Biopsies performed at tertiary care centers are superior to referral biopsies in predicting pathologic Gleason sum.
OBJECTIVE
Biopsy grading at tertiary care centers may or may not be superior to biopsies performed at referral institutions.


METHODS
Referral biopsy and tertiary care center biopsy Gleason sums were studied in 758 men treated with radical prostatectomy (RP) at a tertiary care center between 1992 and 2004. Grade agreement was calculated using the Cohen kappa (ê). Logistic regression models predicting high-grade prostate cancer at RP were fitted using either referral or tertiary care center biopsies. Comparison of bootstrap-corrected predictive accuracy estimates were performed using the Mantel-Haenszel test.


RESULTS
Grade agreement between biopsy and RP Gleason sum was higher (P = 0.003) for tertiary care center biopsies v referral biopsies (55.5% v 47.9%; P = 0.003). Upgrading occurred in 39.8% of referral biopsies v 32.6% of tertiary care center biopsies (P = 0.03). Tertiary care center biopsies were more accurate in determining RP Gleason sum than referral biopsies (71.5% v 65.6%, P = 0.04).


CONCLUSIONS
More accurate prediction of RP Gleason grade may be achieved if biopsy is performed and graded at tertiary care centers.
Karakiewicz
Pierre I
PI
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada. pierre.karakiewicz@umontreal.ca
Chun
Felix K-H
FK
Gallina
Andrea
A
Suardi
Nazareno
N
Briganti
Alberto
A
Erbersdobler
Andreas
A
Schlomm
Thorsten
T
Walz
Jochen
J
Currlin
Eike
E
Michl
Uwe
U
Haese
Alexander
A
Arjane
Philippe
P
Heinzer
Hans
H
Graefen
Markus
M
Huland
Hartwig
H
D000328:Adult; D000368:Aged; D001706:Biopsy; D006268:Health Facilities / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012017:Referral and Consultation