title: Biopsies performed at tertiary care centers are superior to referral biopsies in predicting pathologic Gleason sum.
abstract: 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.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada. pierre.karakiewicz@umontreal.ca
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Felix K-H
authors: FK
authors: Chun
authors: Andrea
authors: A
authors: Gallina
authors: Nazareno
authors: N
authors: Suardi
authors: Alberto
authors: A
authors: Briganti
authors: Andreas
authors: A
authors: Erbersdobler
authors: Thorsten
authors: T
authors: Schlomm
authors: Jochen
authors: J
authors: Walz
authors: Eike
authors: E
authors: Currlin
authors: Uwe
authors: U
authors: Michl
authors: Alexander
authors: A
authors: Haese
authors: Philippe
authors: P
authors: Arjane
authors: Hans
authors: H
authors: Heinzer
authors: Markus
authors: M
authors: Graefen
authors: Hartwig
authors: H
authors: Huland
mesh_terms: 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