Evauation of concordance of gleason score between prostate biopsy and radical prostatectomy

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Published Oct 10, 2018
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Vol. 96 No. 7 (2018): Issue Jul 2018

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Nada Mansouri
Issam Msakni
Faten Gargouri
Ramzi Khiari
Ammar Bouziani
Besma Laabidi

Abstract

Background:   
Histological Gleason score grading is a main determinant of prostate cancer treatment. However, the final histological examination may reveal that concordance rates between biopsy and pathological Gleason sums are inadequate.
The aim of this study was to evaluate the concordance of Gleason score between prostate biopsy and radical prostatectomy specimen and to study factors predictive of up-grading of Gleason score at radical prostatectomy.
Methods :
 We conducted a descriptive and retrospective study including cases of patients who underwent  prostatectomy between 2008 and 2015.
  We proceeded to a histological examination of 30 cases of radical prostatectomy and 17 corresponding biopsies. The data of the remaining 13 prostate biopsies, not performed in our hospital, have been picked from detailed histological reports.
Results :
  Our results showed that the concordance in the Gleason score was 43% (kappa = 0.11, poor agreement).Gleason score was upgraded in 54% of the cases. At radical prostatectomy, it increased by two  points in one case and by one point in 14 cases. The Gleason score was under-graded on prostatic biopsies in an only 1 case.
Using the new classification ISUP 2014, the concordance rate was 26% (kappa = 0.04,  very poor agreement). Gleason score was upgraded in 78% of the cases for Group 1 (SG 3 + 3) and 63% for group 2 (SG 3 + 4). The concordance rate was highest for Group 4 (4 + 3).
Variables  as age, serum PSA (prostate specific antigen) , numbre of cores, percentage of positive cores, or prostate volume were not significant predictors of upgrading of Gleason score on radical prostatectomy specimen.
Conclusion :
  Thus, the high rate of discordance of Gleason score between prostate biopsy and radical prostatectomy specimen implies an understanding of factors predictive of discordance of this score allowing urologists, pathologists and oncologists to support patients in a more suitable way, choosing the appropriate therapeutic modality for each patient.

Keywords:

