Prostate cancer patients who have a small prostate and a biopsy Gleason score of 6 or less are at increased risk of having that score upgraded upon pathologic examination of the radical prostatectomy specimen, according to researchers.
Pathologic upgrading also is more likely if patients have more than 1 core positive for cancer and a greater cancer burden.
Hasmet Sarici, MD, and colleagues at Ankara Training and Research Hospital in Ankara, Turkey, retrospectively studied 321 men who had a biopsy Gleason score of 6 or less and who underwent radical retropubic prostatectomy. Biopsy and pathologic Gleason scores were concordant in 190 patients (59.2%) and 131 (40.8%) had a pathologic upgrading to Gleason score 7 or higher, the researchers reported in the Canadian Urological Association Journal (2014;8:E342-E346).
Men with a prostate volume less than 40 cc had a 5.6 times increased likelihood of Gleason score upgrading on final pathology. Men with more than 1 core positive for cancer had a 5.7 times increased risk. A maximum percent of cancer in any core was associated with a 2-fold increased risk. Age, PSA, and time since surgery did not predict Gleason score upgrading.
The investigators concluded that their results have clinical implications for risk stratification and treatment choice, especially in choosing among non-surgical treatment options, such as active surveillance and watchful waiting.