Prostate cancer upgrading or downgrading of biopsy Gleason scores at radical prostatectomy: predicti

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Recommendations for managing clinically localized prostate cancer are structured around clinical risk criteria,with prostate biopsy (PB) Gleason score (GS) being the most important factor.Biopsy to radical prostatectomy (RP) specimen upgrading/downgrading is well described,and is often the rationale for costly imaging or genomic studies.We present simple,no-cost analyses of clinical parameters to predict which GS 6 and GS 8 patients will change to GS 7 at prostatectomy.From May 2006 to December 2012,1590 patients underwent robot-assisted radical prostatectomy (RARP).After exclusions,we identified a GS 6 cohort of 374 patients and a GS 8 cohort of 91 patients.During this era,>1000 additional patients were enrolled in an active surveillance (AS) program.For GS 6,265 (70.9%) of 374 patients were upgraded,and the cohort included 183 (48.9%) patients eligible for AS by the Prostate Cancer Research International Active Surveillance Study (PRIAS) standards,of which 57.9% were upgraded.PB features that predicted a >90% chance of upgrading included ≥7 cores positive,maximum foci length ≥8 mm in any core,and total tumor involvement ≥30%.For GS 8,downgrading occurred in 46 (50.5%),which was significantly higher for single core versus multiple cores (80.4% vs 19.6%,P=0.011).Biochemical recurrence (BCR) occurred in 3.4% of GS 6 upgraded versus 0% nonupgraded,and in GS 8,19.6% downgraded versus 42.2% nondowngraded.In counseling men with clinically localized prostate cancer,the odds of GS change should be presented,and certain men with high-volume GS 6 or low-volume GS 8 can be counseled with GS 7-based recommendations.
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