Abstract
Objective
We intended to analyze the outcomes and predictive factors for underestimating the
prostate cancer (PCa) grade group (GG) from prostate biopsies in a large monocentric
cohort of patients treated by minimally invasive radical prostatectomy (RP).
Materials and Methods
Using a monocentric prospectively maintained database, we included 3062 patients who
underwent minimally invasive RP between 2006 and 2013. We explored clinicopathologic
features and outcomes associated with a GG upgrade from biopsy to RP. Multivariate
logistic regression was used to develop and validate a nomogram to predict upgrading
for GG1.
Results
Biopsy GG was upgraded after RP in 51.5% of cases. Patients upgraded from GG1 to GG2
or GG3 after RP had a longer time to biochemical recurrence than those with GG2 or
GG3 respectively, on both biopsy and RP, but a shorter time to biochemical recurrence
than those who remained GG1 after RP (P < .0001). In multivariate analyses, variables predicting upgrading for GG1 PCa were
age (P = .0014), abnormal digital rectal examination (P < .0001), prostate-specific antigen density (P < .0001), percentage of positive cores (P < .0001), and body mass index (P = .037). A nomogram was generated and validated internally.
Conclusions
Biopsy grading system is misleading in approximately 50% of cases. Upgrading GG from
biopsy to RP may have consequences on clinical outcomes. A nomogram using clinicopathologic
features could aid the probability of needing to upgrade GG1 patients at their initial
evaluation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2016.CA Cancer J Clin. 2016; 66: 7-30
- Incidence of initial local therapy among men with lower-risk prostate cancer in the United States.J Natl Cancer Inst. 2006; 98: 1134-1141
- Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology.Eur Urol. 2006; 49: 820-826
- Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades.Eur Urol. 2012; 61: 1019-1024
- Predicting 15-year prostate cancer specific mortality after radical prostatectomy.J Urol. 2011; 185: 869-875
- The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: definition of grading patterns and proposal for a new grading system.Am J Surg Pathol. 2016; 40: 244-252
- The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma.Am J Surg Pathol. 2005; 29: 1228-1242
- Long-term follow-up of a large active surveillance cohort of patients with prostate cancer.J Clin Oncol. 2015; 33: 272-277
- Active surveillance program for prostate cancer: an update of the Johns Hopkins experience.J Clin Oncol. 2011; 29: 2185-2190
- Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly.Eur Urol. 2009; 55: 1-8
- Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance.Eur Urol. 2008; 54: 1297-1305
- Active surveillance for the management of prostate cancer in a contemporary cohort.Cancer. 2008; 112: 2664-2670
- Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance.J Urol. 2008; 180 (discussion: 1967-8): 1964-1967
- Outcomes of localized prostate cancer following conservative management.JAMA. 2009; 302: 1202-1209
- A UK-based investigation of inter- and intra-observer reproducibility of Gleason grading of prostatic biopsies.Histopathology. 2006; 48: 644-654
- A contemporary study correlating prostate needle biopsy and radical prostatectomy Gleason score.J Urol. 2008; 179 (discussion: 1338-9): 1335-1338
- Insignificant prostate cancer and active surveillance: from definition to clinical implications.Eur Urol. 2009; 55: 1321-1330
- Upgrade in Gleason score between prostate biopsies and pathology following radical prostatectomy significantly impacts upon the risk of biochemical recurrence.BJU Int. 2011; 108: E202-E210
- Role of repeated biopsy of the prostate in predicting disease progression in patients with prostate cancer on active surveillance.Cancer. 2008; 113: 286-292
- Prognostic significance of Gleason score discrepancies between needle biopsy and radical prostatectomy.Eur Urol. 2008; 53 (discussion: 775-6): 767-775
- Prognostic significance of the disparity between biopsy and pathologic gleason score after radical prostatectomy in clinical candidates for active surveillance according to the Royal Marsden Criteria.Clin Genitourin Cancer. 2016; 14: e329-e333
- Clinical predictors of upgrading to Gleason grade 4 or 5 disease at radical prostatectomy: potential implications for patient selection for radiation and androgen suppression therapy.Int J Radiat Oncol Biol Phys. 2013; 45: 841-846
- Clinically significant Gleason sum upgrade: external validation and head-to-head comparison of the existing nomograms.Cancer. 2012; 118: 378-385
- Clinical predictors of Gleason score upgrading: implications for patients considering watchful waiting, active surveillance, or brachytherapy.Cancer. 2007; 109: 2432-2438
- Biopsy core number represents one of foremost predictors of clinically significant gleason sum upgrading in patients with low-risk prostate cancer.Urology. 2009; 73: 1087-1091
- A nomogram for predicting upgrading in patients with low- and intermediate-grade prostate cancer in the era of extended prostate sampling.BJU Int. 2010; 105: 352-358
- Development and multi-institutional validation of an upgrading risk tool for Gleason 6 prostate cancer.Cancer. 2013; 119: 3992-4002
- Predicting the risk of harboring high-grade disease for patients diagnosed with prostate cancer scored as Gleason ≤ 6 on biopsy cores.World J Urol. 2015; 33: 787-792
- Primary Gleason pattern upgrading in contemporary D'Amico low-risk prostate cancer patients: implications for future biomarkers and imaging modalities.BJU Int. 2017; 119: 692-699
- Three-dimensional prostate mapping biopsy has a potentially significant impact on prostate cancer management.J Clin Oncol. 2009; 27: 4321-4326
- Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology.Eur Urol. 2015; 67: 569-576
- Multiparametric magnetic resonance imaging (MRI) and MRI-transrectal ultrasound fusion biopsy for index tumor detection: correlation with radical prostatectomy specimen.Eur Urol. 2016; 70: 846-853
- Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.Lancet. 2017; 389: 815-822
Article info
Publication history
Published online: April 25, 2017
Accepted:
April 14,
2017
Received in revised form:
April 4,
2017
Received:
January 9,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
