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Advances in Urology
Volume 2013 (2013), Article ID 710421, 7 pages
http://dx.doi.org/10.1155/2013/710421
Research Article

Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens

Departments of Urology and Pathology, Faculty of Medical Sciences, University of Campinas (Unicamp), Rua Tessália Vieira de Camargo 126, Cidade Universitária “Zeferino Vaz,” 13083-887 Campinas-SP, Brazil

Received 31 July 2013; Revised 23 September 2013; Accepted 23 September 2013

Academic Editor: Axel S. Merseburger

Copyright © 2013 Leonardo Oliveira Reis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ≤6, 7, and ≥8; 94 patients (27.4%) had PSA recurrence, mean followup 80.2 months (median 99). Independent predictors of Gleason upgrading (logistic regression) and disease-free survival (DFS) (Kaplan-Meier, log-rank) were determined. Results. Gleason discordance was 45.7% (37.32% upgrading and 8.45% downgrading). Upgrading risk decreased by 2.4% for each 1 g of prostate weight increment, while it increased by 10.2% for every 1 ng/mL of PSA, 72.0% for every 0.1 unity of PSA density and was 21 times higher for those with BGS 7. Gleason upgrading showed increased clinical stage ( ), higher tumor extent ( ), extraprostatic extension ( ), positive surgical margins ( ), seminal vesicle invasion ( ), less “insignificant” tumors ( ), and also worse DFS, , , . However, when setting the final Gleason score (BGS to PGS 7 versus BGS 7 to PGS 7), avoiding allocation bias, DFS impact is not confirmed, , , Conclusions. Gleason upgrading is substantial and confers worse outcomes. Prostate weight is inversely related to upgrading and its protective effect warrants further evaluation.