Biopsy Gleason score: How does it correlate with the final pathological diagnosis in prostate cancer?

Objective To evaluate the role of the Gleason score of needle biopsies of the prostate in predicting the final pathological staging of patients with carcinoma of the prostate treated by radical prostatectomy. Patients and methods The records of 466 patients with carcinoma of the prostate treated by radical prostatectomy were reviewed, comparing the Gleason scores of the core-needle biopsies with the Gleason score and final pathological staging of the surgical specimens. Results The biopsy grade was the same as that of the prostatectomy specimen in 54% of the patients. The most common discordance was the upgrading of well-differentiated tumours in 75% of the patients. When the biopsy grade was compared with the surgical pathological stage, 49% of low- and 82% of high-grade lesions in the biopsy had capsular penetration by tumour or locally advanced disease (Stage C and D1). Conclusion Well-differentiated tumours on the biopsy core are not predictive of organ-confined disease, but a poorly differentiated lesion is a good indicator of extracapsular extension of the cancer.