Research Article
BibTex RIS Cite

Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması

Year 2017, Volume: 12 Issue: 1, 25 - 30, 24.04.2017
https://doi.org/10.17517/ksutfd.205510

Abstract

Amaç: Prostat biyopsisiile elde edilen Gleason skoru (GS)lokalize prostat kanseri olgularının tedavi kararında önem taşıdığı için radikal prostatektomi (RP)GSile uyumuoldukça önemlidir. Ancak literatürde bu uyum %24-50 arasında bildirilmektedir. Çalışmamızda kliniğimizde yapılan prostat biyopsileri ile RP sonrası elde edilen patolojik bulguların uyumu değerlendirilmiştir.

Gereç ve Yöntemler: KSÜ Tıp Fakültesi Üroloji Kliniği'nde standart 12 kor transrektalbiyopsi ile prostat kanseri tanısı konan ve sonraki sekiz haftada RP yapılan 24 hastanın patoloji sonuçları retrospektif olarak değerlendirildi. Biyopsilerde GS, kanserli kor sayısı,kanserli korlardaki kanser yüzdesi değerlendirildi. Ayrıca yaş,prostat hacmi,PSA değerlerininbiyopsi ve RP GS’ları arasındaki uyuma etkisi araştırıldı. GS artışı ya da azalışı bir prognostik gruptan diğerine geçiş olarak tanımlandı.Prognostik gruplar GS 6; 7 ve 8≤  olarak kategorize edildi.

 Bulgular: Hastaların ortanca yaşı 68 (58-79) yıl,ortanca PSA değeri 9,65 ng/ml (4.2-149) ve prostat hacmi 46.5 ml'ydi (27-70). Tüm hastalar değerlendirildiğinde yalnızca bir olguda (%4.2) GS düşüşü saptandı. Biyopsisinde GS=6 olan olguların %43.5'sinde (n:7/16) RP GS’unda artışısaptanırken, GS=7 olan 7 hastanın ise sadece birinde GS artışı izlendi. GS=8 olan bir hastanın RP GS biyopsi GS’u ile aynıydı. Prostat biyopsi ve patolojik GS arasındaki genel uyum %62.5ve kappa değeri 0,31(p:0,025) idi. GS artışı ile ileri yaş arasında k:0.47 (p=0.01),PSA> 9 olan 14 vaka için k:0.50 (p=0.021) ve prostat hacmi ≥30 cc olan olgularda k:0.42 (p=0.014) olarak bulundu.

Sonuç: Çalışmamızda iğne biyopsi GS ile RP GS arasındaki uyum oranı literatürle uyumlu bulunmakla birlikte, verilerimiz biyopsi ile daha doğru derecelendirme için yeni teknik yaklaşımlara yönelmemiz gerektiğini düşündürtmektedir.

 Anahtar kelimeler: biyopsi, prostat kanseri, Gleason skoru, radikal prostatektomi

