The Study On The Risk Factors Of Gleason Score Upgrading Between Prostate Needle Biopsy And Radical Prostatectomy

Objects: To explore the risk factors of Gleason Score Upgrading between Prostate Needle Biopsy and Radical Prostatectomy.Methods: A total of 72 patients who were diagnosed with prostate cancer by transrectal ultrasound guided prostate biopsy and underwent radical prostatectomy from August 2013 to October 2016 in The Second Hospital of Dalian Medical University were included in the study.We collected the complete sets of clinical and pathological parameters of the patients,including age,body mass index(BMI),preoperative tPSA(total prostate-specific antigen),f-PSA(free prostate-specific antigen),prostate volume(PV),PSAD(prostate-specific antigen density),number of biopsy cores involved with cancer,clinical stage,biopsy Gleason scores(BGS)and pathological Gleason scores(PGS).According to the discrepancy between GS of biopsy and radical prostatectomy specimens,the patients were divided into two groups,namely GS upgrading group and no GS upgrading group.Univariable and multivariable logistic regression analysis were used to identify risk factors of GS upgrading after radical prostatectomy.Result: All patients were aged 58-85 years(mean 71 years),with BMI 18.37-32.04kg/ m2(average 24.71kg/m2),t-PSA 2.99-112.35ng/ml(mean 37.02ng/ml),f-PSA 0.37-31.84ng/ml(mean 4.25ng/ml).Proatate volume was 13.25-139.28ml(mean38.31ml),and PV was categorized as 30 ml or less(in 34),30-60ml(in 28)and greater than 60ml(in 10).The percentage of positive puncture needle was 7.7%-100%(mean50%),and the clinical stage was categorized as T1c-T2a(in 21),T2b(in 12)and T2c-T3(in 39).The GS at biopsy was categorized as 6 or less(in 28),7(in 19)and greater than 8(in 25).Of the 72 patients,the pathological GS was upgraded in 31(43.1%),downgraded in 8(11.1%),and remained the same in 33(45.8%).For the univariate analysis,therewere no significant differences between two groups in age(P=0.719),BMI(P=0.788),tPSA(P=0.481),f-PSA(P=0.532),f/t-PSA(P=0.085),PSAD(P=0.113),number of biopsy cores involved with cancer(P=0.429),and clinical stage(P=0.085).However,the upgrading group had smaller PV(P=0.038)and lower GS(P=0.003).On multivariable logistic regression analysis for influential factors,the clinical and pathological characteristic that predicted pathological GS upgrading were a smaller PV(P=0.042)and a lower GS(P=0.002).Men with a prostate of <30ml were more than 4.0 times as likely to be upgraded than men with prostate of >60ml.Men with a prostate of 30-60 ml were more than 3.0 times as likely to be upgraded than men with prostate of >60ml.Patients with GS?6 were more than 5.7 times as likely to be upgraded than men with GS?8.Patients with GS=7 were more than 1.85 times as likely to be upgraded than men with GS?8.Conclusions: The prostate biopsy GS may underestimate the degree of malignancy of prostate cancer.Smaller PV and lower biopsy GS are risk factors of clinically significant upgrading of GS,which should be kept in mind when deciding on therapy decisions for patients with prostate cancer.