title: Clinical impact of prostate biopsy undergrading in an academic and community setting.
abstract: OBJECTIVE
  To evaluate whether the rate of Gleason score (GS) upgrade on final pathology, the rate of positive surgical margins (PSM) and the rate of biochemical recurrence (BCR) after radical prostatectomy (RP) were different if prostate biopsy (PB) was graded by community pathologists (CP) as compared to specialized uro-pathologists (UP).
  
  
  METHODS
  A consecutive series of patients undergoing RP in our institution between 2005 and 2013 were retrospectively reviewed. Any GS higher or lower in RP specimen as compared to PB GS was defined as GS upgrade or downgrade, respectively. Additionally, stratification for the new ISUP 2014 grading system was performed. Predictors of GS upgrade and PSMs and prognostic parameters for BCR were assessed by stepwise logistic regression models and by multivariable Cox regression analyses, respectively.
  
  
  RESULTS
  A total of 786 patients were available for analysis, and median follow-up was 36 months (1-101 months). A GS upgrade was found in 345 patients (43.9 %) and a GS downgrade in 91 patients (11.6 %). Discordance between PB GS and RP GS was significantly more frequent when grading had been performed by a CP (50.5 % upgrade, 9.0 % downgrade) than by a UP (33.1 % upgrade, 15.7 % downgrade, p < 0.001). CP evaluation was an independent predictor for GS upgrade (odds ratio [OR] 1.91, p < 0.001) and for PSMs (OR 1.69, p = 0.003), as well as an independent predictor of BCR (hazard ratio [HR] 1.65, p = 0.028).
  
  
  CONCLUSIONS
  Pathologic evaluation of PBs by a dedicated UP should be recommended to reduce the rate of biopsy undergrading, PSM and BCR after RP.
authors.affiliation: Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland. Ashkan.Mortezavi@usz.ch.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Mortezavi
authors.affiliation: Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors.forename: Etienne Xavier
authors.initials: EX
authors.lastname: Keller
authors.affiliation: Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors.forename: Cédric
authors.initials: C
authors.lastname: Poyet
authors.affiliation: Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hermanns
authors.affiliation: Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors.forename: Karim
authors.initials: K
authors.lastname: Saba
authors.affiliation: Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Randazzo
authors.affiliation: Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors.forename: Christian Daniel
authors.initials: CD
authors.lastname: Fankhauser
authors.affiliation: Institute of Surgical Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Wild
authors.affiliation: Institute of Surgical Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Holger
authors.initials: H
authors.lastname: Moch
authors.affiliation: Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland.
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
authors.affiliation: Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstr.10, 8091, Zurich, Switzerland. Daniel.Eberli@usz.ch.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eberli
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D003151:Community Health Centers; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013557:Switzerland; D020728:Transurethral Resection of Prostate / Q000379:methods*
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: Gleason score; Positive surgical margin; Prognosis; Prostate cancer; Transrectal biopsy; Undergrading