Prostate biopsy clinical and pathological variables that predict significant grading changes in patients with intermediate and high grade prostate cancer

Abstract

Objective: To identify the clinical and pathological variables that predict pathological changes in the significant proportion of men with prostate cancer who have an intermediate- or high-grade biopsy Gleason score (GS) of >or=7 and who are upgraded or downgraded on interpretation of radical prostatectomy (RP) pathological specimens, as GS is critical in treatment decisions.

Patients and methods: We retrospectively evaluated 1129 patients who had RP after a biopsy showing a GS of >or=7, at our institution, from 2000 to 2007. Complete relevant clinical information was available for all patients. A multivariable logistic regression analysis was used to identify predictors of pathological grading changes.

Results: The overall mean age was 61 years, with median prostate-specific antigen (PSA) level of 6 ng/mL. Of the 1129 patients, the surgical GS was upgraded in 296 (26.2%), downgraded in 210 (18.6%), and remained the same in 623 (55.2%). Factors predicting a surgical GS upgrade were a higher PSA level (P = 0.005), presence of perineural invasion (P = 0.043), absence of inflammation (P < 0.001), and absence of associated high-grade prostatic intraepithelial neoplasia (P = 0.02). In an analysis of pathological variables the number of positive cores (P = 0.033) was predictor of upgrading. Large prostate volume (P = 0.004) and low maximum percentage cancer in any core (P = 0.001) were predictors of downgrading.

Conclusion: Men with a higher PSA level, perineural invasion and high-volume cancer at biopsy are most likely to be upgraded, while men with a large prostate volume and low-volume cancer at biopsy are more likely to be downgraded. These findings have implications for men with prostate cancer managed without confirmation by RP of their true GS.