TY - JOUR
T1 - Prognostic Significance of Gleason Score Discrepancies between Needle Biopsy and Radical Prostatectomy
AU - Müntener, Michael
AU - Epstein, Jonathan I.
AU - Hernandez, David J.
AU - Gonzalgo, Mark L.
AU - Mangold, Leslie
AU - Humphreys, Elizabeth
AU - Walsh, Patrick C.
AU - Partin, Alan W.
AU - Nielsen, Matthew E.
PY - 2008/4
Y1 - 2008/4
N2 - Objectives: Discordance between the Gleason score (GS) on needle biopsy (NB) and the GS of the radical prostatectomy (RP) specimen is a common finding. The objective of this study was to evaluate the prognostic significance of these discrepancies with respect to outcomes following RP. Methods: In the study, 6625 men treated by RP were categorized as having NB=RP (68.8%), NB<RP (25.0%) or NB>RP (6.2%) GS, and stratified for analyses into RP GS groups. The Kaplan-Meier method was used to analyze differences in biochemical recurrence-free survival (BRFS), and multivariate Cox analyses were performed to estimate the independent relative risk of progression associated with GS discrepancies. Results: Across multiple RP GS strata (3+4, 7, 8, 8-10), patients with a lower NB GS experienced significantly better BRFS than patients with equal NB and RP GS (all p < 0.05). NB<RP GS was independently associated with better (pooled HR, 0.76, p = 0.001) BRFS, within and across RP GS strata. Similarly, patients with NB>RP GS had poorer BRFS than patients with NB=RP GS across multiple RP GS strata (≤3+3, 3+4, 7; all p < 0.05). NB>RP GS was independently associated with worse (pooled HR, 1.91, p < 0.001) BRFS probabilities, within and across RP GS strata. Conclusions: Our data suggest that the GS of the NB adds additional prognostic value to the RP GS in a consistent manner that may be applicable to strategies of risk stratification and patient counseling after surgery.
AB - Objectives: Discordance between the Gleason score (GS) on needle biopsy (NB) and the GS of the radical prostatectomy (RP) specimen is a common finding. The objective of this study was to evaluate the prognostic significance of these discrepancies with respect to outcomes following RP. Methods: In the study, 6625 men treated by RP were categorized as having NB=RP (68.8%), NB<RP (25.0%) or NB>RP (6.2%) GS, and stratified for analyses into RP GS groups. The Kaplan-Meier method was used to analyze differences in biochemical recurrence-free survival (BRFS), and multivariate Cox analyses were performed to estimate the independent relative risk of progression associated with GS discrepancies. Results: Across multiple RP GS strata (3+4, 7, 8, 8-10), patients with a lower NB GS experienced significantly better BRFS than patients with equal NB and RP GS (all p < 0.05). NB<RP GS was independently associated with better (pooled HR, 0.76, p = 0.001) BRFS, within and across RP GS strata. Similarly, patients with NB>RP GS had poorer BRFS than patients with NB=RP GS across multiple RP GS strata (≤3+3, 3+4, 7; all p < 0.05). NB>RP GS was independently associated with worse (pooled HR, 1.91, p < 0.001) BRFS probabilities, within and across RP GS strata. Conclusions: Our data suggest that the GS of the NB adds additional prognostic value to the RP GS in a consistent manner that may be applicable to strategies of risk stratification and patient counseling after surgery.
KW - Gleason score
KW - Needle biopsy
KW - PSA recurrence
KW - Prostate cancer
KW - Radical prostatectomy
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U2 - 10.1016/j.eururo.2007.11.016
DO - 10.1016/j.eururo.2007.11.016
M3 - Article
C2 - 18060681
AN - SCOPUS:39549100371
SN - 0302-2838
VL - 53
SP - 767
EP - 776
JO - European Urology
JF - European Urology
IS - 4
ER -