Concordance Between Trans-rectal Ultrasound Guided Biopsy Results and Radical Prostatectomy Final Pathology: Are We Getting Better at Predicting Final Pathology?
CUA Online Library. Walker R. 06/22/13; 31418; UP-39
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Abstract
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Introduction and Objectives: Inaccuracy in biopsy (Bx) Gleason scoring poses a risk to men who may then receive inappropriate treatment. We sought to evaluate if there was a shift in discordance rates between Bx and radical prostatectomy (RP) at our institution in recent years while considering the implementation of active surveillance and the shift in pathological grading of Bx scores caused by the 2005 International Society of Urologic Pathology update to Gleason scoring protocol.
Methods: We retrospectively reviewed patients who underwent RP at our institution between May 2004 and April 2011. We analysed clinical and pathological correlates of upgrading in three subgroups: GS6/6, GS6/7, and GS7/7, where the first score belongs to the biopsy and the second to the RP. We applied the log-rank test and Cox model to a Kaplan Meier analysis of biochemical recurrence in the subgroups, and also mapped GS6/7 discordance over time.
Results: Our search yielded 1,717 patients that met our inclusion criteria. Bx results are concordant with final pathology in only 65% of patients. The three subgroups had significantly different mean PSA, patient age, tumour volume, margin status, pathologic stage, prostate weight, TRUS volume, and rate of progression (p<0.05) while core number and BMI were not significantly different (p=0.6 and p =0.3, respectively). We noted a rising discordance initially, a fall during 2006, and an increasing trend thereafter. However there was no sustained increase or decrease over the study period taken as a whole (p=0.06).
Conclusions: Despite that no sustained trend was observed, the falling discordance in 2006 may reflect the accommodation to the 2005 update while the gradual adoption of active surveillance may have led to the otherwise increasing trends. However the observed may also be spurious Bx sampling errors.
Methods: We retrospectively reviewed patients who underwent RP at our institution between May 2004 and April 2011. We analysed clinical and pathological correlates of upgrading in three subgroups: GS6/6, GS6/7, and GS7/7, where the first score belongs to the biopsy and the second to the RP. We applied the log-rank test and Cox model to a Kaplan Meier analysis of biochemical recurrence in the subgroups, and also mapped GS6/7 discordance over time.
Results: Our search yielded 1,717 patients that met our inclusion criteria. Bx results are concordant with final pathology in only 65% of patients. The three subgroups had significantly different mean PSA, patient age, tumour volume, margin status, pathologic stage, prostate weight, TRUS volume, and rate of progression (p<0.05) while core number and BMI were not significantly different (p=0.6 and p =0.3, respectively). We noted a rising discordance initially, a fall during 2006, and an increasing trend thereafter. However there was no sustained increase or decrease over the study period taken as a whole (p=0.06).
Conclusions: Despite that no sustained trend was observed, the falling discordance in 2006 may reflect the accommodation to the 2005 update while the gradual adoption of active surveillance may have led to the otherwise increasing trends. However the observed may also be spurious Bx sampling errors.
Introduction and Objectives: Inaccuracy in biopsy (Bx) Gleason scoring poses a risk to men who may then receive inappropriate treatment. We sought to evaluate if there was a shift in discordance rates between Bx and radical prostatectomy (RP) at our institution in recent years while considering the implementation of active surveillance and the shift in pathological grading of Bx scores caused by the 2005 International Society of Urologic Pathology update to Gleason scoring protocol.
Methods: We retrospectively reviewed patients who underwent RP at our institution between May 2004 and April 2011. We analysed clinical and pathological correlates of upgrading in three subgroups: GS6/6, GS6/7, and GS7/7, where the first score belongs to the biopsy and the second to the RP. We applied the log-rank test and Cox model to a Kaplan Meier analysis of biochemical recurrence in the subgroups, and also mapped GS6/7 discordance over time.
Results: Our search yielded 1,717 patients that met our inclusion criteria. Bx results are concordant with final pathology in only 65% of patients. The three subgroups had significantly different mean PSA, patient age, tumour volume, margin status, pathologic stage, prostate weight, TRUS volume, and rate of progression (p<0.05) while core number and BMI were not significantly different (p=0.6 and p =0.3, respectively). We noted a rising discordance initially, a fall during 2006, and an increasing trend thereafter. However there was no sustained increase or decrease over the study period taken as a whole (p=0.06).
Conclusions: Despite that no sustained trend was observed, the falling discordance in 2006 may reflect the accommodation to the 2005 update while the gradual adoption of active surveillance may have led to the otherwise increasing trends. However the observed may also be spurious Bx sampling errors.
Methods: We retrospectively reviewed patients who underwent RP at our institution between May 2004 and April 2011. We analysed clinical and pathological correlates of upgrading in three subgroups: GS6/6, GS6/7, and GS7/7, where the first score belongs to the biopsy and the second to the RP. We applied the log-rank test and Cox model to a Kaplan Meier analysis of biochemical recurrence in the subgroups, and also mapped GS6/7 discordance over time.
Results: Our search yielded 1,717 patients that met our inclusion criteria. Bx results are concordant with final pathology in only 65% of patients. The three subgroups had significantly different mean PSA, patient age, tumour volume, margin status, pathologic stage, prostate weight, TRUS volume, and rate of progression (p<0.05) while core number and BMI were not significantly different (p=0.6 and p =0.3, respectively). We noted a rising discordance initially, a fall during 2006, and an increasing trend thereafter. However there was no sustained increase or decrease over the study period taken as a whole (p=0.06).
Conclusions: Despite that no sustained trend was observed, the falling discordance in 2006 may reflect the accommodation to the 2005 update while the gradual adoption of active surveillance may have led to the otherwise increasing trends. However the observed may also be spurious Bx sampling errors.
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