Extreme Gleason Upgrading From Biopsy to Radical Prostatectomy: A Population-based Analysis.
To examine the risk factors associated with the odds of extreme Gleason upgrading at radical prostatectomy (RP) (defined as a Gleason prognostic group score increase of ≥2), we utilized a large, population-based cancer registry.



The Surveillance, Epidemiologic, and End Results database was queried (2010-2011) for all patients diagnosed with Gleason 3 + 3 or 3 + 4 on prostate needle biopsy. Available clinicopathologic factors and the odds of upgrading and extreme upgrading at RP were evaluated using multivariate logistic regression.



A total of 12,459 patients were identified, with a median age of 61 (interquartile range: 56-65) and a diagnostic prostate-specific antigen (PSA) of 5.5 ng/mL (interquartile range: 4.3-7.5). Upgrading was observed in 34% of men, including 44% of 7402 patients with Gleason 3 + 3 and 19% of 5057 patients with Gleason 3 + 4 disease. Age, clinical stage, diagnostic PSA, and % prostate needle biopsy cores positive were independently associated with odds of any upgrading at RP. In baseline Gleason 3 + 3 disease, extreme upgrading was observed in 6%, with increasing age, diagnostic PSA, and >50% core positivity associated with increased odds. In baseline Gleason 3 + 4 disease, extreme upgrading was observed in 4%, with diagnostic PSA and palpable disease remaining predictive. Positive surgical margins were significantly higher in patients with extreme upgrading at RP (P < .001).



Gleason upgrading at RP is common in this large population-based cohort, including extreme upgrading in a clinically significant portion.
Department of Urology, University of Washington School of Medicine, Seattle, WA. Electronic address: wintersb@uw.edu.
Brian R
BR
Winters
Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
Jonathan L
JL
Wright
Department of Urology, University of Washington School of Medicine, Seattle, WA.
Sarah K
SK
Holt
Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
Daniel W
DW
Lin
Department of Urology, University of Washington School of Medicine, Seattle, WA.
William J
WJ
Ellis
Department of Urology, University of Washington School of Medicine, Seattle, WA.
Bruce L
BL
Dalkin
Department of Urology, University of Washington School of Medicine, Seattle, WA.
George R
GR
Schade
D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors