Gleason upgrades after RP: affects of prostate size/volume

[Guest guest]

Below is a recent abstract of a report that probability of Gleason

upgrades from biopsy to RP decreases with increasing prostate size.

Rather counter-intuitive as one would expect biopsy sampling error to

increase with increasing prostate size.

Also, for the same prostate volume/size lower Gleason tumors (sum<=6)

had higher probabilities of being upgraded in examination after RP than

Gleason 7 (3+4)..

The Best to You and Yours,

Jon

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1: J Urol. 2007 Dec 11 [Epub ahead of print] Links

Small Transrectal Ultrasound Volume Predicts Clinically Significant

Gleason Score Upgrading After Radical Prostatectomy

Turley RS, Hamilton RJ, Terris MK, Kane CJ, Aronson WJ, Presti JC Jr,

Amling CL, Freedland SJ;

SEARCH Database Study Group.

Division of Urological Surgery, Duke Prostate Center (RST, RJH, SJF).

PURPOSE: Needle biopsy Gleason scores are often upgraded after

pathological examination of the prostate following radical

prostatectomy. It has been suggested that larger prostates would be

associated with a greater risk of upgrading since a smaller percentage

of the gland is sampled and, thus, the highest grade disease would more

likely be missed, assuming an equal number of cores is taken from

similar locations. We examined the likelihood of clinically relevant

upgrading after radical prostatectomy as a function of transrectal

ultrasound volume.

MATERIALS AND METHODS: We examined the association between transrectal

ultrasound volume and upgrading (higher Gleason score category in the

radical prostatectomy specimen than in the biopsy) in 586 men treated

with radical prostatectomy between 1995 and 2006 in the SEARCH database

who underwent at least a sextant biopsy using multivariate logistic

regression. Transrectal ultrasound volume was categorized as 20 or less

(in 71), 21 to 40 (in 334), 41 to 60 (in 123) and greater than 60 cm(3)

(in 58). Gleason score was examined as a categorical variable of 2-6, 3

+ 4 and 4 + 3 or greater.

RESULTS: Overall 138 cases (24%) were upgraded, 80 (14%) were

downgraded, and 368 (62%) had identical biopsy and pathological Gleason

sum groups. Larger transrectal ultrasound volume was significantly

associated with decreased likelihood of upgrading (p trend <0.001). For

transrectal ultrasound volumes greater than 60, 41 to 60, 21 to 40 and

20 cm(3) or less, the estimated multivariate adjusted probability of

upgrading was 12.6%, 27.5%, 36.4% and 45.5% for Gleason 2-6 tumors, and

6.1%, 8.5%, 18.9% and 20.9% for Gleason 3 + 4 tumors, respectively.

CONCLUSIONS: Larger transrectal ultrasound volumes were at decreased

risk for clinically significant upgrading after radical prostatectomy.

This fact should be kept in mind when deciding on treatment decisions

for men with apparently low grade prostate cancer on biopsy.