-

Abstract

Comparýson of the gleason scores of prostate needle býopsýes and radýcal prostatectomy specýmens“gleason score ýn prostatýc adenocarcýnoma”Aim: Gleason score (GS) is an important prognostic marker for prostate cancer and it is strongly correlatedwith stage and prognosis. However, needle biopsy (NB) GS is not always consistent with that of radicalprostatectomy (RP) specimens. In this study, the correlation of GSs of NB and RP specimens will be examined.Materials and Methods: Study population comprised of 51 patients who had diagnosed as adenocarcinomaby prostate NB and underwent RP operation. The GSs of both specimens were compared and their correlationwas investigated. In addition, the effect of blood prostate-specific antigen (PSA) levels and number of tumorpositive quadrants in NBs on the correlation was also examined. Results: Gleason scores of NBs were 6, 7and 9 in 43 (84.3%), 7 (13.7%) and 1 (2%) patients respectively. Exact correlation existed between GSs of NBand RP specimens for 35 (68.6%) cases. Positive predictive values for biopsy GSs 6 and 7 were 65.1% and100%, respectively. Fifteen (29.4%) biopsies were undergraded and 1 (2%) was overgraded. Blood PSA levelsand number of tumor positive quadrants in prostate NBs did not affect GS correlation (p>0.05). Conclusion:Gleason scoring system is an important parameter on determining the treatment and prognosis in prostatecancer. Thereby, it is important to provide a correlation between GSs of prostate NBs and RP specimens forthe treatment

Keywords

• -

Prostat İğne Biyopsisi Ve Radikal Prostatektomi Materyallerinde Gleason Skorlarının Karşılaştırılması

Abstract

AMAÇ: Gleason skoru (GS) prostat kanserinde önemli bir prognostik belirteç olup evre ve prognozla kuvvetli korelasyon göstermektedir. Ancak prostat iğne biyopsilerine (İB) ve radikal prostatektomi (RP) materyallerine verilen skorlar her zaman uyum göstermemektedir. Çalışmamızda İB ve RP'lere verilen GS'lerin tanısal uyumluluğu araştırılacaktır. GEREÇ VE YÖNTEM: Çalışmaya prostat İB'de adenokarsinom tanısı alarak RP operasyonu geçirmiş 51 hasta alındı. Her iki materyale verilen GS'ler karşılaştırılarak verilen skorların tanısal uyumluluğu araştırıldı. Ayrıca olgulara ait serum prostat spesifik antijen (PSA) seviyeleri ile biyopside tümör içeren kadran sayısının tanısal uyuma etkisi incelendi. BULGULAR: Prostat iğne biyopsisi GS'leri sırasıyla 43 (%84,3) olguda 6, 7 (%13,7) olguda 7 ve 1 (%2) olguda 9 idi. Elli bir olgunun 35'inde (%68,6) İB ve RP GS'lerinde tam uyum vardı. İğne biyopsisinde GS 6'ya sahip 43 olgunun 28'inde (%65,1) ve GS 7'ye sahip 7 olgunun tamamında (%100) RP materyaliyle tam uyum vardı. Bu oranlar GS 6 ve 7'nin pozitif prediktif değerleriydi. On beş (%29,4) olgunun İB materyalinde GS, RP materyalinin skorundan düşükken, 1 (%2) olguda daha yüksek verilmişti. Prostat İB'lerinde tümör pozitif kadran sayısının ve serum PSA seviyesinin GS uyumluluğunu anlamlı etkilemediği saptandı (p>0,05). SONUÇ: Gleason skorlama sistemi prostat kanserinde tedavi ve prognozu belirlemede önemli bir parametredir. Bu nedenle İB'de verilen GS'nin RP materyalindeki GS ile uyumun sağlanması tedaviyi belirlemede önemlidir. Anahtar Kelimeler: Prostat, Adenokarsinom, Gleason Skoru COMPARISON OF THE GLEASON SCORES OF PROSTATE NEEDLE BIOPSIES AND RADICAL PROSTATECTOMY SPECIMENS ABSTRACT AIM: Gleason score (GS) is an important prognostic marker for prostate cancer and it is strongly correlated with stage and prognosis. However, needle biopsy (NB) GS is not always consistent with that of radical prostatectomy (RP) specimens. In this study, the correlation of GSs of NB and RP specimens will be examined. MATERIALS AND METHODS: Study population comprised of 51 patients who had diagnosed as adenocarcinoma by prostate NB and underwent RP operation. The GSs of both specimens were compared and their correlation was investigated. In addition, the effect of blood prostate-specific antigen (PSA) levels and number of tumor positive quadrants in NBs on the correlation was also examined. RESULTS: Gleason scores of NBs were 6, 7 and 9 in 43 (84.3%), 7 (13.7%) and 1 (2%) patients respectively. Exact correlation existed between GSs of NB and RP specimens for 35 (68.6%) cases. Positive predictive values for biopsy GSs 6 and 7 were 65.1% and 100%, respectively. Fifteen (29.4%) biopsies were undergraded and 1 (2%) was overgraded. Blood PSA levels and number of tumor positive quadrants in prostate NBs did not affect GS correlation (p>0.05). CONCLUSION: Gleason scoring system is an important parameter on determining the treatment and prognosis in prostate cancer. Thereby, it is important to provide a correlation between GSs of prostate NBs and RP specimens for the treatment. Key Words: Prostate, Adenocarcinoma, Gleason Score

