Risk factors for Gleason score upgrade from prostate biopsy to radical prostatectomy

• Published in: Exploration of targeted anti-tumor therapy Vol. 5; no. 4; pp. 981 - 996
• Main Authors: Smani, Shayan, Sundaresan, Vinaik, Lokeshwar, Soum D, Choksi, Ankur U, Carbonella, Jeffrey, Brito, Joseph, Renzulli, Joseph, Sprenkle, Preston, Leapman, Michael S
• Format: Journal Article
• Language: English
• Published: United States Open Exploration Publishing 01-01-2024; Open Exploration Publishing Inc
• Subjects: concordance; gleason score upgrading; magnetic resonance imaging fusion biopsy; prostate cancer; prostate-specific antigen; Review; Gleason score upgrading; Prostate cancer; magnetic resonance imaging fusion biopsy; concordance; prostate-specific antigen
• ISSN: 2692-3114; 2692-3114
• DOI: 10.37349/etat.2024.00259

Accurate identification of prostate cancer Gleason grade group remains an important component of the initial management of clinically localized disease. However, Gleason score upgrading (GSU) from biopsy to radical prostatectomy can occur in up to a third of patients treated with surgery. Concern for disease undergrading remains a source of diagnostic uncertainty, contributing to both over-treatment of low-risk disease as well as under-treatment of higher-risk prostate cancer. This review examines the published literature concerning risk factors for GSU from time of biopsy to prostatectomy final pathology. Risk factors identified for Gleason upgrading include patient demographic and clinical factors including age, body mass index, race, prostate volume, and biomarker based assays, including prostate-specific antigen (PSA) density, and testosterone values. In addition, prostate magnetic resonance imaging (MRI) findings have also been associated with GSU. Biopsy-specific characteristics associated with GSU include lower number of biopsy cores and lack of targeted methodology, and possibly increasing percent biopsy core positivity. Recognition of risk factors for disease undergrading may prompt confirmatory testing including repeat sampling or imaging. Continued refinements in imaging guided biopsy techniques may also reduce sampling error contributing to undergrading.