%0 Journal Article
%T Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens
%A Leonardo Oliveira Reis
%A Emerson Luis Zani
%A Leandro L. L. Freitas
%A Fernandes Denardi
%A Athanase Billis
%J Advances in Urology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/710421
%X Background. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ¡Ü6, 7, and ¡Ý8; 94 patients (27.4%) had PSA recurrence, mean followup 80.2 months (median 99). Independent predictors of Gleason upgrading (logistic regression) and disease-free survival (DFS) (Kaplan-Meier, log-rank) were determined. Results. Gleason discordance was 45.7% (37.32% upgrading and 8.45% downgrading). Upgrading risk decreased by 2.4% for each 1£¿g of prostate weight increment, while it increased by 10.2% for every 1£¿ng/mL of PSA, 72.0% for every 0.1 unity of PSA density and was 21 times higher for those with BGS 7. Gleason upgrading showed increased clinical stage ( ), higher tumor extent ( ), extraprostatic extension ( ), positive surgical margins ( ), seminal vesicle invasion ( ), less ¡°insignificant¡± tumors ( ), and also worse DFS, , , . However, when setting the final Gleason score (BGS to PGS 7 versus BGS 7 to PGS 7), avoiding allocation bias, DFS impact is not confirmed, , , Conclusions. Gleason upgrading is substantial and confers worse outcomes. Prostate weight is inversely related to upgrading and its protective effect warrants further evaluation. 1. Introduction Gleason score (GS) remains the most widely accepted grading system in the evaluation of prostate cancer and is one of the most important factors influencing tumor prognosis and treatment choice for patients diagnosed with prostate cancer [1]. Nevertheless, several studies have reported a poor Gleason score concordance between biopsy and radical prostatectomy (RP) specimens [1¨C4]. Failure of accurately obtaining the biopsy specimen to precisely reflect the true nature of the cancer is especially important for patients considering nonextirpative treatments, such as external beam radiotherapy, brachytherapy, cryotherapy, or expectant management [5]. Also, whether the clinical outcome of Gleason score discordance is similar to that of concordant tumors of the higher grade, concordant tumors of the lower grade, or somewhere in between remains to be solved. Targeting a better guidance to patients during their treatment decision process, we investigated factors predictive of Gleason score upgrading between biopsy and surgical specimens and the impact of discordance scores on postoperative outcomes. 2. Materials and Methods 2.1. Patient Selection A prospectively maintained database of 360 consecutive patients who underwent 10¨C12 core
%U http://www.hindawi.com/journals/au/2013/710421/