BACKGROUND: The accuracy of the prostate biopsy Gleason grade to predict the prostatectomy Gleason grade varies tremendously in the literature. OBJECTIVES: Determine the accuracy and distribution of the prostate biopsy Gleason grade and prostatectomy Gleason grade at LCMC (Lahey Clinic Medical Center) and worldwide. DESIGN, SETTING, AND PARTICIPANTS: Participants included 2890 patients who had not received preoperative hormones, and for whom preoperative and postoperative Gleason sums were available. Participants underwent radical prostatectomy at LCMC, an academic referral center, from 1982-2007. Studies for the meta-analysis were selected from Medline: 1994-2007. Search criteria included keywords "Gleason," "biopsy," and "prostatectomy," >/=200 patients, and whether the biopsy and prostatectomy Gleason scores categorized into the predefined Gleason grades. The meta-analysis included 15 studies and the LCMC database for 14,839 total patients. MEASUREMENTS: Gleason scores 2-6, 7, and 8-10 were converted to low, moderate, and high grade, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated. The kappa statistic and chi-square were used to compare biopsy and prostatectomy grades. RESULTS AND LIMITATIONS: The percentage of patients in whom the prostatectomy grade was accurately predicted, upgraded, and downgraded was 58%, 36%, and 5% at LCMC and 63%, 30%, and 7% in the meta-analysis, respectively. The PPV for low-, moderate-, and high-grade cancer was 54%, 70%, and 60% for LCMC and 62%, 70%, and 50% for the meta-analysis, respectively. The sensitivity decreased with increasing Gleason grade (low, moderate, and high) for LCMC (91%, 38%, 28%) and the meta-analysis (90%, 40%, 33%), respectively. The distribution of low-, moderate-, and high-grade cancer on biopsy (69%, 25%, and 6%) and prostatectomy specimen (47%, 44%, and 9%) demonstrated only "fair" agreement (kappa, 0.37). CONCLUSIONS: Patients and practitioners need to be cognizant of significant upgrading for low-grade disease and the downgrading for high-grade disease.
BACKGROUND: The accuracy of the prostate biopsy Gleason grade to predict the prostatectomy Gleason grade varies tremendously in the literature. OBJECTIVES: Determine the accuracy and distribution of the prostate biopsy Gleason grade and prostatectomy Gleason grade at LCMC (Lahey Clinic Medical Center) and worldwide. DESIGN, SETTING, AND PARTICIPANTS: Participants included 2890 patients who had not received preoperative hormones, and for whom preoperative and postoperative Gleason sums were available. Participants underwent radical prostatectomy at LCMC, an academic referral center, from 1982-2007. Studies for the meta-analysis were selected from Medline: 1994-2007. Search criteria included keywords "Gleason," "biopsy," and "prostatectomy," >/=200 patients, and whether the biopsy and prostatectomy Gleason scores categorized into the predefined Gleason grades. The meta-analysis included 15 studies and the LCMC database for 14,839 total patients. MEASUREMENTS: Gleason scores 2-6, 7, and 8-10 were converted to low, moderate, and high grade, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated. The kappa statistic and chi-square were used to compare biopsy and prostatectomy grades. RESULTS AND LIMITATIONS: The percentage of patients in whom the prostatectomy grade was accurately predicted, upgraded, and downgraded was 58%, 36%, and 5% at LCMC and 63%, 30%, and 7% in the meta-analysis, respectively. The PPV for low-, moderate-, and high-grade cancer was 54%, 70%, and 60% for LCMC and 62%, 70%, and 50% for the meta-analysis, respectively. The sensitivity decreased with increasing Gleason grade (low, moderate, and high) for LCMC (91%, 38%, 28%) and the meta-analysis (90%, 40%, 33%), respectively. The distribution of low-, moderate-, and high-grade cancer on biopsy (69%, 25%, and 6%) and prostatectomy specimen (47%, 44%, and 9%) demonstrated only "fair" agreement (kappa, 0.37). CONCLUSIONS:Patients and practitioners need to be cognizant of significant upgrading for low-grade disease and the downgrading for high-grade disease.
Authors: Anup Vora; Tim Large; Jenny Aronica; Sherod Haynes; Andrew Harbin; Daniel Marchalik; Hanaa Nissim; John Lynch; Gaurav Bandi; Kevin McGeagh; Keith Kowalczyk; Reza Ghasemian; Krishnan Venkatesan; Mohan Verghese; Jonathan Hwang Journal: Int Urol Nephrol Date: 2013-07-18 Impact factor: 2.370
Authors: Attila Majoros; Attila Marcell Szász; Péter Nyirády; Eszter Székely; Péter Riesz; Attila Szendrői; Attila Keszthelyi; Janina Kulka; Imre Romics Journal: Int Urol Nephrol Date: 2013-08-30 Impact factor: 2.370
Authors: Kevin C McCammack; Natalie M Schenker-Ahmed; Nathan S White; Shaun R Best; Robert M Marks; Jared Heimbigner; Christopher J Kane; J Kellogg Parsons; Joshua M Kuperman; Hauke Bartsch; Rahul S Desikan; Rebecca A Rakow-Penner; Michael A Liss; Daniel J A Margolis; Steven S Raman; Ahmed Shabaik; Anders M Dale; David S Karow Journal: Abdom Radiol (NY) Date: 2016-05
Authors: Armando Stabile; Francesco Giganti; Andrew B Rosenkrantz; Samir S Taneja; Geert Villeirs; Inderbir S Gill; Clare Allen; Mark Emberton; Caroline M Moore; Veeru Kasivisvanathan Journal: Nat Rev Urol Date: 2019-07-17 Impact factor: 14.432
Authors: K C McCammack; C J Kane; J K Parsons; N S White; N M Schenker-Ahmed; J M Kuperman; H Bartsch; R S Desikan; R A Rakow-Penner; D Adams; M A Liss; R F Mattrey; W G Bradley; D J A Margolis; S S Raman; A Shabaik; A M Dale; D S Karow Journal: Prostate Cancer Prostatic Dis Date: 2016-01-12 Impact factor: 5.554
Authors: Ashkan Mortezavi; Etienne Xavier Keller; Cédric Poyet; Thomas Hermanns; Karim Saba; Marco Randazzo; Christian Daniel Fankhauser; Peter J Wild; Holger Moch; Tullio Sulser; Daniel Eberli Journal: World J Urol Date: 2016-03-01 Impact factor: 4.226
Authors: Anouk A M A van der Aa; Christophe K Mannaerts; Hans van der Linden; Maudy Gayet; Bart Ph Schrier; Massimo Mischi; Harrie P Beerlage; Hessel Wijkstra Journal: World J Urol Date: 2018-02-01 Impact factor: 4.226