Upgrade In Gleason Score Between Biopsy And Radical Prostatectomy Pathology Indicates Poor Outcomes In Prostate Cancer

Gleason score (GS) plays an important role in determining the biology of prostate cancer but prognostic information is scanty. A total of 966 patients with paired biopsy and radical prostatectomy histology were enrolled from 8 academic hospitals in China from January 2005 to March 2013, with median follow-up of 53 months. Kaplan-Meier curves and multivariate models were generated to compare the GS upgrade to those in whom the Gleason score remains the same on the risk of postoperative biochemical recurrence/progression and death. Overall, 331 patients (34.26%) experienced a GS upgrade post Radical Prostatectomy (RP). We found that patients with upgraded GS experienced a significantly higher rate of biochemical recurrence/clinical progression/death/cancer-specific mortality compared to those with concordant GS (P<0.001). According to the biopsy GS, patients were divided into 3 groups (biopsy GS <= 6, GS=7, and GS >= 8), patients with upgraded GS suffered a significantly higher biochemical recurrence (P<0.005) than those with concordant GS in the 3 groups. In multivariate models, a change in GS was an independent predictor of biochemical recurrence (2.01 (1.45-2.80), P<0.001), progression (1.77 (1.06-2.96), P=0.003) and death (1.83 (0.83-4.04), P=0.036) in the preoperative setting only. Patients experiencing an upgrade in their GS between biopsy and post RP exhibited significantly more aggressive pathological features than corresponding concordant tumors, and a higher risk of biochemical recurrence/progression and death post RP.