Correlation between trans rectal ultrasound guided prostate biopsy and radical prostatectomy specimen and risk factors for upgraded Gleason score in prostate cancer

Abstract

Background: Gleason score is an important pathologic factor for risk stratification in prostate cancer. Upgraded Gleason score is not uncommon after radical prostatectomy

Objectives: This study aimed to investigate the prevalence of upgraded Gleason scores between trans rectal
ultrasound guided prostate biopsy (TRUS-biopsy) and radical prostatectomy (RP) specimen and to determine
the predictive factors for increased Gleason scores.

Methods: We retrospectively reviewed the medical records of prostate cancer patients who underwent RP from June 2006 – June 2016 at King Chulalongkorn Memorial Hospital (KCMH). Gleason scores from TRUS-biopsy and RP were compared. Pre-operative clinical parameters were analyzed to determine the risk factors of upgraded Gleason scores between the group of patients with increased Gleason scores and those with no increased Gleason scores.

Results: In all, 33% (68/204) of patients had upgraded Gleason scores after RP. Patients with upgraded Gleason scores had significantly lower ages (P = 0.02), higher PSA levels (P = 0.01) and longer durations from TRUS-biopsy to RP (P = 0.047). Patient’s age 65 years, PSA 10 ng/mL and duration from TRUS-biopsy to RP 6 months were statistically significant factors for increased Gleason scores in both univariate and multivariate analysis.

Conclusions: The prevalence of upgraded Gleason scores is 33%. Patient’s age 65 years, PSA 10 ng/ml and
duration from TRUS-biopsy to RP 6 months are predictors for upgrading Gleason score after surgery. These
results provide clinical implication for the treatment planning of patients with risk of upgraded prostate cancer.