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Concordance Between Biopsy and Radical Prostatectomy Gleason Scores: Evaluation of Determinants in a Large-Scale Study of Patients Undergoing RARP in Belgium

  • Original Article
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Pathology & Oncology Research

Abstract

To determine whether Gleason scores were concordant between prostate biopsies (bGS) and the definitive resection specimen (pGS) excised with robot-assisted radical prostatectomy (RARP); to identify clinical and pathological factors that might predict upgrading; and to evaluate how upgrading affected outcome. Between 2009 and 2016, 25 Belgian centers participated in collecting prospective data for patients that underwent RARP. We analyzed the concordance rate between the bGS and the pGS in 8021 patients with kappa statistics, and we compared concordance rates from different centers. We assessed the effect of several clinical and pathological factors on the concordance rate with logistic regression analysis. The concordance rate for the entire population was 62.9%. Upgrading from bGS to pGS occurred in 27.3% of patients. The number of biopsies was significantly associated with concordance. Older age (>60 y), a higher clinical T stage (≥cT2), a higher PSA value at the time of biopsy (>10 ng/ml), and more time between the biopsy and the radical prostatectomy were significantly associated with a higher risk of upgrading. Positive margins and PSA relapse occurred more frequently in upgraded patients. Center size did not significantly affect the concordance rate (p = 0.40).This prospective, nationwide analysis demonstrated a Gleason score concordance rate of 62.9%. Upgrading was most frequently observed in the non-concordant group. We identified clinical and pathological factors associated with (non)-concordance. Upgrading was associated with a worse oncological outcome. Center volume was not associated with pathological accuracy.

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Funding

Commision for the Reimbursement of Medical Devices and Implants (Rijksinstituut voor Ziekte- en Invaliditeitsverzekering/Institut National d’Assurance Maladie Invalidité) andBelgian Association of Urology.

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Author notes

  1. Joniau S. and Ameye F. are Senior authors

Authors and Affiliations

  1. Department of Urology, AZ Maria Middelares, Ghent, Belgium

    C. Soenens, P. Dekuyper & F. Ameye

  2. Belgian Cancer Registry, Brussels, Belgium

    G. De Coster, N. Van Damme & E. Van Eycken

  3. Department of Urology, Erasmus Hospital, Brussels, Belgium

    T. Quackels & T. Roumeguère

  4. Department of Urology, University Hospital of Leuven, Leuven, Belgium

    B. Van Cleynenbreugel & S. Joniau

Authors
  1. C. Soenens
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for the Be-RALP registry

Contributions

Conception and design: Charlotte Soenens, Peter De Kuyper, Thierry Roumeguère, Thierry Quackels, Ben Van Cleynenbreugel, Steven Joniau, Filip Ameye.

Acquisition of data: Nancy van Dame, Liesbeth van Eycken.

Analysis and interpretation of data: Charlotte Soenens, Steven Joniau, Filip Ameye, Greet de Coster.

Drafting of the manuscript: Charlotte Soenens, Steven Joniau, Filip AmeyeCritical revision of the manuscript for important intellectual content: Steven Joniau, Filip Ameye.

Statistical analysis: Greet de Coster, Charlotte Soenens.

Obtaining funding: Filip Ameye, Liesbeth Van Eycken.

Administrative, technical or material support: Greet de Coster, Nancy Van Damme, Liesbeth Van Eycken.

Supervision: Steven Joniau, Filip Ameye.

Corresponding author

Correspondence to C. Soenens.

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Conflict of Interest

None declared.

Research Involving Human Participants and/or Animals and Informed Consent

Yes, involving data of humans. No experiments on humans were performed.Informed consent was obtained.

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Joniau S. is a Senior Clinical Researcher of the FWO (Research Foundation Flanders)

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Soenens, C., Dekuyper, P., De Coster, G. et al. Concordance Between Biopsy and Radical Prostatectomy Gleason Scores: Evaluation of Determinants in a Large-Scale Study of Patients Undergoing RARP in Belgium. Pathol. Oncol. Res. 26, 2605–2612 (2020). https://doi.org/10.1007/s12253-020-00860-w

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  • DOI: https://doi.org/10.1007/s12253-020-00860-w

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