References

  • Hanno P, Malkowicz SB and Wein AJ (eds): Clinical Manual of Urology. 3rd edition. McGraw Hill, New York, NY, pp 519, 2001.
  • 2. Donovan J, Hamdy F, Neal D, et al; ProtecT Study Group: Prostate testing for cancer and treatment (ProtecT) feasibility study. Health Technol Assess 2003; 7: 1-88
  • 3. Bostwick DG. Grading prostate cancer. Am J Clin Pathol 1994; 102: 38-56.
  • 4. Pan CC, Potter SR, Partin AW, Epstein JI. The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens. A proposal to modify the Gleason grading system. Am J Surg Pathol 2000; 24: 563-569.
  • 5. Rubin MA, Bismar TA, Curtis S, Montie JE. Prostate needle biopsy reporting: how are the surgical members of the Society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients? Am J Surg Pathol 2004; 28: 946-52.
  • 6. El Hajj A, Ploussard G, de la Taille A, et al. Analysis of outcomes after radical prostatectomy in patients eligible for active surveillance (PRIAS). BJU Int 2013;111: 53-9.
  • 7. Patel AR, Jones JS. Optimal biopsy strategies for the diagnosis and staging of prostate cancer. Curr Opin Urol 2009; 19: 232-7.
  • 8. Lim T, Park SC, Jeong YB, Kim HJ, Rim JS. Predictors of Gleason score upgrading after radical prostatectomy in low-risk prostatecancer. Korean J Urol 2009; 50: 1182-7.
  • 9. Miyake H, Kurahashi T, Takenaka A, Hara I, Fujisawa M.Improved accuracy for predicting the Gleason score of prostatecancer by increasing the number of transrectal biopsy cores. Urol Int 2007; 79: 302-6.
  • 10. Hong SK, Han BK, Lee ST, et al. Prediction of Gleason score upgrading in low-risk prostate cancersdiagnosed via multi (>or =12)-core prostate biopsy. World J Urol 2009; 27: 271-6.
  • 11. Dong F, Jones JS, Stephenson AJ, Magi-Galluzzi C, Reuther AM, Klein EA. Prostate cancer volume at biopsy predicts clinically significant upgrading. J Urol 2008; 179: 896-900.
  • 12. Fu Q, Moul JW, Banez LL, et al. Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer. Med Oncol 2012; 29: 3339-44.
  • 13. Freedland SJ, Kane CJ, Amling CL, Aronson WJ, Terris MK, Prest JC. Upgrading and downgrading of prostate needle biopsyspecimens: risk factors and clinical implications. Urology 2007; 69: 495-9.
  • 14. Richstone L, Bianco FJ, Shah HH, et al. Radical prostatectomy inmen aged > or =70 years: effect of age on upgrading, upstagingand the accuracy of a preoperative nomogram. BJU Int 2008; 101: 541–6.
  • 15. Landis, J.R.; Koch, G.G. The measurement of observer agreement for categorical data. Biometrics 1977: 33: 159–174.
  • 16. Moon SJ, Park SY, Lee TY. Predictive factors of Gleason score upgrading in localized and locally advanced prostate cancer diagnosed by prostate biopsy. Korean J Urol 2010; 51: 677-82.
  • 17. Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: Incidence and predictive factors using modified Gleason grading system and factoring in tertiary grades. Eur Urol 2012;61:1019-24.
  • 18. Kassouf W,Nakanishi H, Ochiai A, Babaian KN, Troncoso P, Babaian RJ. Effect of prostate volume on tumor gradein patients undergoing radical prostatectomy in the era ofextended prostatic biopsies J Urol 2007; 178: 111–114.
  • 19. Turley RS, Hamilton RJ, Terris MK et al. Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy: results from the SEARCH database. J Urol 2008; 179: 523– 527.
  • 20. Tilki D, Schlenker B, John M, et al. Clinical and pathologic predictors of Gleason sum upgrading in patients after radical prostatectomy: results from a single institution series. Urol Oncol 2011; 29: 508–514.
  • 21. Poulos CK, Daggy JK, Cheng L. Prostate needle biopsies: multiple variables are predictive of final tumor volume in radical prostatectomy specimens Cancer 2004;101: 527–532.
  • 22. Sebo TJ, Bock BJ, Cheville JC, Lohse C, Wollan P, Zincke H. The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol 2000;163:174–178.
  • 23. Kuroiwa K, Shiraishi T, Naito S. Gleason score correlation between biopsy and prostatectomy specimens and prediction of high-grade Gleason patterns: significance of centralpathologic review. Urology 2011; 77: 407–411.
