diagnosed from 2004 to 2006 who underwent a radical prostatectomy. We used the kappa statistic to evaluate the Gleason score concordance from biopsy and prostatectomy specimens. Logistic regression was used to determine the parameters that predict the undergrading of the Gleason score in prostate biopsies.ResultsThe kappa statistic between biopsy and prostatectomy Gleason score was 0.42 (p < 0.0001), with 67% of patients exactly matched, and 26% (n = 95) patients with Gleason score underestimated by the biopsy. In a multi-adjusted model, increasing age, advanced clinical stage, having less than ten biopsy cores, and longer delay between the two procedures, were all independently associated with biopsy undergrading. In particular, the proportion of exact match increased to 72% when the patients had ten or more needle biopsy cores. The main limitation of the study is that both biopsy and prostatectomy specimens were examined by different laboratories.ConclusionsThe data show that concordance between biopsy and prostatectomy Gleason scores lies within the classic clinical standards in this population-based study. The number of biopsy cores appears to strongly impact on the concordance between biopsy and radical prostatectomy Gleason score.
Highlights
In this population-based study, we investigated the degree of concordance between Gleason scores obtained from prostate biopsies and those obtained from prostatectomy specimens, as well as the determinants of biopsy understaging
With reference to the last issue, it is worth mentioning that the European Association of Urologists (EAU) in 2008 recommended obtaining at least 10 cores during the biopsy [12], while in the most recent guidelines reduced this number to eight [13]. In this population-based study, we investigated the degree of concordance between Gleason scores (GSs) obtained from needle biopsy of the prostate and radical prostatectomy, and we assessed the parameters that may be related to undergrading the GS in prostate biopsy
An exact match was observed for 67% of patients (n = 248) while for 26% (n = 95) the GS was underestimated by the biopsy; in 7% of patients, it was overestimated
Summary
In this population-based study, we investigated the degree of concordance between Gleason scores obtained from prostate biopsies and those obtained from prostatectomy specimens, as well as the determinants of biopsy understaging. The Gleason score (GS) closely correlates with clinical behavior, and provides an important index of prognosis. This score is one of the key determinants in treatment decision making, together with stage, age and prostate-specific antigen [1]. It has been observed that the GS from needle biopsies underestimates the GS of the radical prostatectomy specimen in 19 to 57% of all cases depending on the series and the periods examined [2,3,4,5,6,7,8] Such downgrading has a significant impact on treatment decisions and patient outcomes, when the choice of treatment is between active surveillance and curative intent therapy
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