The problem with surveillance in the young man with prostate cancer

You make a decision to do nothing based on the potential of  inaccurate information. (A biopsy that undergrades the disease)

What you see is not what you get.

Gleason Score And Laterality Concordance Between Prostate Biopsy And Prostatectomy Specimens

27 Feb 2010 – Treatment decisions in prostate cancer are guided by Gleason grade and laterality (unilateral vs. bilateral) findings on prostate needle biopsy which samples a small proportion of the prostate. Surgical decisions with respect to nerve sparing and lymph node dissection are also influenced by prostate biopsy findings. We reviewed the findings on prostate biopsy compared to subsequent prostatectomy specimen in the same patient.

152 patients underwent open radical retropubic prostatectomy. The majority were low grade on biopsy with 56% having Gleason grade less than 7. Upgrading in Gleason score from biopsy to prostatectomy occurred in 34% of patients, while only 16% were downgraded to a lower Gleason score. Of those patients with unilateral involvement on prostate biopsy, 80% were actually found to have bilateral involvement in the final surgical specimen. Only 26% of the time were both the Gleason grade and laterality in complete agreement between biopsy and prostatectomy specimen. Concordance in Gleason score was improved when more than 8 core needle biopsies were taken, with 12 cores now being our standard.

Prostate biopsy often underestimates prostatectomy Gleason score and bilateral involvement, which is a consistent finding confirmed in multiple clinical studies. This information has implications for patient counseling, particularly when discussing active surveillance (true Gleason grade may be higher than biopsy grade) or focal therapy (unilateral disease may actually be bilateral disease).

Written by Kenneth Nepple, MD and Fadi Joudi, MD as part of Beyond the Abstract on This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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Main News Category: Prostate / Prostate Cancer

Also Appears In:  Urology / Nephrology,

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