title: Predicting the risk of patients with biopsy Gleason score 6 to harbor a higher grade cancer.
abstract: OBJECTIVE
  Prostate cancer Gleason score 3 + 3 = 6 is currently the most common score assigned on prostatic biopsies. We analyzed the clinical variables that predict the likelihood of a patient with biopsy Gleason score 6 to harbor a higher grade tumor.
  
  
  METHODS
  The study population consisted of 448 patients with a mean age of 59.1 years who underwent radical prostatectomy between February 2003 to October 2006 for Gleason score 6 adenocarcinoma. The effect of preoperative variables on the probability of a Gleason score upgrade on final pathological evaluation was evaluated using logistic regression, and classification and regression tree analysis.
  
  
  RESULTS
  Gleason score upgrade was found in 91 of 448 patients (20.3%). Logistic regression showed that only serum prostate specific antigen and the greatest percent of cancer in a core were significantly associated with a score upgrade (p = 0.0014 and 0.023, respectively). Classification and regression tree analysis showed that the risk of a Gleason score upgrade was 62% when serum prostate specific antigen was higher than 12 ng/ml and 18% when serum prostate specific antigen was 12 ng/ml or less. In patients with serum prostate specific antigen lower than 12 ng/ml the risk of a score upgrade could be dichotomized at a greatest percent of cancer in a core of 5%. The risk was 22.6% and 10.5% when the greatest percent of cancer in a core was higher than 5% and 5% or lower, respectively.
  
  
  CONCLUSIONS
  The probability of patients with a prostate biopsy Gleason score of 6 to conceal a Gleason score of 7 or higher can be predicted using serum prostate specific antigen and the greatest percent of cancer in a core. With these parameters it is possible to predict upgrade rates as high as 62% and as low as 10.5%.
authors.affiliation: Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois 60637, USA. ong1000@netvision.net.il
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.forename: Jerome B
authors.initials: JB
authors.lastname: Taxy
authors.forename: Shang
authors.initials: S
authors.lastname: Lin
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Zagaja
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg
authors.forename: Arieh L
authors.initials: AL
authors.lastname: Shalhav
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology* / Q000601:surgery; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen