Background: A single institution’s experience with radical prostatectomy over a 9 year period was reviewed.
Methods: A retrospective review of 1849 consecutive radical prostatectomies was performed. Patient characteristics, surgical stastics, and pathologic data were analyzed. Institutional review board approval was obtained prior to initiation of the study.
Results: Mean patient age was 61 years old (range 34-78) and 1554 (84%) of patients were 50-70 years old. 2.5% of radical prostatectomy specimens were Gleason 2,3, or 4, 52% were Gleason 5 or 6, 34% were Gleason 7, 11% were Gleason 8,9, or 10. Of 866 patients with biopsy Gleason sum 5 or 6, 27% of radical prostatectomy specimens were upgraded to Gleason 7 or higher. Of 205 patients with biopsy Gleason sum 7, radical prostatectomy specimens were upgraded to Gleason 8 or higher in 15% of cases and downgraded to Gleason 6 or lower in 14% of cases. Of 98 patients with biopsy Gleason sum 8-10, 38% of radical prosatectomy specimens were downgraded to Gleason sum 7 or lower. 266 (14%) biopsy reports demonstrated tumor volume of < 25% of total tissue and were designated “small tumor volume.” Of these patients, radical prosatectomy specimens had large volume disease in 63%, moderate volume disease in 18% and low volume disease in 19%. 788 (43%) of biopsy reports demonstrated unilateral prostate cancer. Of this group, 57% of patients had prostate cancer present in 3 or 4 quadrants of radical prostatectomy specimen.
Conclusions: While transrectal prostate biopsy is the standard for diagnosis of prostate cancer, radical prostatectomy pathology, tumor laterality, and tumor volume may differ significantly from biopsy results. 27-38% of biopsies did not accurately predict radical prostatectomy pathology for biopsy Gleason sum 5-6, 7, and 8-10 respectively. Low volume disease and unilateral disease on biopsy were reflective of true volume and unilateral nature of the disease in only 19% and 43% of patients respectively. One should be extremely cautious in using biopsy information to predict the true nature of disease.