To evaluate whether upgrading of the biopsy after radical prostatectomy (RP) affects disease outcome in terms of unfavorable pathology and biochemical failure.
We retrospectively evaluated the records of 174 patients who underwent RP. Prostate biopsy and RP specimen Gleason scores (GSs) and correlative clinical data were recorded, and a multivariate analysis was applied.
Overall (138 patients), the disease of 69 men (50.0%) was upgraded, in 19 (13.8%) it was downgraded, and in 50 (36.2%) it had an identical biopsy and pathological GS. Accuracy rates were significantly higher for GS 8-10 compared to low GSs, with a concordance of 50.0 and 12.2%, respectively (p < 0.01). Multivariate analysis revealed the single independent prognostic factor for a non-organ-confined disease as a RP GS 8-10 (p = 0.035). The factors associated with a positive surgical margin were a biopsy GS 8-10 (p < 0.001) and the presence of biopsy score upgrading (p = 0.02). Biopsy GS >or=8 (p < 0.001) and presence of biopsy score upgrading (p = 0.009) were the two independent predictors of relapse after RP.
This study demonstrated that biopsy upgrading was present in almost half of the patients who underwent RP and it was significantly related to positive surgical margins and biochemical relapse after RP.