@Article{,
AUTHOR = {Robert Qi, Wen-chi Foo, Michael N. Ferrandino, Leah G. Davis, Sitharthan Sekar, Thomas A. Longo, Ghalib Jibara, Tracy Han, Ilhan Gokhan, Judd W. Moul},
TITLE = {Over half of contemporary clinical Gleason 8 on prostate biopsy are downgraded at radical  prostatectomy},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {24},
YEAR = {2017},
NUMBER = {5},
PAGES = {8982--8989},
URL = {http://www.techscience.com/CJU/v24n5/60913},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> Contemporary clinical guidelines utilize the highest Gleason sum (HGS) in any one core on prostate biopsy to determine prostate cancer treatment. Here, we present a large discrepancy between prostate cancer risk stratified as high risk on biopsy and their pathology after radical prostatectomy.<br/>

<b>Materials and methods:</b> We retrospectively reviewed 1424 men who underwent either open or robotic-assisted prostatectomy between 2004 and 2015. We analyzed 148 men who were diagnosed with HGS 8 on prostate biopsy. Biopsy and prostatectomy pathology were compared in aggregate and over 1 year time intervals. Chi-squared test, Fisher's exact test, Student's t-test, and Wilcoxon Rank-Sum test were used for statistical analysis.<br/>

<b>Results:</b> A total of 61.5% (91/148) of clinical HGS 8 diagnoses were downgraded on prostatectomy, with 58.8% (87/148) downgraded to Gleason 7 (Gleason 4 + 3 n = 59; Gleason 3 + 4 n = 28). Factors associated with downgrading include lower prostate-specific antigen (PSA) at biopsy (median 6.8 ng/mL versus 9.1 ng/mL, p < 0.001), number of Gleason 8 biopsy cores (median 1 versus 2, p < 0.02), presence of Gleason pattern 3 on biopsy cores (67.9% versus 44.8%, p < 0.03), pT2 staging (72.4% versus 55.1%, p < 0.04), positive margins (53.9% versus 69.1%, p < 0.04), extracapsular extension (53.4% versus 74.1%, p < 0.02), and smaller percent tumor (median 10% versus 15%, p < 0.004).<br/>

<b>Conclusion:</b> The large percentage of pathology downgrading of biopsy-diagnosed HGS 8 suggests suboptimal risk-stratification that may lead to suboptimal treatment strategies and much patient distress. Our study adds great urgency to the efforts refining prostate cancer clinical assessment.},
DOI = {}
}