Upgrading in prostatic cancer: Clinical and pathological parameters that predict the Gleason's scores changes

Prostate cancer is the most common malignancy in men. Several studies have shown that the difference between biopsy and prostatectomy specimen Gleason score (GS) ranges from 28% to 58%. The aim of this study was to investigate equivalence of GS between biopsy and radical prostatectomy specimen. We also aimed to evaluate the clinical and pathological parameters that predict GS changes. We retrospectively reviewed data from 101 patients who underwent prostatectomy at our hospital. Prostate needle biopsies were performed under ultrasound guidance through the trans-rectal route after quinolone group antibiotic prophylaxis. At least 10 core biopsies were taken. Upgrading was defined as an increase in total GS or increase in initial GS. The mean age of patients was 63.15 and the mean prostate specific antigen (PSA) level was 12.25. The most common needle biopsy GS was 3+3 (79.2%) followed by 3+4 (11.9%). The most frequent pathological GS was 3+3 (52.5%) followed by 3+4 (28.7%). 38.6% of the patients received an upgrading on radical prostatectomy material. We evaluated the correlation s between the patients’ ages, preoperative PSA, biopsy GS, number of tumor cores, number of cores with presence of high grade prostatic intraepithelial and/or atypical small acinar proliferation accompanying tumor, positive surgical margin status and upgrading. When multivariate logistic regression analysis was performed, in patients above the age of 65 (p=0.019) with higher PSA (p=0.024), an increase was observed in GS of prostatectomy material compared to needle biopsy. Patients who were upgraded were more likely to have positive surgical margins (p=0.022). Accurate staging is crucial in prostate cancer for optimal treatment planning. In our study upgrading was found to be correlated with age and PSA. We believe prospective studies involving larger patient series and more parameters will allow us to reach clearer judgments on this topic.