Reliability of small amounts of cancer in prostate biopsies to reveal pathologic grade

King, Christopher R.; McNeal, John E.; Gill, Harcharan; Brooks, James D.; Srinivas, Sandy; Presti, Joseph C.

doi:10.1016/j.urology.2005.12.031

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Volume 67, Issue 6 , Pages 1229-1234, June 2006

Reliability of small amounts of cancer in prostate biopsies to reveal pathologic grade

Christopher R. King
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
- Division of Urologic Oncology, Stanford University School of Medicine, Stanford, California, USA
- Reprint requests: Christopher R. King, Ph.D., M.D., Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305-5847.
John E. McNeal
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Division of Urologic Oncology, Stanford University School of Medicine, Stanford, California, USA
Harcharan Gill
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Division of Urologic Oncology, Stanford University School of Medicine, Stanford, California, USA
James D. Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Division of Urologic Oncology, Stanford University School of Medicine, Stanford, California, USA
Sandy Srinivas
- Department of Medical Oncology, Stanford University School of Medicine, Stanford, California, USA
- Division of Urologic Oncology, Stanford University School of Medicine, Stanford, California, USA
Joseph C. Presti Jr
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Division of Urologic Oncology, Stanford University School of Medicine, Stanford, California, USA

Received 26 September 2005; accepted 14 December 2005.

Abstract

Objectives

To examine grade reliability when biopsies contain very small amounts of prostate cancer. Prostate biopsy findings are known to undergrade prostate cancer compared with the pathologic specimens yet remain the only grade guiding disease management.

Methods

The presence of a clinically significant grade change from biopsy cores to matched prostatectomy specimens was examined in 371 patients. The biopsies were characterized for primary and secondary Gleason grade, number of positive cores, and total linear length of cancer. The pathologic specimens were characterized for cancer volume and relative percentage by grade. The rates of upgrading or downgrading were tested against all clinical and biopsy information for any significant predictive value.

Results

The overall rate of upgrading was 40.7% and downgrading was 16.1%. Upgrading was constant and independent of any clinical or biopsy tumor volume indexes. Specifically, when cancer was present in only one biopsy core and measured 2 mm or less (n = 48), it was just as predictive of the pathologic grade as that from any greater number of positive cores and any greater extent of cancer length present. Downgrading was less frequent for biopsies with small amounts of cancer.

Conclusions

Histologic grading from small amounts of cancer in prostate biopsies is reliable and not more prone to grading errors. A repeat biopsy for these patients may not be indicated.