Preoperative and Postoperative Gleason Score Correlation of Patients Who Underwent Radical Prostatectomy

Objective: We aimed to report the consistency between transrectal needle biopsy (TRNB) Gleason scores (GSs) and prostatectomy specimen GSs based on upgrading and downgrading rates. Materials and Methods: Data of patients who underwent open, laparoscopic or robot-assisted radical prostatectomy with the diagnosis of prostate cancer between 2006 and 2018 were retrospectively reviewed. Results: Two hundred and fifty two patients were included in the study. The mean age of the patients was 61.9[+ or -]6.1 years. The mean serum prostatespecific antigen (PSA) TRNB was 9[+ or -]5.3 ng/dL. The distribution of TRNB GSs was as follows: G6 (3+3)=178, G7 (3+4)=21, G7 (4+3)=48, G8 (4+4)=1, G9 (4+5)=9. According to the final pathology result after radical prostatectomy, GSs were as follows: G6 (3+3)=141, G7 (3+4)=25, G7 (4+3)=74, G8 (4+4)=3, G9 (4+5)=8. Prostate cancer was limited to prostate in 220 patients and extracapsular spread was observed in 32 patients. There was seminal vesicle invasion in 24 patients and perineural invasion in 49 patients. When TRNB GSs and prostatectomy specimen GSs were compared, 57 (22.6%) patients were upgraded and nine (3.6%) patients had downgrading. The preoperative PSA of the patients undergoing upgrading were significantly higher than those without upgrading, 10.7+6.2 ng/dL versus 8.5+4.9 ng/dL, p=0.018. The age and body mass index of the upgrading and non-upgraded patients were similar, p=0.598 and p=0.133, respectively. Conclusion: Upgrading in the final pathology assessment after radical prostatectomy is still an important problem for clinicians today. It may be beneficial to develop biopsy sampling techniques for accurate grading of the disease and to use radiological imaging for this purpose. Keywords: Prostate cancer, prostate specific antigen, pathology, upgrade, downgrade