Prostate biopsy clinical and pathological variables that predict significant grading changes in patients with...

To identify the clinical and pathological variables that predict pathological changes in the significant proportion of men with prostate cancer who have an intermediate- or high-grade biopsy Gleason score (GS) of >or=7 and who are upgraded or downgraded on interpretation of radical prostatectomy (RP) pathological specimens, as GS is critical in treatment decisions.

We retrospectively evaluated 1129 patients who had RP after a biopsy showing a GS of >or=7, at our institution, from 2000 to 2007. Complete relevant clinical information was available for all patients. A multivariable logistic regression analysis was used to identify predictors of pathological grading changes.

The overall mean age was 61 years, with median prostate-specific antigen (PSA) level of 6 ng/mL. Of the 1129 patients, the surgical GS was upgraded in 296 (26.2%), downgraded in 210 (18.6%), and remained the same in 623 (55.2%). Factors predicting a surgical GS upgrade were a higher PSA level (P = 0.005), presence of perineural invasion (P = 0.043), absence of inflammation (P < 0.001), and absence of associated high-grade prostatic intraepithelial neoplasia (P = 0.02). In an analysis of pathological variables the number of positive cores (P = 0.033) was predictor of upgrading. Large prostate volume (P = 0.004) and low maximum percentage cancer in any core (P = 0.001) were predictors of downgrading.

Men with a higher PSA level, perineural invasion and high-volume cancer at biopsy are most likely to be upgraded, while men with a large prostate volume and low-volume cancer at biopsy are more likely to be downgraded. These findings have implications for men with prostate cancer managed without confirmation by RP of their true GS.