Introduction:
As a result of widespread use of PSA screening, most patients with new diagnosis of prostate cancer present with PSA bellow 10. Less variability in PSA level decreases PSA predictive value for organ confined disease. In this setting, clinical stage and Gleason score (GS) remain as the utmost important information for the prognosis and the treatment approach of patients with new diagnosis of prostate cancer. The goal of this study is to evaluate the efficacy of GS and other variables of prostate biopsy to predict final GS and pathologic stage in patients undergoing radical retropubic prostatectomy.
Methods:
The records of 220 patients treated with radical prostatectomy between the years 2000 and 2004 were retrospectively reviewed. Preoperative prostate biopsy GS was compared to post-operative GS and pathologic stage after prostatectomy. The total number and percent of positive cores as well as tumor volume on prostate biopsy were correlated with final tumor volume and pathologic stage.
Results:
Similar GS on prostate biopsy and radical prostatectomy specimen was observed in 64% of the cases. 28% of the patients had a final GS which was higher than the GS on prostate biopsy. The most frequent upgrade was from GS 6 to 7 in 80% of the cases. Among patients with preoperative GS = 6, 77% showed organ confined disease while 59% of those with GS = 7 on prostate biopsy demonstrated capsular penetration or tumor invasion of seminal vesicles on final pathology. Bilateral positive cores and percent of positive cores > 50% on prostate biopsy had a linear correlation with final tumor volume and more advanced prostatic disease.
Conclusion:
Good correlation was observed between prostate biopsy GS and GS on the prostatectomy specimen. Although the diagnosis of low grade prostate tumor by prostate biopsy is frequently associated with organ confined disease, the total number and percent of positive cores on prostate biopsy further enhance the accuracy of prostate biopsy to predict the presence of tumors limited to the prostate.High grade tumors that are present in several cores and that involve both lobes of the prostate at the time of prostate biopsy have the highest association with extraprostatic disease on prostatectomy specimen. This group of patients should be considered for research protocols including adjuvant or neoadjuvant chemotherapy.

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