Prognostic significance of Gleason score discrepancies between needle biopsy and radical prostatectomy.
OBJECTIVE
Discordance between the Gleason score (GS) on needle biopsy (NB) and the GS of the radical prostatectomy (RP) specimen is a common finding. The objective of this study was to evaluate the prognostic significance of these discrepancies with respect to outcomes following RP.


METHODS
In the study, 6625 men treated by RP were categorized as having NB=RP (68.8%), NB<RP (25.0%) or NB>RP (6.2%) GS, and stratified for analyses into RP GS groups. The Kaplan-Meier method was used to analyze differences in biochemical recurrence-free survival (BRFS), and multivariate Cox analyses were performed to estimate the independent relative risk of progression associated with GS discrepancies.


RESULTS
Across multiple RP GS strata (3+4, 7, 8, 8-10), patients with a lower NB GS experienced significantly better BRFS than patients with equal NB and RP GS (all p<0.05). NB<RP GS was independently associated with better (pooled HR, 0.76, p=0.001) BRFS, within and across RP GS strata. Similarly, patients with NB>RP GS had poorer BRFS than patients with NB=RP GS across multiple RP GS strata (< or =3+3, 3+4, 7; all p<0.05). NB>RP GS was independently associated with worse (pooled HR, 1.91, p<0.001) BRFS probabilities, within and across RP GS strata.


CONCLUSIONS
Our data suggest that the GS of the NB adds additional prognostic value to the RP GS in a consistent manner that may be applicable to strategies of risk stratification and patient counseling after surgery.
Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. michael.muentener@usz.ch <michael.muentener@usz.ch>
Michael
M
Müntener
Jonathan I
JI
Epstein
David J
DJ
Hernandez
Mark L
ML
Gonzalgo
Leslie
L
Mangold
Elizabeth
E
Humphreys
Patrick C
PC
Walsh
Alan W
AW
Partin
Matthew E
ME
Nielsen
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D016019:Survival Analysis
D017430:Prostate-Specific Antigen