Concordance Between Biopsy and Radical Prostatectomy Gleason Scores: Evaluation of Determinants in a Large-Scale Study o
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ORIGINAL ARTICLE
Concordance Between Biopsy and Radical Prostatectomy Gleason Scores: Evaluation of Determinants in a Large-Scale Study of Patients Undergoing RARP in Belgium C. Soenens 1 & P. Dekuyper 1 & G. De Coster 2 & N. Van Damme 2 & E. Van Eycken 2 & T. Quackels 3 & T. Roumeguère 3 & B. Van Cleynenbreugel 4 & S. Joniau 4 & F. Ameye 1 & for the Be-RALP registry Received: 5 November 2019 / Accepted: 23 June 2020 # Arányi Lajos Foundation 2020
Abstract To determine whether Gleason scores were concordant between prostate biopsies (bGS) and the definitive resection specimen (pGS) excised with robot-assisted radical prostatectomy (RARP); to identify clinical and pathological factors that might predict upgrading; and to evaluate how upgrading affected outcome. Between 2009 and 2016, 25 Belgian centers participated in collecting prospective data for patients that underwent RARP. We analyzed the concordance rate between the bGS and the pGS in 8021 patients with kappa statistics, and we compared concordance rates from different centers. We assessed the effect of several clinical and pathological factors on the concordance rate with logistic regression analysis. The concordance rate for the entire population was 62.9%. Upgrading from bGS to pGS occurred in 27.3% of patients. The number of biopsies was significantly associated with concordance. Older age (>60 y), a higher clinical T stage (≥cT2), a higher PSA value at the time of biopsy (>10 ng/ml), and more time between the biopsy and the radical prostatectomy were significantly associated with a higher risk of upgrading. Positive margins and PSA relapse occurred more frequently in upgraded patients. Center size did not significantly affect the concordance rate (p = 0.40).This prospective, nationwide analysis demonstrated a Gleason score concordance rate of 62.9%. Upgrading was most frequently observed in the non-concordant group. We identified clinical and pathological factors associated with (non)-concordance. Upgrading was associated with a worse oncological outcome. Center volume was not associated with pathological accuracy. Keywords Prostate cancer . Gleason score . Concordance . Upgrading . Center size Joniau S. and Ameye F. are Senior authors Joniau S. is a Senior Clinical Researcher of the FWO (Research Foundation Flanders) * C. Soenens [email protected]
B. Van Cleynenbreugel [email protected]
P. Dekuyper [email protected]
S. Joniau [email protected]
G. De Coster [email protected] N. Van Damme [email protected] E. Van Eycken [email protected] T. Quackels [email protected] T. Roumeguère [email protected]
F. Ameye [email protected] 1
Department of Urology, AZ Maria Middelares, Ghent, Belgium
2
Belgian Cancer Registry, Brussels, Belgium
3
Department of Urology, Erasmus Hospital, Brussels, Belgium
4
Department of Urology, University Hospital of Leuven, Leuven, Belgium
C. Soenens et al.
Introduction Prostate cancer (Pca) is the
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