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Impact of Gleason pattern up gradation after radical prostatectomy for carcinoma prostate patients with low biopsy
Jagdeesh N Kulkarni1, Rohan S Valsangkar, Yogesh R Jadhav
1Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India. jnkulkarni@gmail.com
Context:
Biopsy Gleason score (b-GS) is often different from the Gleason score obtained after analysis of radical prostatectomy (RP) specimen (rp-GS). Upgradation has an important implication in decision making for cancer prostate management, and is the focus of this study.
Aim:
To evaluate Gleason score upgradation after radical prostatectomy with low biopsy score (≤ 6) and its correlation to pathological findings and outcome.
Settings And Design:
This was a retrospective analysis of 257 cases of prostate cancer patients with initial b-GS ≤ 6, over a period of 14 years.
Materials And Methods:
Data were divided into two groups according to (rp- GS) as 1) Group A (n=151; rp-GS ≤ 6 ) 2) and Group B(n=106; rp-GS ≥7). Both groups were compared in terms of the following: 1) preoperative variables e.g. age, PSA, transurethral resection of prostate (TURP) status, clinical T stage; 2) pathological features - rp GS, pathological stage (pT), capsular penetration, cut margin, seminal vesicle and lymph node status; 3) biochemical recurrence, overall and cancer specific mortality.
Statistical Analysis Used:
Student's t test and Chi-square test.
Results:
Group B had worse pathological features, except lymph node invasion, and they received significantly more adjuvant hormonal/local radiotherapy and had higher recurrence rate. However, the overall and cancer-specific mortality were similar in both the groups.
Conclusions:
b-GS upgradation after radical prostatectomy is frequent and correlates with adverse pathological features, higher use of adjuvant therapy and higher recurrence rate. In Group B, adjuvant therapy delays the biochemical or clinical relapse and controls mortality in short-term follow up. Group A had favorable pathological findings and less recurrence rate.