  • 24. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol1989; 142: 71–75.
  • 25. Budaus L, Graefen M, Salomon G, et al. The novel nomogram of Gleason sum upgrade: possible application for the eligible criteria of low dose rate brachytherapy. Int J Urol 2010;17: 862-868.
  • 26. Colleselli D, Pelzer AE, Steiner E, et al. Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range. Prostate Cancer Prostatic Dis 2010;13: 182-185.
  • 27. Ruijter E, van Leenders G, Miller G, et al. Errors in histological grading by prostatic needle biopsy specimens: frequency and predisposing factors. J Pathol 2000;192: 229-233.
  • 28. Chung PH, Darwish OM, Roehrborn CG, Kapur P, Lotan Y. Histologic upgrading in patients eligible for active surveillance on saturation biopsy. Can J Urol 2015; 22: 7656-60.
  • 29. Sarici H, Telli O, Yigitbasi O, et al. Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score ≤6. Can Urol Assoc J 2014; 8: E342-6.
  • 30. Lee F, Gottsch H, Ellis WJ, True LD, Lin DW, Wright JL. Differences in upgrading of prostate cancer in prostatectomies between community and academic practices. Adv Urol 2013; 2013: 471234.
  • 31. Nayyar R, Singh P, Gupta NP, et al. Upgrading of Gleason score o radical prostatectomy specimen compared to the pre-operative needle core biopsy: an Indian experience. Indian J Urol 2010; 26: 56-9.
  • 32. Sfoungaristos S, Perimenis P. Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer. Can Urol Assoc J 2013; 7: E93-7.
  • 33. di Loreto C, Fitzpatrick B, Underhill S, et al. Correlation between visual clues, objective architectural features, and interobserver agreement in prostate cancer. Am J Clin Pathol. 1991; 96: 70-5.
  • 34. Corcoran NM, Hovens CM, Hong MK, et al. Underestimation of Gleason score at prostate biopsy reflects sampling error in lower volume tumours. BJU Int 2012;109: 660-4.
  • 35. King CR, McNeal JE, Gill H, Presti JC Jr. Extended prostate biopsy scheme improves reliability of Gleason grading: implications for radiotherapy patients nt J Radiat Oncol Biol Phys. 2004; 59: 386-91.
  • 36. Divrik RT, Eroglu A, Sahin A, Zorlu F, Ozen H. Increasing the number of biopsies increases the concordance of Gleason scores of needle biopsies and prostatectomy specimens. Urol Oncol. 2007; 25: 376-82.
  • 37. Moussa AS, Meshref A, Schoenfield L, et al. Importance of additional "extreme" anterior apical needle biopsies in the initial detection of prostate cancer. Urology. 2010; 75: 1034-9.
  • 38. Abdel-Khalek M, Sheir KZ, El-Baz M, Ibrahiem el-H. Is transition zone biopsy valuable in benign prostatic hyperplasia patients with serum prostate-specific antigen >10 ng/ml and prior negative peripheral zone biopsy?Scand J Urol Nephrol. 2005; 39: 49-55.
  • 39. Capitanio U, Karakiewicz PI, Valiquette L, et al. Biopsy core number represents one of foremost predictors of clinically significant Gleason sum upgrading in patients with low-risk prostate cancer. Urology 2009; 73: 1087–91.
  • 40. Ayres BE, Montgomery BS, Barber NJ, et al. The role of transperineal template prostate biopsies in restaging men with prostate cancer managed by active surveillance. BJU Int. 2012; 109: 1170-6
  • 41. Takashima R, Egawa S, Kuwao S, Baba S. Anterior distribution of Stage T1c nonpalpable tumors in radical prostatectomy specimens. Urology. 2002; 59: 692-7.
  • 42. Pereira RA, Costa RS, Muglia VF,et al. Gleason score and tumor laterality in radical prostatectomy and transrectal ultrasound-guided biopsy of the prostate: a comparative study. Asian J Androl. 2015; 17: 815-20.
  • 43. Crawford ED, Rove KO, Barqawi AB, et al. Clinical-pathologic correlation between transperineal mapping biopsies of the prostate and three-dimensional reconstruction of prostatectomy specimens. Prostate 2013; 73: 778-87.
  • 44. Krughooff K, Eid K, Phillips J, et al.The accuracy of prostate cancer localization diagnosed on transrectal ultrasound- guided biopsy compared to 3-dimensional transperineal approach. Adv Urol 2013;2013: 249080.

