How accurately does prostate biopsy Gleason score predict pathologic findings and disease free survival?

OBJECTIVE. Due to the significant impact on prognosis by subgrouping of pro statectomy Gleason scores < 7, 7, and > 7, we undertook this study to answe r whether the biopsy Gleason score was as predictive of disease free surviv al and assess the correlation with the prostatectomy Gleason score in a mod ern prostatectomy series. METHODS. An analysis of 1,031 patients who underwent radical prostatectomy for clinically localized prostate cancer was performed. All data was prospe ctively collected. The Gleason score was categorized into 3 different group s (< 7, 7, and > 7) for biopsy and prostatectomy specimens. Disease free su rvival was then analyzed for each group. Discrepancies between scores and o utcomes were evaluated. RESULTS. Accurate correlation was noted in 54.8, 66.8, and 47.4% of Gleason scores < 7, 7, and > 7, respectively, Overall accuracy was 58.3%. Both, bi opsy and prostatectomy Gleason score correlated significantly with disease free survival (P = 0.001), furthermore the classification (Gleason scores < 7, 7 and > 7) was highly significant (P = 0.001). Patients with prostatect omy Gleason < 7 tumors had significant survival advantage over those with b iopsy Gleason < 7, (P = 0.001). However, disease free survival was superior for patients with biopsy Gleason > 7 than those with prostatectomy Gleason > 7, (P = 0.02). The overall disease free survival was similar among the p atients with Gleason score of 7 (P = 0.12). CONCLUSIONS. It appears that biopsy Gleason score, although oftentimes not correlating strongly with the prostatectomy Gleason score, is an important prognostic factor in prostate cancer. There are significant differences in disease free survival between biopsy and prostatectomy Gleason score catego ries. (C) 2001 Wiley-Liss, Inc.