title: Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range.
abstract: When offering watchful waiting or active monitoring protocols to prostate cancer (PCa) patients, differentiation between Gleason scores (GS) 6 and 7 at biopsy is important. However, upgrading after prostatectomy is common. We investigated the impact of different PSA levels on misclassification in the PSA range of 2-3.9 and 4-10 ng ml(-1). A total of 448 patients with GS 6 PCa on prostate biopsy were evaluated by comparing biopsy and prostatectomy GS. Possible over diagnosis was defined as GS <7, pathological stage pT2a and negative surgical margins, and possible under diagnosis was defined as pT3a or greater, or positive surgical margins; the percentage of over- or under diagnosis was determined for correctly and upgraded tumors after prostatectomy. A match between biopsy and prostatectomy GS was found in 210 patients (46.9%). Patients in the PSA range of 2.0-3.9 and 4.0-10.0 ng ml(-1) were upgraded in 32.6 and 44.0%, respectively. Over diagnosis was more common than under diagnosis (23.2% vs 15.6%). When upgraded there was a significant increase in under diagnosis. As almost 40% of GS 6 tumors on biopsy are GS 7 or higher after surgery with a significant rise in under diagnosis there is a risk of misclassification and subsequent delayed or even insufficient treatment, when relying on favorable biopsy GS.
authors.affiliation: Department of Urology, University of Tuebingen, Tuebingen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Colleselli
authors.forename: A E
authors.initials: AE
authors.lastname: Pelzer
authors.forename: E
authors.initials: E
authors.lastname: Steiner
authors.forename: S
authors.initials: S
authors.lastname: Ongarello
authors.forename: G
authors.initials: G
authors.lastname: Schaefer
authors.forename: G
authors.initials: G
authors.lastname: Bartsch
authors.forename: C
authors.initials: C
authors.lastname: Schwentner
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen