OBJECTIVES: The prostate biopsy Gleason grade frequently differs from the radical prostatectomy (RP) grade. Given the critical role that needle biopsy plays in treatment decisions, we sought to determine the risk factors for upgrading and downgrading the prostate biopsy specimen. METHODS: We determined the significant predictors of upgrading (worse RP grade than biopsy grade) and downgrading (better RP grade than biopsy grade) among 1113 men treated with RP from 1996 to 2005 within the Shared Equal Access Regional Cancer Hospital (SEARCH) database who had undergone at least sextant biopsy. The Gleason sum was examined as a categorical variable of 2 to 6, 3+4, and 4+3 or greater. RESULTS: Overall, the disease of 299 men (27%) was upgraded and 123 (11%) was downgraded, and 691 men (62%) had identical biopsy and pathologic Gleason sum groups. Upgrading was associated with adverse pathologic features (P < or = 0.001) and the risk of biochemical progression (P = 0.001). Downgrading was associated with more favorable pathologic features (P < or = 0.01) and a decreased risk of progression (P = 0.04). On multivariate analysis, greater prostate-specific antigen levels (P < 0.001), more biopsy cores with cancer (P = 0.001), and obesity (P = 0.003) were all significantly and positively associated with upgrading. In contrast, biopsy Gleason sum 3+4 (P = 0.001) and obtaining eight or more biopsy cores (P = 0.01) were associated with a lower likelihood of upgrading. CONCLUSIONS: Men whose disease was upgraded were at a greater risk of adverse pathologic features and biochemical progression. Men with "high-risk" cancer (greater prostate-specific antigen levels, more positive cores, and obese) were more likely to have their disease category upgraded, and obtaining more biopsy cores reduced the likelihood of upgrading.
OBJECTIVES: The prostate biopsy Gleason grade frequently differs from the radical prostatectomy (RP) grade. Given the critical role that needle biopsy plays in treatment decisions, we sought to determine the risk factors for upgrading and downgrading the prostate biopsy specimen. METHODS: We determined the significant predictors of upgrading (worse RP grade than biopsy grade) and downgrading (better RP grade than biopsy grade) among 1113 men treated with RP from 1996 to 2005 within the Shared Equal Access Regional Cancer Hospital (SEARCH) database who had undergone at least sextant biopsy. The Gleason sum was examined as a categorical variable of 2 to 6, 3+4, and 4+3 or greater. RESULTS: Overall, the disease of 299 men (27%) was upgraded and 123 (11%) was downgraded, and 691 men (62%) had identical biopsy and pathologic Gleason sum groups. Upgrading was associated with adverse pathologic features (P < or = 0.001) and the risk of biochemical progression (P = 0.001). Downgrading was associated with more favorable pathologic features (P < or = 0.01) and a decreased risk of progression (P = 0.04). On multivariate analysis, greater prostate-specific antigen levels (P < 0.001), more biopsy cores with cancer (P = 0.001), and obesity (P = 0.003) were all significantly and positively associated with upgrading. In contrast, biopsy Gleason sum 3+4 (P = 0.001) and obtaining eight or more biopsy cores (P = 0.01) were associated with a lower likelihood of upgrading. CONCLUSIONS:Men whose disease was upgraded were at a greater risk of adverse pathologic features and biochemical progression. Men with "high-risk" cancer (greater prostate-specific antigen levels, more positive cores, and obese) were more likely to have their disease category upgraded, and obtaining more biopsy cores reduced the likelihood of upgrading.
Authors: Stephen J Freedland; Christopher L Amling; Frederick Dorey; Christopher J Kane; Joseph C Presti; Martha K Terris; William J Aronson Journal: Urology Date: 2002-10 Impact factor: 2.649
Authors: Stephen J Freedland; Elizabeth A Platz; Joseph C Presti; William J Aronson; Christopher L Amling; Christopher J Kane; Martha K Terris Journal: J Urol Date: 2006-02 Impact factor: 7.450
Authors: Christopher R King; John E McNeal; Harcharan Gill; Joseph C Presti Journal: Int J Radiat Oncol Biol Phys Date: 2004-06-01 Impact factor: 7.038
Authors: Christopher L Amling; Robert H Riffenburgh; Leon Sun; Judd W Moul; Raymond S Lance; Leo Kusuda; Wade J Sexton; Douglas W Soderdahl; Timothy F Donahue; John P Foley; Andrew K Chung; David G McLeod Journal: J Clin Oncol Date: 2003-12-22 Impact factor: 44.544
Authors: Stephen J Freedland; William J Aronson; Christopher J Kane; Joseph C Presti; Christopher L Amling; David Elashoff; Martha K Terris Journal: J Clin Oncol Date: 2003-12-22 Impact factor: 44.544
Authors: Anthony V D'Amico; Judd W Moul; Peter R Carroll; Leon Sun; Deborah Lubeck; Ming-Hui Chen Journal: J Natl Cancer Inst Date: 2003-09-17 Impact factor: 13.506
Authors: M Schernthaner; T H Helbich; B J Fueger; M Margreiter; M Memarsadeghi; A Stiglbauer; H-G Linhart; A Doan; K Pinker; P Brader Journal: Radiologe Date: 2011-11 Impact factor: 0.635
Authors: Joan Alexander; Jude Kendall; Jean McIndoo; Linda Rodgers; Robert Aboukhalil; Dan Levy; Asya Stepansky; Guoli Sun; Lubomir Chobardjiev; Michael Riggs; Hilary Cox; Inessa Hakker; Dawid G Nowak; Juliana Laze; Elton Llukani; Abhishek Srivastava; Siobhan Gruschow; Shalini S Yadav; Brian Robinson; Gurinder Atwal; Lloyd C Trotman; Herbert Lepor; James Hicks; Michael Wigler; Alexander Krasnitz Journal: Cancer Res Date: 2017-11-27 Impact factor: 12.701
Authors: Al B Barqawi; Ruslan Turcanu; Eduard J Gamito; Scott M Lucia; Colin I O'Donnell; E David Crawford; David D La Rosa; Francisco G La Rosa Journal: Int J Clin Exp Pathol Date: 2011-06-12
Authors: Ryan L Brunsing; Natalie M Schenker-Ahmed; Nathan S White; J Kellogg Parsons; Christopher Kane; Joshua Kuperman; Hauke Bartsch; Andrew Karim Kader; Rebecca Rakow-Penner; Tyler M Seibert; Daniel Margolis; Steven S Raman; Carrie R McDonald; Nikdokht Farid; Santosh Kesari; Donna Hansel; Ahmed Shabaik; Anders M Dale; David S Karow Journal: J Magn Reson Imaging Date: 2016-08-16 Impact factor: 4.813
Authors: Christine Neslund-Dudas; Cathryn H Bock; Kristin Monaghan; Nora L Nock; James J Yang; Andrew Rundle; Deliang Tang; Benjamin A Rybicki Journal: Prostate Date: 2007-11-01 Impact factor: 4.104