The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer

Background Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectom...

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Bibliographic Details
Published in:The Prostate 2019-12, Vol.79 (16), p.1805-1810
Main Authors: Jang, Won Sik, Koh, Dong Hoon, Kim, Jongchan, Lee, Jong Soo, Chung, Doo Yong, Ham, Won Sik, Rha, Koon Ho, Choi, Young Deuk
Format: Article
Language:English
Subjects:
Aged
biochemical recurrence
Biopsy
Biopsy, Needle
Cancer surgery
Disease-Free Survival
Gleason grade
Humans
Kaplan-Meier Estimate
Male
Medical records
Middle Aged
needle biopsy
Neoplasm Grading
Prognosis
Prostate cancer
Prostatectomy
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
radical prostatectomy
Retrospective Studies
Urological surgery
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Summary:Background Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectomy (RP) affects oncologic outcomes is currently unknown. Herein, we investigated the prognostic impact of downgrading and upgrading from NB to RP among men with GS 7 PC. Methods We retrospectively reviewed the medical records of 3003 patients with localized PC who underwent RP between 2005 and 2014. We included 692 patients with GS 7 PC on both NB and RP specimens. We analyzed the data using Kaplan‐Meier methods and Cox proportional hazard models. Results Of the 692 patients enrolled in this study, 389 (56.2%) and 303 (43.8%) patients had RP GS 3 + 4 = 7 and RP GS 4 + 3 = 7 PC, respectively. On the basis of NB and RP GS, 264 (38.1%), 125 (18.1%), 142 (20.5%), and 161 (23.3%) patients were classified as 3 + 4/3 + 4, 4 + 3/3 + 4, 3 + 4/4 + 3, and 4 + 3/4 + 3, respectively. Kaplan‐Meier curves showed significant differences in biochemical recurrence (BCR)‐free survival across the groups (P 
ISSN:0270-4137
1097-0045
DOI:10.1002/pros.23905