Comparison Between Needle Biopsy and Radical Prostatectomy Samples in Assessing Gleason Score in Prostatic Adenocarcinomas

Year 2017, Volume: 12 Issue: 1, 25 - 30, 24.04.2017
https://doi.org/10.17517/ksutfd.205510

Abstract

Objective:
Prostate
biopsy  Gleason score is important for
treatment planning in patients with localized prostate cancer. Therefore, concordance
between biopsy and radical prostatectomy (RP) pathologies is critically
important. However, discordance rates between those two was reported as 24-50%
in the literature. Aim of present study is to evaluate concordance rates
between biopsy and RP results.

Material
and Methods:
A
retrospective review of 24 patients, who underwent prostate biopsy (standart 12
cores) due to elevated PSA or abnormal digital rectal examination and diagnosed
with localised prostate cancer was performed. All patients underwent radical
prostatectomy within 8 weeks after biopsy. Associations between preoperative
clinical factors and Gleason score upgrading were analyzed. Those factors
include Gleason scores, percentage of positive cores, age, prostate volume and
PSA value.  Gleason upgrading or
downgrading was defined as an increase or decrease from one prognostic group to
another. Prognostic groups were categorised as GS 6; 7 and 8≤.

Results: Median age of
patients was68 (58–79) years and median PSA was 9,65 ng/ml (4.2–149). Median
prostate volume was 46,5 ml (27–70). Overall, needle biopsies were under-graded
in 1 (4.2%) cases, overgraded in 8 (33.3%), and correctly graded in 15 (62.5%)
patients. While upgrading was identified in 7 out of 16 (43,5%) patients with
GS 6 on needle biopsy, only one patient with GS=7 on biopsy was upgraded.
Overall concordance between biopsy and pathological GS was 62.5% (p =
0.025) and k value was 0.31. Independent predictors of upgrading were age
(k:0.47 [p=0.01]), PSA> 9 (k:0.50 [p=0.021])
and prostate volume ≥30 cc (k:0.42 [p=0.014]).







Conclusion:
Although
our results were consistent with the literature, new approachs are required to
better grading with biopsy.

