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Upgrading Between Biopsy And Pathology Gleason Score Depends on Tumor Location on Prostatectomy Specimen
Tony Luongo, MD, Andrey Layer, MD, Victoria Banchevsky, PA, Gennaro Carpinito, MD, Elizabeth Genega, MD.
Tufts Medical Center, Boston, MA, USA.
INTRODUCTION: Gleason score in the biopsy is critical in the assessment of disease risk and treatment decision for newly diagnosed prostate cancer. However biopsy Gleason score has limitations with regards to accuracy to pathologic Gleason score.
OBJECTIVE: The objective of this study is to determine if one of the factors influencing the accuracy of biopsy Gleason score in predicting pathology Gleason score is the tumor location on prostatectomy specimen.
METHODS: We reviewed the records of 696 men who underwent radical prostatectomy from 1995 to 2013 at our institution with known tumor location in the surgical specimen. 336 men had Gleason score 7 (3+4) or higher in the prostatectomy specimen which represented the cohort of the study. The study did not include patients with pathologic Gleason score 6 (3+3). The tumor locations were spatially distributed into apical and base tumors. In addition the tumor locations were divided into anterior, anterolateral, lateral, posterior, and posterolateral tumors. Chi-square test was used to compare Gleason score upgrading rates in men with and without tumor involvement of different areas of the prostate.
RESULTS: In our cohort of prostatectomy patients high grade cancer was not found on prostate biopsy in 142 (42.3%). The results show significant upgrading rates in certain locations of the prostate. Tumor involvement of the apical, anterolateral and anterior locations of the prostate were associated with significantly higher frequencies of missed high-grade cancer at transrectal biopsy. However, if the tumor was only located in the apex of the prostate and did not spread to other locations the upgrading rate was 15/43 (34.9%) and not significantly worse than the rest of the cohort. The tumors of the anterior and anterolateral location of the prostate were associated with significant upgrading rates between biopsy and pathology Gleason Score 11/17 (64.7%).
CONCLUSION: Significant upgrading rates between biopsy and pathologic Gleason score are seen in apical and anterior tumors of the prostate. This may indicate undersampling of these areas during transrectal biopsy. Increase attention to these areas at the time of biopsy would improve correlation between transrectal biopsy and prostatectomy Gleason score.
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