Abstract:
OBJECTIVE:To evaluate increases in Gleason grade because of sample bias after immediate rebiopsy or prostatectomy for patients considered active surveillance candidates by institutional protocol. METHODS:A contemporary medical literature search was performed using PubMed. Series were included if the patients had no more than Gleason 6 prostate cancer score on initial biopsy and underwent a prostatectomy or rebiopsy within 6 months. Patient sets using neoadjuvant hormonal therapy or focal prostate treatment were excluded. RESULTS:In patients who would have fallen into the D'Amico low-risk prostate cancer group, 42% were found to have an increase in the Gleason score: 32% resulting in grade ≥ 7 disease and 3% grade ≥ 8. For series that limited patients to the Epstein criteria, Gleason upgrades were 34%, 29%, and 2%, respectively. Of the 139 patients whose second tissue specimens were from a rebiopsy, 17% were found to have grade ≥ 7 disease, whereas only 1 patient had grade ≥ 8. There were no consistent multivariate analysis variables among the series to predict for an increase in Gleason score. CONCLUSION:More than one third of the patients were found to have been undergraded based on their initial prostate biopsy. Therefore, 1 biopsy alone may not be sufficient to offer active surveillance as an option. Further exploration is necessary to better ensure low-risk disease before active surveillance.
journal_name
Urologyjournal_title
Urologyauthors
Shapiro RH,Johnstone PAdoi
10.1016/j.urology.2012.06.022subject
Has Abstractpub_date
2012-09-01 00:00:00pages
661-6issue
3eissn
0090-4295issn
1527-9995pii
S0090-4295(12)00674-7journal_volume
80pub_type
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