Is the biopsy Gleason score important in predicting outcomes for patients after radical prostatectomy once the pathological Gleason score is known?
OBJECTIVE
To evaluate whether specific preoperative variables might better predict the concordance between biopsy and radical prostatectomy (RP) Gleason grade, and to assess the effect of the biopsy Gleason score (bGS) when controlling for the pathological GS (pGS) on clinical outcomes in patients undergoing RP.


METHODS
Between 1989 and 1998, 1088 men had RP at our institution, with a median follow-up of 56 months. To evaluate the independent effect of bGS within categories of pGS, we stratified the sample by pGS (three categories; <or=6, 7, 8-10). Within each stratum we constructed Kaplan-Meier plots of recurrence-free survival by bGS (in the same three categories), assessing the significance of the differences among the three curves by the log-rank test.


RESULTS
Overall, only 41.1% of patients had exactly concordant findings between bGS and pGS; concordance rates did not differ significantly when stratified by preoperative variables. On multivariate analysis, a change in the pGS compared with the bGS had a significant, independent effect on recurrence rates, specifically a 15% change in risk for a one-unit change in GS (P = 0.021).


CONCLUSIONS
There was only modest agreement between the bGS and the pGS; the bGS continued to have independent prognostic influence after RP and assignment of the pGS.
Vira
Manish A
MA
The Smith Institute for Urology, North Shore Long Island Jewish Health System, New Hyde Park, NY 11040, USA. mvira@nshs.edu
Guzzo
Thomas
T
Heitjan
Daniel F
DF
Tomaszewski
John E
JE
D'Amico
Anthony
A
Wein
Alan J
AJ
Malkowicz
S Bruce
SB
D001706:Biopsy / Q000379:methods*; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery
D017430:Prostate-Specific Antigen