Importance of prostate-specific antigen (PSA) as a predictive factor for concordance between the Gleason scores of prostate biopsies and RADICAL prostatectomy specimens

Abstract

OBJECTIVE:To evaluate the concordance between the Gleason scores of prostate biopsies and radical prostatectomy specimens, thereby highlighting the importance of the prostate-specific antigen (PSA) level as a predictive factor of concordance.METHODS:We retrospectively analyzed 253 radical prostatectomy cases performed between 2006 and 2011. The patients were divided into 4 groups for the data analysis and dichotomized according to the preoperative PSA, <10 ng/mL and ≥10 ng/mL. A p-score <0.05 was considered significant.RESULTS:The average patient age was 63.3±7.8 years. The median PSA level was 9.3±4.9 ng/mL. The overall concordance between the Gleason scores was 52%. Patients presented preoperative PSA levels <10 ng/mL in 153 of 235 cases (65%) and ≥10 ng/mL in 82 of 235 cases (35%). The Gleason scores were identical in 86 of 153 cases (56%) in the <10 ng/mL group and 36 of 82 (44%) cases in the ≥10 ng/mL group (p = 0.017). The biopsy underestimated the Gleason score in 45 (30%) patients in the <10 ng/mL group and 38 (46%) patients in the ≥10 ng/mL (p = 0.243). Specifically, the patients with Gleason 3 + 3 scores according to the biopsies demonstrated global concordance in 56 of 110 cases (51%). In this group, the patients with preoperative PSA levels <10 ng/dL had higher concordance than those with preoperative PSA levels ≥10 ng/dL (61% x 23%, p = 0.023), which resulted in 77% upgrading after surgery in those patients with PSA levels ≥10 ng/dl.CONCLUSION:The Gleason scores of needle prostate biopsies and those of the surgical specimens were concordant in approximately half of the global sample. The preoperative PSA level was a strong predictor of discrepancy and might improve the identification of those patients who tended to be upgraded after surgery, particularly in patients with Gleason scores of 3 + 3 in the prostate biopsy and preoperative PSA levels ≥10 ng/mL.

Global Gleason grade groups in prostate cancer: concordance of biopsy and radical prostatectomy grades and predictors of upgrade and downgrade

“…GS discrepancies resulting in upgrades and downgrades from biopsy to radical prostatectomy (RP) remain an important issue in clinical practice after 2005. The concordance between GS on biopsy and RP ranged from 28% to 70% before the 2005 ISUP consensus, and has ranged from 41% to 63% since 2005% . Although some found improved agreement between biopsy GS and RP GS after 2005, in some studies there was only marginal improvement .…”

“…Although some found improved agreement between biopsy GS and RP GS after 2005, in some studies there was only marginal improvement . From 2005 to 2014 the reported rates of downgrading and upgrading were 5–21% and 22–47%, respectively . Importantly, the lack of concordance between the biopsy GS and RP GS can potentially impact under‐ and overtreatment.…”

Correlation of serum prostate specific antigen with clinical, radiological and pathological variables in patients with prostate enlargement

“…However there was no significant correlation between mean PSA level and Gleason score of <7 (p>0.05). 12 Dobruch et al also found weak correlation of Gleason score of serum PSA in their study on 377 patients with LUTS who underwent TRUS guided prostatic biopsy. 10 In our study out of 16 patients who were biopsy proven prostate carcinoma, among 16 patients with biopsy proven adenocarcinoma, 1 (0.9%) patients had cT1c disease, whereas cT2 and cT3 were seen in 13 (12.8%) and 2 (1.98%) patients respectively.…”

Histopathological evaluation of clinically diagnosed prostatic lesions.

“…Digital rectal examination (DRE) and transrectal ultrasonography are a primary diagnostic tools having a low specificity and sensitivity 1,6 , and the transrectal biopsy is an essential factor for the confirmation of the diagnosis. 7 Histopathologic assessment can be further confirmed by the use of immunohistochemistry in select cases for the diagnosis and characterization of prostate cancer. 8 The prostate specific antigen (PSA) is a protein, which is produced by the cells of prostate gland and is nowadays widely used in the diagnosis and management of prostatic cancer.…”