Introduction: A study was conducted to develop a new correct system to improve the overall rate of Gleason sum concordance between biopsy and final pathology. Materials and Methods: A total of 592 consecutive patients who had undergone transrectal ultrasound-guided prostate biopsy and radical prostatectomy were evaluated during the first stage. Age, PSA, PSA density (PSAD), biopsy cores, positive cores, prostate volume, positive core rate (PCR), core volume rate (CVR) and digital rectal examination findings were considered predictive factors. A multiple logistic regression analysis involving a backward elimination selection procedure and linear regression analysis involving a stepwise procedure were applied to select independent predictors. Results: Positive cores, PCR, CVR and PSAD were included in our assessing credibility model in the first stage. A significantly higher area under the receiver-operating curve was obtained in our model compared with CVR alone (0.641 vs. 0.517). In the second stage, patients with credibility of pre-operative Gleason score <0.388 were subjected to further evaluation. Compared with the 2 statuses, the rate of overall concordance was significantly increased (60.3 vs. 50.2%, p = 0.002). Conclusions: We developed a follow-up strategy based on the new and correct system, which represents an important consideration procedure when clinicians make decisions with regard to treatment plans.

Keywords:
Concordance rate, Correct system, Gleason score, Prostate cancer, Prostate biopsy
1.
Jemal A, Center MM, DeSantis C, Ward EM: Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010;19:1893-1907.
2.
Li L, Wang L, Feng Z, et al: Prostate cancer magnetic resonance imaging (MRI): multidisciplinary standpoint. Quant Imaging Med Surg 2013;3:100-112.
3.
Epstein JI, Amin M, Boccon-Gibod L, et al: Prognostic factors and reporting of prostate carcinoma in radical prostatectomy and pelvic lymphadenectomy specimens. Scand J Urol Nephrol Suppl 2005;216:34-63.
4.
Froehner M, Propping S, Koch R, Borkowetz A, Liebeheim D, Toma M, Baretton GB, Wirth MP: Is the post-radical prostatectomy Gleason score a valid predictor of mortality after neoadjuvant hormonal treatment? Urol Int 2015, Epub ahead of print.
5.
Rusthoven CG, Waxweiler TV, DeWitt PE, Flaig TW, Raben D, Kavanagh BD: Gleason stratifications prognostic for survival in men receiving definitive external beam radiation therapy for localized prostate cancer. Urol Oncol 2015;33:71.e11-e19.
6.
Pierorazio PM, Walsh PC, Partin AW, et al: Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 2013;111:753-760.
7.
Steinberg DM, Sauvageot J, Piantadosi S, Epstein JI: Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings. Am J Surg Pathol 1997;21:566-576.
8.
Alchin DR, Murphy D, Lawrentschuk N: What are the predictive factors for Gleason score upgrade following RP? Urol Int 2015;96:1-4.
9.
Yoo C, Oh CY, Cho JS, et al: Clinical significance of a large difference (≥2 points) between biopsy and post-prostatectomy pathological Gleason scores in patients with prostate cancer. J Korean Med Sci 2011;26:507-512.
10.
Noguchi M, Stamey TA, Mcneal JE, Yemoto CM: Relationship between systematic biopsies and histological features of 222 radical prostatectomy specimens: lack of prediction of tumor significance for men with nonpalpable prostate cancer. J Urol 2001;166:104-109; discussion 109-110.
11.
Chun FK, Steuber T, Erbersdobler A, et al: Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol 2006;49:820-826.
12.
Freedland SJ, Kane CJ, Amling CL, et al: Upgrading and downgrading of prostate needle biopsy specimens: risk factors and clinical implications. Urology 2007;69:495-499.
13.
Kulkarni GS, Lockwood G, Evans A, et al: Clinical predictors of Gleason score upgrading: implications for patients considering watchful waiting, active surveillance, or brachytherapy. Cancer 2007;109:2432-2438.
14.
Capitanio U, Karakiewicz PI, Valiquette L, et al: Biopsy core number represents one of foremost predictors of clinically significant Gleason sum upgrading in patients with low-risk prostate cancer. Urology 2009;73:1087-1091.
15.
Kim KH, Lim SK, Shin TY, et al: Upgrading of Gleason score and prostate volume: a clinicopathological analysis. BJU Int 2013;111:1310-1316.
16.
Truong M, Slezak JA, Lin CP, et al: Development and multi-institutional validation of an upgrading risk tool for Gleason 6 prostate cancer. Cancer 2013;119:3992-4002.
17.
Davies JD, Aghazadeh MA, Phillips S, et al: Prostate size as a predictor of Gleason score upgrading in patients with low risk prostate cancer. J Urol 2011;186:2221-2227.
18.
Chung MS, Lee SH, Lee DH, Chung BH: Is small prostate volume a predictor of Gleason score upgrading after radical prostatectomy? Yonsei Med J 2013;54:902-906.
19.
Stewart CS, Leibovich BC, Weaver AL, Lieber MM: Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol 2001;166:86-92; discussion 91-92.
20.
Van Praet C, Libbrecht L, D'Hondt F, et al: Agreement of Gleason score on prostate biopsy and radical prostatectomy specimen: is there improvement with increased number of biopsy cylinders and the 2005 revised Gleason scoring? Clin Genitourin Cancer 2014;12:160-166.
21.
Yang CW, Lin TP, Huang YH, et al: Does extended prostate needle biopsy improve the concordance of Gleason scores between biopsy and prostatectomy in the Taiwanese population? J Chin Med Assoc 2012;75:97-101.
22.
King CR, McNeal JE, Gill H, Presti JC Jr: Extended prostate biopsy scheme improves reliability of Gleason grading: implications for radiotherapy patients. Int J Radiat Oncol Biol Phys 2004;59:386-391.
23.
Wang JY, Zhu Y, Wang CF, Zhang SL, Dai B, Ye DW: A nomogram to predict Gleason sum upgrading of clinically diagnosed localized prostate cancer among Chinese patients. Chin J Cancer 2014;33:241-248.
24.
Kattan MW, Shariat SF, Andrews B, et al: The addition of interleukin-6 soluble receptor and transforming growth factor beta1 improves a preoperative nomogram for predicting biochemical progression in patients with clinically localized prostate cancer. J Clin Oncol 2003;21:3573-3579.
25.
Richters A, Derks J, Fossion LM, Kil PJ, Verhoeven RH, Aarts MJ: Presence and number of positive surgical margins after radical prostatectomy for prostate cancer: effect on oncological outcome in a population-based cohort. Urol Int 2015;95:472-477.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.