Prostate - Adenocarcinoma - Biopsy - Prostatectomy - Pathology

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References

  1. Institut national de la santé publique, Unité de recherche en épidémiologie des cancers en Tunise. Registre des cancers Nord Tunisie 2004-2006. Tunis: INSP; 2007.
  2. Institut national de la santé publique, Unité de recherche en épidémiologie des cancers en Tunise. Registre des cancers du sud Tunisien 2000-2002. Tunis: INSP; 2007.
  3. Seamonds B, Yang N, Anderson K et al. Evaluation of prostate-specific antigen and prostatic acid phosphatase as prostate cancer markers. Urology. 1986;28(6):472‑9.
  4. Quon H, Loblaw A, Nam R. Dramatic increase in prostate cancer cases by 2021. BJU Int. 2011;108(11):1734‑8.
  5. Patel S. Emerging Adjuvant Therapy for Cancer: Propolis and its Constituents. J Diet Suppl. 2016;13(3):245‑68.
  6. Ristau BT, Cahn D, Uzzo RG, Chapin BF, Smaldone MC. The role of radical prostatectomy in high-risk localized, node-positive and metastatic prostate cancer. Future Oncol. 2016;12(5):687-99.
  7. Sanyal C, Aprikian AG, Cury FL, Chevalier S, Dragomir A. Management of localized and advanced prostate cancer in Canada: A lifetime cost and quality-adjusted life-year analysis. 2016;122(7):1085-96..
  8. Phillips JL, Sinha AA. Patterns, art, and context: Donald Floyd Gleason and the development of the Gleason grading system. Urology. 2009;74(3):497‑503.
  9. Hernandez DJ, Nielsen ME, Han M, Partin AW. Contemporary evaluation of the D'amico risk classification of prostate cancer. Urology. 2007;70(5):931‑5.
  10. Epstein JI et al. A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score. Eur Urol. 2015;69(3):428-35.
  11. Emanu JC, Avildsen IK, Nelson CJ. Erectile dysfunction after radical prostatectomy: prevalence, medical treatments, and psychosocial interventions. Curr Opin Support Palliat Care. 2016;10(1):102‑7.
  12. Bruinsma SM, et al. Active surveillance for prostate cancer: a narrative review of clinical guidelines. Nat Rev Urol. 2016;3(3):151-67.
  13. Daubenmier JJ, Weidner G, Marlin R, Crutchfield L, Dunn-Emke S, Chi C, et al. Lifestyle and health-related quality of life of men with prostate cancer managed with active surveillance. Urology. 2006;67(1):125‑30.
  14. Eymerit-Morin C, Zidane M, Lebdai S, Triau S, Azzouzi AR, Rousselet M-C. Histopathology of prostate tissue after vascular-targeted photodynamic therapy for localized prostate cancer. Virchows Arch Int J Pathol. 2013; 463(4):547‑52.
  15. Ouzzane A, Coloby P, Mignard J-P, Allegre J-P, Soulie M, Rebillard X, et al. (Recommendations for best practice for prostate biopsy). Prog En Urol J Assoc Fr Urol Société Fr Urol. 2011;21(1):18‑28.
  16. Villers A, Lemaitre L, Haffner J, Puech P. Current status of MRI for the diagnosis, staging and prognosis of prostate cancer: implications for focal therapy and active surveillance. Curr Opin Urol. 2009;19(3):274‑82.
  17. Pryalukhin AE, Vandromme A, Dellmann A, Donhuijsen K, Hammerer PG. Prostate Biopsy Core Handling: Comparison of Contemporary Preembedding Methods. Urol Int. 2015;95(2):203‑8.
  18. Schmid HP, McNeal JE. An abbreviated standard procedure for accurate tumor volume estimation in prostate cancer. Am J Surg Pathol. 1992;16(2):184‑91.
  19. Samaratunga H, Montironi R, True L, Epstein JI, Griffiths DF, Humphrey PA, et al. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling. Mod Pathol Off J U S Can Acad Pathol Inc. 2011;24(1):6‑15.
  20. Fromont G, Molinié V, Soulié M, Salomon L. Analyse et facteurs pronostiques de la pièce opératoire après prostatectomie totale pour cancer de la prostate. Prog En Urol. 2015;25(15):999‑1009.
  21. Epstein JI, Zelefsky MJ, Sjoberg DD, Nelson JB, Egevad L, Magi-Galluzzi C, et al. A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score. 2015;69(3):428-35.
  22. Cohen J. A Coefficient of Agreement for Nominal Scales. Educ Psychol Meas. 1960;20(1):37‑46.
  23. Helpap B, Egevad L. Modified Gleason grading. An updated review. Histol Histopathol. 2009;24(5):661‑6.
  24. Danneman D, Drevin L, Robinson D, Stattin P, Egevad L. Gleason inflation 1998-2011: a registry study of 97,168 men. BJU Int. 2015;115(2):248‑55.
  25. Stackhouse DA, Sun L, Schroeck FR, Jayachandran J, Caire AA, Acholo CO, et al. Factors Predicting Prostatic Biopsy Gleason Sum Under Grading. J Urol. 2009;182(1):118‑24.
  26. Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol. 2012;61(5):1019‑24.
