A contemporary study correlating prostate needle biopsy and radical prostatectomy Gleason score

We determined whether contemporary practice patterns of Gleason grading for prostate needle biopsy and radical prostatectomy have evolved.

We correlated needle biopsy (assigned at Johns Hopkins Hospital and other institutions) and radical prostatectomy Gleason score for 1,455 men who underwent radical prostatectomy at Johns Hopkins Hospital from 2002 to 2003, and compared the results with those of a 1994 study of similar design.

Outside institutions diagnosed Gleason score 2-4 in 1.6% (23 of 1,455) of needle biopsies vs 22.3% (87 of 390) in 1994. Of needle biopsies labeled Gleason score 2-4, 30.4% revealed radical prostatectomy Gleason score 7-10. In 2002 to 2003 no Johns Hopkins Hospital needle biopsy was assigned Gleason score 2-4. Needle biopsies designated Gleason score 6 or less had 80.0% accuracy with regard to radical prostatectomy Gleason score vs 63% accuracy in older data. For needle biopsy Gleason score 7 or greater, 35.5% (outside institution) and 24.8% (Johns Hopkins Hospital) of radical prostatectomies displayed Gleason score less than 7. Overall, outside and Johns Hopkins Hospital needle biopsy diagnoses showed 69.7% and 75.9% agreement with radical prostatectomy Gleason score, respectively. Direct comparison of Johns Hopkins Hospital and needle biopsy Gleason scores elsewhere revealed 81.8% agreement, with 87.1% for Gleason score 5-6, 68.1% for Gleason score 7 and 35.1% for Gleason score 8-10. For 59.4% of outside needle biopsies with Gleason score 8-10, Johns Hopkins Hospital Gleason score was 7 or less. Conversely, for 64.9% of Johns Hopkins Hospital needle biopsies with Gleason score 8-10, outside Gleason score was 7 or less. For needle biopsies with Gleason score 5-6, 7 and 8-10, the incidence of nonorgan confined disease at radical prostatectomy was 17.7%, 47.8% and 50.0%, respectively, for Johns Hopkins Hospital vs 18.2%, 44.6% and 37.5% for outside institutions.

The last decade has seen the near elimination of once prevalent under grading of needle biopsy. All cases still assigned Gleason score 2-4 show Gleason score 5 or greater at radical prostatectomy and nearly a third reveal Gleason score 7-10, reaffirming that Gleason score 2-4 is a needle biopsy diagnosis that should not be made. As evidenced by variable over grading and under grading, as well as poor correlation with pathological stage, difficulties in the assignment of Gleason pattern 4 and overall Gleason score of 8-10 on needle biopsy remain an important issue.