Abstract

Objective: Gleason score (GS) is highly correlated with the aggressiveness and progression of prostate cancer. According to literature data, the correlation between biopsy GS and radical prostatectomy (RP) GS is reported to be very low interestingly. Aim of this study is to evaluate effect of preoperative clinical and pathological variables on predicting tumor grade changes and correlation between biopsy and RP in patients with prostate cancer and to compare old literature data with our new results.

Methods: Between January 2017 and March 2020; 229 patients who underwent prostate biopsy and then underwent RP were included in the study. Medical records of these patients were reviewed retrospectively. Demographic data of patients in group with upgrade and downgrade, preoperative and postoperative variables predicting upgrading and downgrading; it was compared with the data of the control group without upgrade or downgrade.

Results: In 123 of our patients (53.7%), there was a correlation between prostate biopsy and RP specimen pathologies in terms of GS; upgrading was observed in 72 (31.4%) patients and downgrading in 34 (14.8%) patients. Prostate weight in RP, positivity of surgical margins, extracapsular extension and seminal vesicle invasion were found to be among the factors that could predict the upgrading and preoperative total PSA value was found to be among the factors that could predict the downgrading with statistically significant effect.

Conclusion: Overall accuracy of biopsy GS in predicting true disease grade is severely limited. As a matter of fact, we came to the conclusion that almost half of true stage of prostate cancer is an unpredictable disease due to the incompatibility between biopsy and RP GS. Fact that our results are in line with the literature shows that what we know has not changed yet. Since current standard clinical and pathological variables are not sufficiently predictive for clinical use, additional tools are needed to better predict upgrading and downgrading.