Under staging and under grading in a contemporary series of patients undergoing radical prostatectomy: Results from the Cancer of the Prostate Strategic Urologic Research Endeavor database

Purpose: We determined the prevalence of under staging and under grading in contemporary patients undergoing radical prostatectomy in academic and com munity based urology practices, and defined important predictors of under s taging in this population. Materials and Methods: We compared clinical T stage and biopsy Gleason scor e with pathological T stage and prostatectomy Gleason score in 1,313 patien ts enrolled in the Cancer of the Prostate Strategic Urologic Research Endea vor database, a longitudinal registry of patients with prostate cancer, who underwent radical prostatectomy, including 53% since 1995. Under grading w as determined for the primary and secondary Gleason patterns and defined as a biopsy Gleason pattern of 1 to 3 that became pathological Gleason patter n 4 or 5. Under staging was defined as a clinically organ confined tumor th at was extraprostatic stages pT3 to 4 or N+ at radical prostatectomy. Univa riate and multivariate analysis was performed to determine important risk f actors for under staging and significant risk factors were used to identify the likelihood of under staging in clinically relevant patient subgroups. The importance of the percent of positive biopsies in regard to the likelih ood of under staging was determined by assigning patients to previously des cribed risk groups based on serum prostate specific antigen (PSA) at diagno sis and biopsy Gleason score. Results: Under grading of primary and secondary Gleason patterns occurred i n 13% and 29% of patients, respectively, while under staging occurred in 24 %. Univariate and multivariate analysis revealed that PSA at diagnosis, bio psy Gleason score and the percent of positive biopsies were significant pre dictors of under staging. The percent of positive biopsies appeared to be m ost important for predicting the likelihood of extraprostatic disease exten sion in intermediate or high risk disease based on serum PSA at diagnosis a nd biopsy Gleason grade. Conclusions: The prevalence of under grading and under staging in contempor ary patients undergoing radical prostatectomy may be lower than previously reported. PSA at diagnosis, biopsy Gleason score and the percent of positiv e biopsies are important predictors of under staging. The percent of positi ve biopsies should be incorporated into risk assessment models of newly dia gnosed prostate cancer.