References

  • Hanno P, Malkowicz SB and Wein AJ (eds): Clinical Manual of Urology. 3rd edition. McGraw Hill, New York, NY, pp 519, 2001.
  • 2. Donovan J, Hamdy F, Neal D, et al; ProtecT Study Group: Prostate testing for cancer and treatment (ProtecT) feasibility study. Health Technol Assess 2003; 7: 1-88
  • 3. Bostwick DG. Grading prostate cancer. Am J Clin Pathol 1994; 102: 38-56.
  • 4. Pan CC, Potter SR, Partin AW, Epstein JI. The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens. A proposal to modify the Gleason grading system. Am J Surg Pathol 2000; 24: 563-569.
  • 5. Rubin MA, Bismar TA, Curtis S, Montie JE. Prostate needle biopsy reporting: how are the surgical members of the Society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients? Am J Surg Pathol 2004; 28: 946-52.
  • 6. El Hajj A, Ploussard G, de la Taille A, et al. Analysis of outcomes after radical prostatectomy in patients eligible for active surveillance (PRIAS). BJU Int 2013;111: 53-9.
  • 7. Patel AR, Jones JS. Optimal biopsy strategies for the diagnosis and staging of prostate cancer. Curr Opin Urol 2009; 19: 232-7.
  • 8. Lim T, Park SC, Jeong YB, Kim HJ, Rim JS. Predictors of Gleason score upgrading after radical prostatectomy in low-risk prostatecancer. Korean J Urol 2009; 50: 1182-7.
  • 9. Miyake H, Kurahashi T, Takenaka A, Hara I, Fujisawa M.Improved accuracy for predicting the Gleason score of prostatecancer by increasing the number of transrectal biopsy cores. Urol Int 2007; 79: 302-6.
  • 10. Hong SK, Han BK, Lee ST, et al. Prediction of Gleason score upgrading in low-risk prostate cancersdiagnosed via multi (>or =12)-core prostate biopsy. World J Urol 2009; 27: 271-6.
  • 11. Dong F, Jones JS, Stephenson AJ, Magi-Galluzzi C, Reuther AM, Klein EA. Prostate cancer volume at biopsy predicts clinically significant upgrading. J Urol 2008; 179: 896-900.
  • 12. Fu Q, Moul JW, Banez LL, et al. Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer. Med Oncol 2012; 29: 3339-44.
  • 13. Freedland SJ, Kane CJ, Amling CL, Aronson WJ, Terris MK, Prest JC. Upgrading and downgrading of prostate needle biopsyspecimens: risk factors and clinical implications. Urology 2007; 69: 495-9.
  • 14. Richstone L, Bianco FJ, Shah HH, et al. Radical prostatectomy inmen aged > or =70 years: effect of age on upgrading, upstagingand the accuracy of a preoperative nomogram. BJU Int 2008; 101: 541–6.
  • 15. Landis, J.R.; Koch, G.G. The measurement of observer agreement for categorical data. Biometrics 1977: 33: 159–174.
  • 16. Moon SJ, Park SY, Lee TY. Predictive factors of Gleason score upgrading in localized and locally advanced prostate cancer diagnosed by prostate biopsy. Korean J Urol 2010; 51: 677-82.
  • 17. Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: Incidence and predictive factors using modified Gleason grading system and factoring in tertiary grades. Eur Urol 2012;61:1019-24.
  • 18. Kassouf W,Nakanishi H, Ochiai A, Babaian KN, Troncoso P, Babaian RJ. Effect of prostate volume on tumor gradein patients undergoing radical prostatectomy in the era ofextended prostatic biopsies J Urol 2007; 178: 111–114.
  • 19. Turley RS, Hamilton RJ, Terris MK et al. Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy: results from the SEARCH database. J Urol 2008; 179: 523– 527.
  • 20. Tilki D, Schlenker B, John M, et al. Clinical and pathologic predictors of Gleason sum upgrading in patients after radical prostatectomy: results from a single institution series. Urol Oncol 2011; 29: 508–514.
  • 21. Poulos CK, Daggy JK, Cheng L. Prostate needle biopsies: multiple variables are predictive of final tumor volume in radical prostatectomy specimens Cancer 2004;101: 527–532.
  • 22. Sebo TJ, Bock BJ, Cheville JC, Lohse C, Wollan P, Zincke H. The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol 2000;163:174–178.
  • 23. Kuroiwa K, Shiraishi T, Naito S. Gleason score correlation between biopsy and prostatectomy specimens and prediction of high-grade Gleason patterns: significance of centralpathologic review. Urology 2011; 77: 407–411.
  • 24. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol1989; 142: 71–75.
  • 25. Budaus L, Graefen M, Salomon G, et al. The novel nomogram of Gleason sum upgrade: possible application for the eligible criteria of low dose rate brachytherapy. Int J Urol 2010;17: 862-868.