Keywords

• Prostat, Adenokarsinom, Gleason Skoru

References

1. Carlson GD, Calvanese CB, Kahane H, Epstein JI. Accuracy of biopsy Gleason Scores from a large uropathology laboratory: use of a diagnostic protocol to minimize observer variability. Urology 1998; 51: 525–529.
2. Kojima M, Troncoso P, Babaian RJ. Use of prostatespecific antigen and tumor volume in predicting needle biopsy grading error. Urology 1995; 45: 807–812.
3. Babaian RJ, Grunow WA. Reliability of Gleason grading system in comparing prostate biopsies with total prostatectomy specimens. Urology 1985; 25: 564–567.
4. Thickman D, Speers WC, Philpott PJ, Shapiro H. Effect of the number of core biopsies of the prostate on predicting Gleason score of prostate cancer. J Urol 1996; 156: 110–113.
5. Cookson MS, Fleshner NE, Soloway SM, Fair WR. Correlation between Gleason score of needle biopsy and radical prostatectomy specimens: accuracy and clinical implications. J Urol 1997; 157: 559–562.
6. Lange PH, Narayan P. Understaging and undergrading of prostate cancer. Argument for postoperative radiation as adjuvant therapy. Urology 1983; 21: 113–118.
7. Garnett JE, Oyasu R, Grayhack JT. The accuracy of diagnostic biopsy specimens in predicting tumor grades by Gleason’s classification of radical prostatectomy specimens. J Urol 1984; 131: 690–693.
8. Mills SE, Fowler JE Jr. Gleason histologic grading of prostatic carcinoma. Correlations between biopsy and prostatectomy specimens. Cancer 1986; 57: 346–349.

9. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol 1974; 111: 58–64.
10. Müntener M, Epstein JI, Hernandez DJ, et al. Prognostic Significance of Gleason Score Discrepancies between Needle Biopsy and Radical Prostatectomy. European Urology 2008; 53: 767–776.
11. Gonzalgo ML, Bastian PJ, Mangold LA, et al. Relationship between primary Gleason pattern on needle biopsy and clinicopathologic outcomes among men with Gleason score 7 adenocarcinoma of the prostate. Urology 2006; 67: 115–119.
12. Chun FK-H, Steuber T, Erbersdobler A, et al. Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol 2006; 49: 820–826.
13. King CR, Patel DA, Terris MK. Prostate biopsy volume indices do not predict for significant Gleason upgrading. Am J Clin Oncol 2005; 28: 125–129.
14. Mian BM, Lehr DJ, Moore CK, et al. Role of prostate biopsy schemes in accurate prediction of Gleason scores. Urology 2006; 67: 379–383.
15. Epstein JI, Allsbrook Jr WC, Amin MB, Egevad LL. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 2005; 29: 1228–1242.
16. Kvale R, Moller B, Wahlqvist R, et al. Concordance between Gleason scores of needle biopsies and radical prostatectomy specimens: a populationbased study. BJU Int 2009; 103: 1647–1654.
17. Özok HU, Oktay M, Saðnak L, ve ark. Prostat kanserinde iðne biyopsi ve radikal prostatektomi örneklerinin Gleason skorlarý arasýndaki uyum üzerine modifiye Gleason derecelendirme sisteminin etkisi. Turk J Urol 2010; 36: 333–338.
18. Spires SE, Cibull ML, Wood DP Jr, et al. Gleason histologic grading in prostatic carcinoma: correlation of 18-gauge core biopsy with prostatectomy. Arch Pathol Lab Med 1994; 118: 705–708.
19. Steinberg DM, Sauvageot J, Piantadosi S, Epstein JI. Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings. Am J Surg Pathol 1997; 21: 566–576.
20. Corcoran NM, Hovens CM, Hong MKH, et al. Underestimation of Gleason score at prostate biopsy reflects sampling error in lower volume tumours. BJU Int 2011; Published Online. doi:10.1111/j.1464- 410X.2011.10543.x
21. Oesterling JE, Brendler CB, Epstein JI, et al. Correlation of clinical stage, serum prostatic acid phosphatase and preoperative Gleason grade with final pathological stage in 275 patients with clinically localized adenocarcinoma of the prostate. J Urol 1987; 138: 92–98.
22. Narayan P, Jajodia P, Stein R, Tanagho EA. A comparison of fine needle aspiration and core biopsy in diagnosis and preoperative grading of prostate cancer. J Urol 1989; 141: 560–563.
23. Bostwick DG. Grading prostate cancer. Am J Clin Pathol 1994; 102: 38–56.
24. Partin AW, Yoo J, Carter BH, et al. The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol 1993; 150: 110–114.
25. Epstein JI, Pizov G, Walsh PC. Correlation of pathologic findings with progression after radical retropubic prostatectomy. Cancer 1993; 71: 3582–3593.
26. Zagars GK, Pollack A, von Eschenbach AC. Prognostic factors for clinically localized prostate carcinoma; analysis of 938 patients irradiated in the prostate specific antigen era. Cancer 1997; 79: 1370–1380.
27. Coetzee LJ, Layfield LJ, Hard V, Paulson DF. Proliferative index determination in prognostic carcinoma tissue: is there any additional prognostic value greater than that of Gleason score, ploidy and pathologic stage? J Urol 1996; 157: 214–218.
28. Stone NN, Stock RG, Unger P. Indications for seminal vesicle biopsy and laproscopic pelvic lymph node dissection in men with localized carcinoma of the prostate. J Urol 1995; 154: 1392–1396.
29. Ackerman DA, Barry JM, Wicklund RA, et al. Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic lymph node metastasis at radical prostatectomy. J Urol 1993; 150: 1845–1850.
30. Kaya C, Yýlmaz G, Koca O, ve ark. Prostat kanserinde serum PSA düzeyi ve biyopsi Gleason skorunun radikal prostatektomi patolojisini öngörmedeki deðeri. Ýst Týp Fak Derg 2009; 72: 10–13.
31. Montironi R, Mazzucchelli R, Scarpelli M, et al. Prostate carcinoma II: prognostic factors in prostate needle biopsies. BJU Int 2006; 9: 492–497.
32. Montironi R,Mazzucchelli R, ScarpelliM, et al. Prostate carcinoma I: prognostic factors in radical prostatectomy specimens and pelvic lymph nodes. BJU Int 2006; 97: 485–491.
33. Rosai J: Male Reproductive System. In Rosai J ed. Rosai and Ackerman’s Surgical Pathology 9th ed., New York, Mosby, 2004, 1361–1411.