Clinical significance of biopsy-derived primary Gleason score among radical prostatectomy candidates with Gleason 7 tumors

Objectives. To determine the clinical value of assessing primary Gleason scoring among patients with grade 7 tumors at needle biopsy with emphasis on its correlation with final pathologic stage and grade. Methods. A total of 108 contemporary cases of surgically treated prostate cancer graded as Gleason score 7 by needle biopsy were reviewed. The influence of primary Gleason pattern, as determined by needle biopsy, on pathologic outcomes, including positive surgical margins and extracapsular extension, was assessed. We also examined the positive predictive value of the assigned primary Gleason pattern. Results. Among the 108 cases, 79 (73.1%) and 29 (26.9%) demonstrated primary pattern 3 and 4, respectively. The positive predictive value of primary Gleason 3 and 4 was 46% and 35%, respectively. When stratified by the needle biopsy primary Gleason pattern, the incidence of extracapsular extension, positive surgical margins, and seminal vesicle involvement was not significantly different. Conclusions. Pathologic features at radical prostatectomy among patients with biopsy-derived Gleason 7 tumors are not associated with the assigned primary pattern. These data call into question whether pathologists should issue a primary score among patients with Gleason 7 cancers at needle biopsy. (C) 2002, Elsevier Science Inc.