  • 26. Colleselli D, Pelzer AE, Steiner E, et al. Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range. Prostate Cancer Prostatic Dis 2010;13: 182-185.
  • 27. Ruijter E, van Leenders G, Miller G, et al. Errors in histological grading by prostatic needle biopsy specimens: frequency and predisposing factors. J Pathol 2000;192: 229-233.
  • 28. Chung PH, Darwish OM, Roehrborn CG, Kapur P, Lotan Y. Histologic upgrading in patients eligible for active surveillance on saturation biopsy. Can J Urol 2015; 22: 7656-60.
  • 29. Sarici H, Telli O, Yigitbasi O, et al. Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score ≤6. Can Urol Assoc J 2014; 8: E342-6.
  • 30. Lee F, Gottsch H, Ellis WJ, True LD, Lin DW, Wright JL. Differences in upgrading of prostate cancer in prostatectomies between community and academic practices. Adv Urol 2013; 2013: 471234.
  • 31. Nayyar R, Singh P, Gupta NP, et al. Upgrading of Gleason score o radical prostatectomy specimen compared to the pre-operative needle core biopsy: an Indian experience. Indian J Urol 2010; 26: 56-9.
  • 32. Sfoungaristos S, Perimenis P. Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer. Can Urol Assoc J 2013; 7: E93-7.
  • 33. di Loreto C, Fitzpatrick B, Underhill S, et al. Correlation between visual clues, objective architectural features, and interobserver agreement in prostate cancer. Am J Clin Pathol. 1991; 96: 70-5.
  • 34. Corcoran NM, Hovens CM, Hong MK, et al. Underestimation of Gleason score at prostate biopsy reflects sampling error in lower volume tumours. BJU Int 2012;109: 660-4.
  • 35. King CR, McNeal JE, Gill H, Presti JC Jr. Extended prostate biopsy scheme improves reliability of Gleason grading: implications for radiotherapy patients nt J Radiat Oncol Biol Phys. 2004; 59: 386-91.
  • 36. Divrik RT, Eroglu A, Sahin A, Zorlu F, Ozen H. Increasing the number of biopsies increases the concordance of Gleason scores of needle biopsies and prostatectomy specimens. Urol Oncol. 2007; 25: 376-82.
  • 37. Moussa AS, Meshref A, Schoenfield L, et al. Importance of additional "extreme" anterior apical needle biopsies in the initial detection of prostate cancer. Urology. 2010; 75: 1034-9.
  • 38. Abdel-Khalek M, Sheir KZ, El-Baz M, Ibrahiem el-H. Is transition zone biopsy valuable in benign prostatic hyperplasia patients with serum prostate-specific antigen >10 ng/ml and prior negative peripheral zone biopsy?Scand J Urol Nephrol. 2005; 39: 49-55.
  • 39. Capitanio U, Karakiewicz PI, Valiquette L, et al. Biopsy core number represents one of foremost predictors of clinically significant Gleason sum upgrading in patients with low-risk prostate cancer. Urology 2009; 73: 1087–91.
  • 40. Ayres BE, Montgomery BS, Barber NJ, et al. The role of transperineal template prostate biopsies in restaging men with prostate cancer managed by active surveillance. BJU Int. 2012; 109: 1170-6
  • 41. Takashima R, Egawa S, Kuwao S, Baba S. Anterior distribution of Stage T1c nonpalpable tumors in radical prostatectomy specimens. Urology. 2002; 59: 692-7.
  • 42. Pereira RA, Costa RS, Muglia VF,et al. Gleason score and tumor laterality in radical prostatectomy and transrectal ultrasound-guided biopsy of the prostate: a comparative study. Asian J Androl. 2015; 17: 815-20.
  • 43. Crawford ED, Rove KO, Barqawi AB, et al. Clinical-pathologic correlation between transperineal mapping biopsies of the prostate and three-dimensional reconstruction of prostatectomy specimens. Prostate 2013; 73: 778-87.
  • 44. Krughooff K, Eid K, Phillips J, et al.The accuracy of prostate cancer localization diagnosed on transrectal ultrasound- guided biopsy compared to 3-dimensional transperineal approach. Adv Urol 2013;2013: 249080.
There are 44 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Makaleler
Authors

Tayfun Şahinkanat

Faruk Küçükdurmaz

Erkan Efe

Eyüp Koluş This is me

Hasan Çetin Ekerbiçer

Muharrem Bitiren This is me

Publication Date April 24, 2017
Submission Date March 10, 2016
Acceptance Date April 13, 2016
Published in Issue Year 2017 Volume: 12 Issue: 1

Cite

AMA Şahinkanat T, Küçükdurmaz F, Efe E, Koluş E, Ekerbiçer HÇ, Bitiren M. Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması. KSU Medical Journal. April 2017;12(1):25-30. doi:10.17517/ksutfd.205510