Upgrading of Gleason score on radical prostatectomy specimen compared to the pre-operative needle core biopsy: an Indian experience.
OBJECTIVE
To assess the accuracy of Gleason grading/scoring on preoperative needle core biopsy (NCB) compared to the radical prostatectomy (RP) specimen.


METHODS
Data of NCB and RP specimens was analyzed in 193 cases. Gleason grade/scoring was done on both NCB and RP specimens. Sixteen cases were excluded for various reasons. The Gleason scores of the two sets of matched specimens were compared and also correlated with the PSA, age, and number of needle biopsy cores. The overall change was also correlated with the initial score on NCB.


RESULTS
The mean age and PSA were 63.3+/-2(5.27) years and 18.48+/-2(28.42) ng/ml, respectively. The average Gleason score increased from 5.51 +/- 2(1.52) to 6.2 +/- 2(1.42) (P<0.02). The primary grade increased in 57 (32.2%) cases. Overall, 97 (54.8%) cases had an increase in Gleason score. Five other cases had a change from 3 + 4 = 7 to 4 + 3 = 7. Change in Gleason score was significantly more if the score on NCB was </=6 or number of needle cores was </=6. Besides, 28 cases had perineural invasion, 16 had capsular invasion (pT3(a)), and 4 had vascular invasion on RP specimen.


CONCLUSIONS
There is a significant upgrading of Gleason score on RP specimens when compared with NCB. This trend may be correlated positively with lower initial Gleason score on preoperative biopsy and the lower number of cores taken.
Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India.
Rishi
R
Nayyar
Prabhjot
P
Singh
Narmada P
NP
Gupta
Ashok K
AK
Hemal
Prem N
PN
Dogra
Amlesh
A
Seth
Rajeev
R
Kumar