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Predictors for clinically relevant Gleason score upgrade in patients undergoing radical prostatectomy.
MedLine Citation:
PMID:  21592293     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Clinically relevant GSU in the prostatectomy specimen is a common phenomenon. Clinically relevant GSU occurs in one of three patients with clinically 'very' low-risk PCa, and a low number of biopsy cores is the key negative predictor. OBJECTIVES: To evaluate clinical predictors for Gleason score upgrade (GSU) in radical prostatectomy (RP) specimen, especially in patients with 'very' low risk PCA (T1c and biopsy Gleason score ≤6 and PSA <10 ng/ml and ≤2 positive biopsy cores and PSA density <0.15). Patients and Methods 402 consecutive patients undergoing RP between 2004 and 2006, including a subgroup of 62 patients with 'very' low risk PCA, were examined. Patients were categorized for clinically relevant GSU (defined as upgrade into a higher PCA risk category). Parameters including number of biopsy cores obtained, positive biopsy cores, prostate weight, PSA, DRE and pathology department were evaluated for their role as predictors. Furthermore, GSU in RP specimen was analyzed for its impact on pT-stage. RESULTS Clinically relevant GSU occurred in 38.1% in the whole cohort and in 32.3% in the 'very' low risk PCA subgroup. Gleason score downgrade (GSD) occurred in 4.7%. Number of biopsy cores obtained and prostate weight were independent negative predictors of GSU in all 402 patients (P = 0.02 and P = 0.03, respectively). In the 'very' low risk group, only number of biopsy cores obtained revealed as an independent negative predictor of GSU (P = 0.02). PSA, DRE, number of positive cores or pathology department were not associated to GSU. In the 'very' low risk group, GSU was related with extracapsular tumor extension (P = 0.05). Conclusions Clinically relevant GSU in RP specimen is still a challenging problem. Increasing the number of biopsy cores lower this risk significantly. GSD is rare and thus of minor importance for treatment decisions.
Authors:
Christian Thomas; Karin Pfirrmann; Frauke Pieles; Alexander Bogumil; Rolf Gillitzer; Christoph Wiesner; Joachim W Thüroff; Sebastian W Melchior
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-18
Journal Detail:
Title:  BJU international     Volume:  -     ISSN:  1464-410X     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 THE AUTHORS; BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
Affiliation:
Department of Urology, University of Mainz/Germany, Department of Pathology, University of Mainz/Germany, Department of Urology, Klinikum-Bremen-Mitte/Germany.
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