  27. Pichon A, Neuzillet Y, Botto H, Raynaud J-P, Radulescu C, Molinié V, et al. Preoperative low serum testosterone is associated with high-grade prostate cancer and an increased Gleason score upgrading. Prostate Cancer Prostatic Dis. 2015;18(4):382‑7.
  28. Peko J-F, Odzebe AWS, Nsonde-Malanda J, Bambara AT, Ngolet A. Cancer de la prostate : corrélation des scores de Gleason entre les biopsies et les pièces opératoires. Prog En Urol. 2011;21(9):615‑8.
  29. Van Praet C, Libbrecht L, D'Hondt F, Decaestecker K, Fonteyne V, Verschuere S, et al. Agreement of Gleason Score on Prostate Biopsy and Radical Prostatectomy Specimen: Is There Improvement With Increased Number of Biopsy Cylinders and the 2005 Revised Gleason Scoring? Clin Genitourin Cancer. 2014;12(3):160‑6.
  30. Caster JM, Falchook AD, Hendrix LH, Chen RC. Risk of Pathologic Upgrading or Locally Advanced Disease in Early Prostate Cancer Patients Based on Biopsy Gleason Score and PSA: A Population-Based Study of Modern Patients. Int J Radiat Oncol Biol Phys. 2015;92(2):244-51.
  31. Resnick MJ, Koyama T, Fan K-H, Albertsen PC, Goodman M, Hamilton AS, et al. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013;368(5):436‑45.
  32. Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al. Radical Prostatectomy versus Observation for Localized Prostate Cancer. N Engl J Med. 2012;367(3):203‑13.
  33. Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, et al. Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer. N Engl J Med. 2014;370(10):932‑42.
  34. Stark JR, Perner S, Stampfer MJ, Sinnott JA, Finn S, Eisenstein AS, et al. Gleason score and lethal prostate cancer: does 3 + 4 = 4 + 3? J Clin Oncol Off J Am Soc Clin Oncol. 2009;27(21):3459‑64.
  35. Danneman D, Drevin L, Delahunt B, Samaratunga H, Robinson D, Bratt O, et al. The Accuracy of Prostate Biopsies for Predicting Gleason Score in Radical Prostatectomy Specimens. Nationwide trends 2000-2012. BJU Int. 2016; 117(3):373-80.
  36. Porten SP, Whitson JM, Cowan JE, Cooperberg MR, Shinohara K, Perez N, et al. Changes in prostate cancer grade on serial biopsy in men undergoing active surveillance. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(20):2795‑800.
  37. Jain S, Loblaw A, Vesprini D, Zhang L, Kattan MW, Mamedov A, et al. Gleason Upgrading with Time in a Large Prostate Cancer Active Surveillance Cohort. J Urol. 2015;194(1):79-84.
  38. Sheridan TB, Carter HB, Wang W, Landis PB, Epstein JI. Change in prostate cancer grade over time in men followed expectantly for stage T1c disease. J Urol. 2008;179(3):901‑4.
  39. Berglund RK, Masterson TA, Vora KC, Eggener SE, Eastham JA, Guillonneau BD. Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance. J Urol. 2008 Nov;180(5):1964-7; discussion 1967-8.
  40. Arsov C, Becker N, Rabenalt R, Hiester A, Quentin M, Dietzel F, et al. The use of targeted MR-guided prostate biopsy reduces the risk of Gleason upgrading on radical prostatectomy. J Cancer Res Clin Oncol. 2015;141(11):2061‑8.
  41. Brown AM, Elbuluk O, Mertan F, Sankineni S, Margolis DJ, Wood BJ, et al. Recent advances in image-guided targeted prostate biopsy. Abdom Imaging. 2015;40(6):1788‑99.
  42. Schoots IG, Petrides N, Giganti F, Bokhorst LP, Rannikko A, Klotz L, et al. Magnetic Resonance Imaging in Active Surveillance of Prostate Cancer: A Systematic Review. Eur Urol. 2015;67(4):627‑36.
  43. Labanaris AP, Zugor V, Smiszek R, Nützel R, Kühn R, Engelhard K. Guided e-MRI prostate biopsy can solve the discordance between Gleason score biopsy and radical prostatectomy pathology. Magn Reson Imaging. 2010;28(7):943‑6.
  44. Ploussard G, Xylinas E, Durand X, Ouzaïd I, Allory Y, Bouanane M, et al. Magnetic resonance imaging does not improve the prediction of misclassification of prostate cancer patients eligible for active surveillance when the most stringent selection criteria are based on the saturation biopsy scheme. BJU Int. 2011;108(4):513‑7.
  45. Anderson CB, Sternberg IA, Karen-Paz G, Kim PH, Sjoberg D, Vargas HA, et al. Age is Associated with Upgrading at Confirmatory Biopsy among Men with Prostate Cancer Treated with Active Surveillance. J Urol. 2015;194(6):1607‑11.
  46. Krane LS, Menon M, Kaul SA, Siddiqui SA, Wambi C, Peabody JO, et al. Role of PSA velocity in predicting pathologic upgrade for Gleason 6 prostate cancer. Urol Oncol. 2011;29(4):372‑7.
  47. Capitanio U, Karakiewicz PI, Valiquette L, Perrotte P, Jeldres C, Briganti A, et al. Biopsy Core Number Represents One of Foremost Predictors of Clinically Significant Gleason Sum Upgrading in Patients With Low-risk Prostate Cancer. Urology. 2009;73(5):1087‑91.