Incidence and Variables Predicting Gleason Score Up-Grading between Trans-Rectal Ultrasound-Guided Prostate Biopsies and Radical Prostatectomy

Abstract

Objective: To determine whether Gleason score up-grading is still occurring in men diagnosed with adenocarcinoma of the prostate via extended biopsy regimens, and factors that might predict this. Patients and Methods: Between September 1999 and February 2007, 211 men (age: 42–70 years; mean: 60 years) underwent trans-rectal ultrasound-guided prostate biopsies confirming clinically localized adenocarcinoma followed by radical prostatectomy (RP), within our department. Univariate and multivariate logistic regression (LR) analyses using age, serum PSA, prostate volume, clinical stage and total length of cores taken were performed to determine whether Gleason score up-grading could be predicted. Results: A total of 7/20 (35%), 24/64 (38%) and 36/127 (28%) men with 6, 7–9 and at least 10 core biopsies experienced Gleason score up-grading (p = nonsignificant between the 3 groups). Both univariate and multivariate LR analyses failed to determine any of our variables as a predictor of Gleason score up-grading from biopsy to RP. Conclusion: Despite increasing the number of cores taken at biopsy, in order to improve prostate cancer diagnosis, a substantial percentage of men still experience Gleason score up-grading from biopsy to RP. In addition, we were unable to determine any predicting factors for this up-grading.