Grade Group underestimation in prostate biopsy: predictive factors and outcomes in candidates for active surveillance

Abstract MicroAbstract Results from prostate biopsy may differ from the final pathology after radical prostatectomy in half of the cases. Underestimation of Gleason score on the biopsy seems to have consequences on the outcomes. We developed a nomogram to improve risk classification, in order to better counsel patients when several therapeutic options are available. Objective We intended to analyze the outcomes and predictive factors for underestimating the prostate cancer (PCa) Grade Group (GG) from prostate biopsies in a large monocentric cohort of patients treated by minimally invasive Radical Prostatectomy (RP). Materials and Methods Using a monocentric prospectively maintained database, we included 3,062 patients who underwent minimally invasive RP between 2006 and 2013. We explored clinicopathological features and outcomes associated with a GG upgrade from biopsy to RP. Multivariate logistic regression was used to develop and validate a nomogram to predict upgrading for GG1. Results Biopsy GG was upgraded after RP in 51.5% of cases. Patients upgraded from GG1 to GG2 or GG3 after RP had a longer time to biochemical recurrence than those with GG2 or GG3 respectively, on both biopsy and RP, but a shorter time to biochemical recurrence than those who remained GG1 after RP ( p