Prostate Cancer Volume at Biopsy Predicts Clinically Significant Upgrading

No AccessJournal of UrologyAdult urology1 Mar 2008Prostate Cancer Volume at Biopsy Predicts Clinically Significant Upgrading Fei Dong, J. Stephen Jones, Andrew J. Stephenson, Cristina Magi-Galluzzi, Alwyn M. Reuther, and Eric A. Klein Fei DongFei Dong Financial interest and/or other relationship with American Cancer Society. More articles by this author , J. Stephen JonesJ. Stephen Jones More articles by this author , Andrew J. StephensonAndrew J. Stephenson More articles by this author , Cristina Magi-GalluzziCristina Magi-Galluzzi More articles by this author , Alwyn M. ReutherAlwyn M. Reuther More articles by this author , and Eric A. KleinEric A. Klein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.10.060AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A significant proportion of patients with prostate cancer with Gleason score 6 disease at biopsy is upgraded to Gleason score 7 or higher after radical prostatectomy, increasing the risk of adverse outcome. We identified clinical and pathological parameters that predict pathological upgrading in this population. Materials and Methods: A total of 268 patients with biopsy Gleason score 6 prostate cancer who underwent biopsy and radical prostatectomy between October 1999 and January 2007 were included in the study. Pretreatment characteristics were used to identify predictors of pathological upgrading. Upgrading significance was established by comparing radical prostatectomy pathology between cases that were and were not upgraded. Results: A total of 134 patients (50%) were upgraded postoperatively to Gleason score 7 or higher. Preoperative prostate specific antigen greater than 5.0 ng/ml (p = 0.036), prostate weight 60 gm or less (p = 0.004) and more cancer volume at biopsy, defined by cancer involving greater than 5% of the biopsy tissue (p = 0.002), greater than 1 biopsy core (p <0.001) or greater than 10% of any core (p = 0.014), were associated with pathological upgrading. Upgraded patients were more likely to have extraprostatic extension and positive surgical margins at radical prostatectomy (p <0.001 and 0.001, respectively). Conclusions: Prostate specific antigen, prostate volume and biopsy cancer volume predict clinically significant upgrading in patients diagnosed with Gleason score 6 disease. These parameters may be valuable in the pretreatment risk assessment of this patient population. References 1 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Crossref, Medline, Google Scholar 2 : Patterns of prostate cancer biopsy grading: trends and clinical implications. Int J Cancer2000; 90: 305. Google Scholar 3 : Limitations of biopsy Gleason grade: implications for counseling patients with biopsy Gleason score 6 prostate cancer. J Urol2004; 172: 98. Link, Google Scholar 4 : Prostate cancers scored as Gleason 6 on prostate biopsy are frequently Gleason 7 tumors at radical prostatectomy: implication on outcome. J Urol2006; 176: 979. Link, Google Scholar 5 : The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol2000; 163: 163. Link, Google Scholar 6 : Grading prostate cancer. Am J Clin Pathol1994; 102: S38. Google Scholar 7 : Correlation between visual clues, objective architectural features, and interobserver agreement in prostate cancer. Am J Clin Pathol1991; 96: 70. Google Scholar 8 : Accuracy of biopsy Gleason scores from a large uropathology laboratory: use of a diagnostic protocol to minimize observer variability. Urology1998; 51: 525. Crossref, Medline, Google Scholar 9 : Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy. J Urol2003; 169: 136. Link, Google Scholar 10 : Role of prostate biopsy schemes in accurate prediction of Gleason scores. Urology2006; 67: 379. Google Scholar 11 : Use of prostate-specific antigen and tumor volume in predicting needle biopsy grading error. Urology1995; 45: 807. Google Scholar 12 : Clinical predictors of upgrading to Gleason grade 4 or 5 disease at radical prostatectomy: potential implications for patient selection for radiation and androgen suppression therapy. Int J Radiat Oncol Biol Phys1999; 45: 841. Google Scholar 13 : Extended prostate biopsy scheme improves reliability of Gleason grading: implications for radiotherapy patients. Int J Radiat Oncol Biol Phys2004; 59: 386. Google Scholar 14 : Upgrading and downgrading of prostate needle biopsy specimens: risk factors and clinical implications. Urology2007; 69: 495. Google Scholar 15 : The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol2000; 163: 174. Link, Google Scholar 16 : Percent of prostate needle biopsy cores with cancer is significant independent predictor of prostate specific antigen recurrence following radical prostatectomy: results from SEARCH database. J Urol2003; 169: 2136. Google Scholar 17 : A prostate gland volume of more than 75 cm3 predicts for a favorable outcome after radical prostatectomy for localized prostate cancer. Urology1998; 52: 631. Google Scholar 18 : Prostate size and risk of high-grade, advanced prostate cancer and biochemical progression after radical prostatectomy: a search database study. J Clin Oncol2005; 23: 7546. Google Scholar 19 : Improved biochemical relapse-free survival for patients with large/wide glands treated with prostate seed implantation for localized adenocarcinoma of prostate. Urology2006; 68: 1237. Google Scholar Case Western Reserve University School of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic (JSJ, AJS, CMG, AMR, EAK), Cleveland, Ohio© 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byHussein A, Welty C, Ameli N, Cowan J, Leapman M, Porten S, Shinohara K and Carroll P (2015) Untreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course and Pathological OutcomesJournal of Urology, VOL. 194, NO. 1, (85-90), Online publication date: 1-Jul-2015.Davies J, Aghazadeh M, Phillips S, Salem S, Chang S, Clark P, Cookson M, Davis R, Herrell S, Penson D, Smith J and Barocas D (2011) Prostate Size as a Predictor of Gleason Score Upgrading in Patients With Low Risk Prostate CancerJournal of Urology, VOL. 186, NO. 6, (2221-2227), Online publication date: 1-Dec-2011.Newton M, Phillips S, Chang S, Clark P, Cookson M, Davis R, Fowke J, Herrell S, Baumgartner R, Chan R, Mishra V, Blume J, Smith J and Barocas D (2010) Smaller Prostate Size Predicts High Grade Prostate Cancer at Final PathologyJournal of Urology, VOL. 184, NO. 3, (930-937), Online publication date: 1-Sep-2010.Whitman E, Groskopf J, Ali A, Chen Y, Blase A, Furusato B, Petrovics G, Ibrahim M, Elsamanoudi S, Cullen J, Sesterhenn I, Brassell S, Rittenhouse H, Srivastava S and McLeod D (2008) PCA3 Score Before Radical Prostatectomy Predicts Extracapsular Extension and Tumor VolumeJournal of Urology, VOL. 180, NO. 5, (1975-1979), Online publication date: 1-Nov-2008. Volume 179Issue 3March 2008Page: 896-900 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsprostateprostatectomypathologyprostatic neoplasmssurgicalbiopsyMetricsAuthor Information Fei Dong Financial interest and/or other relationship with American Cancer Society. More articles by this author J. Stephen Jones More articles by this author Andrew J. Stephenson More articles by this author Cristina Magi-Galluzzi More articles by this author Alwyn M. Reuther More articles by this author Eric A. Klein More articles by this author Expand All Advertisement PDF downloadLoading ...