The Evaluation of Concordance of the Gleason Score between Prostatectomy and Biopsies Showing more than Two Different Gleason Scores in Positive Cores

Park, Hyoung Keun; Lee, Sang Wook; Byun, Seok Soo; Lee, Sang Eun; Lee, Eunsik

Abstract

Purpose
We evaluated the variables that may predict the final Gleason score of a radical prostatectomy in the patients showing more than two different Gleason scores in their positive core biopsy specimens.
Materials and Methods
We reviewed the pathological data of patients diagnosed with prostate cancer using extended (12 site or more) needle biopsies who underwent a radical retropubic prostatectomy. A total of 73 patients showed more than two different Gleason scores in their biopsy specimen. The following parameters were assessed: highest Gleason score in the biopsy specimen, the Gleason score of the highest tumor percentage in the core and the highest tumor ratio score (Gleason score of highest total tumor length of same Gleason score/total core length of same Gleason score). Concordance of the Gleason scores between the biopsy specimen and prostatectomy was also examined.
Results
The highest tumor ratio score showed the highest (64.4%) concordance rate. The concordance rates of the Gleason scores of the highest tumor percentage in the core and the largest linear cancer length were 59 and 58%, respectively. The concordance rate of the highest Gleason score in the biopsy specimens was only 47%. When stratified by grade: well differentiated (Gleason score=6), moderate (7) and poorly differentiated (8-10), the grade concordance rate of the highest tumor ratio score was 73%. The grade concordance rates of the highest and largest linear cancer length Gleason scores were 64.4 and 64.3%, respectively.
Conclusions
If a biopsy specimen shows more than two different Gleason scores in positive cores, the highest tumor ratio score may be the most useful variable for predicting the final Gleason score from radical prostatectomy specimens.