TY  - EJOU
AU  - Grober, Ethan D. 
AU  - Tsihlias, John 
AU  - Jewett, Michael A. S. 
AU  - Sweet, Joan M. 
AU  - Evans, Andrew J. 
AU  - Trachtenberg, John 
AU  - Robinette, Mike 
AU  - Nam, Robert K. 

TI  - Correlation of the primary Gleason pattern on prostate needle biopsy with clinicopathological factors in Gleason 7 tumors
T2  - Canadian Journal of Urology

PY  - 2004
VL  - 11
IS  - 1
SN  - 1488-5581

AB  - <b>Objectives:</b> To correlate the primary Gleason pattern among patients with biopsy-derived Gleason 7 tumors with the radical prostatectomy specimen Gleason grading and other clinical and pathologic outcomes.<br/>
<b>Methods and materials:</b> Among 474 patients who underwent radical prostatectomy for clinically localized prostate cancer between 1997-2001, 205 (43%) had Gleason 7/10 tumors on pre-operative needle biopsy. Among these patients, 148 (72.2%) were assigned a primary Gleason 3 pattern (3+4=7) and 57 (27.8%) were assigned a primary Gleason 4 pattern (4+3=7). The two groups were compared with respect to age, serum PSA levels, Gleason grade in the radical prostatectomy specimen, pathological stage and surgical margin status.<br/>
<b>Results:</b> Among patients with 3+4 tumors on needle biopsy, 64% remained primary Gleason grade 3 while 35% were up-graded to a primary pattern 4 following analysis of the radical prostatectomy specimen. Patients with 4+3 tumors on needle biopsy remained primary Gleason grade 4 in 51% of patients, while 49% of patients had their tumors down-graded to a primary 3 pattern (p=0.09). There were no differences between patients with needle biopsy 3+4 and 4+3 patterns with respect to total Gleason score in the radical prostatectomy specimen (p=0.42), pTNM stage (p=0.36), extra-prostatic extension (p=0.88), surgical margin involvement (p=0.16), and seminal vesicle invasion (p=0.19). In contrast, the primary Gleason pattern in the radical prostatectomy specimen correlated significantly with pTNM stage (p=0.02) and seminal vesicle invasion (p=0.003), but not with extra-prostatic extension (p=0.32) and surgical margin involvement (p=0.17).<br/>
<b>Conclusions:</b> Among patients with Gleason 7 adenocarcinoma of the prostate, the biopsy-derived primary Gleason pattern does not appear to correlate with important clinical and pathologic outcomes. The utility of distinguishing a primary Gleason pattern on needle biopsy among patients with Gleason 7 tumors remains unclear given the limited and conflicting literature addressing this issue.
KW  - prostatic neoplasms
KW  -  neoplasm staging
KW  -  biopsy
KW  -  prognosis

DO  -