Well-differentiated prostate cancer in core biopsy specimens may be associated with extraprostatic disease.
OBJECTIVE
Accurate determination of the Gleason score in prostate core biopsy specimens is crucial in selecting the type of prostate cancer treatment, especially for patients with well-differentiated tumors (Gleason score 2 to 4). For such patients, an inaccurate biopsy score may result in a therapeutic intervention that is too conservative. We evaluate the role of Gleason score 2-4 in prostate core-needle biopsies for predicting the final pathological staging following radical prostatectomy.


METHODS
Retrospective study at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo.


METHODS
We analyzed the medical records of 120 consecutive patients who underwent radical retropubic prostatectomy to treat clinical localized prostate cancer at our institution between December 2001 and July 2006. Thirty-two of these patients presented well-differentiated tumors (Gleason score 2 to 4) in biopsy specimens and were included in the study. The Gleason scores of the core-needle biopsies were compared with the pathological staging of the surgical specimens.


RESULTS
Sixteen of the 32 patients (50%) presented moderately differentiated tumors (Gleason score 5 to 7) in surgical specimens. Eighteen patients (56%) had tumors with involvement of the prostate capsule and ten (31%) had involvement of adjacent organs. Evaluating the 16 patients that maintained Gleason scores of 2 to 4 in the pathological staging of the surgical specimens, 11 (68.7%) had focal invasion of the prostate capsule and five (31.25%) had organ-confined disease.


CONCLUSIONS
Well-differentiated tumors (Gleason score 2 to 4) seen in biopsies are not predictive of organ-confined disease.
Department of Urology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
José
J
Cury
Rafael Ferreira
RF
Coelho
Miguel
M
Srougi
D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology* / Q000601:surgery; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
D017430:Prostate-Specific Antigen