Prognostic significance of Gleason score discrepancies between needle biopsy and radical prostatectomy.

OBJECTIVES Discordance between the Gleason score (GS) on needle biopsy (NB) and the GS of the radical prostatectomy (RP) specimen is a common finding. The objective of this study was to evaluate the prognostic significance of these discrepancies with respect to outcomes following RP. METHODS In the study, 6625 men treated by RP were categorized as having NB=RP (68.8%), NBRP (6.2%) GS, and stratified for analyses into RP GS groups. The Kaplan-Meier method was used to analyze differences in biochemical recurrence-free survival (BRFS), and multivariate Cox analyses were performed to estimate the independent relative risk of progression associated with GS discrepancies. RESULTS Across multiple RP GS strata (3+4, 7, 8, 8-10), patients with a lower NB GS experienced significantly better BRFS than patients with equal NB and RP GS (all p<0.05). NBRP GS had poorer BRFS than patients with NB=RP GS across multiple RP GS strata (< or =3+3, 3+4, 7; all p<0.05). NB>RP GS was independently associated with worse (pooled HR, 1.91, p<0.001) BRFS probabilities, within and across RP GS strata. CONCLUSIONS Our data suggest that the GS of the NB adds additional prognostic value to the RP GS in a consistent manner that may be applicable to strategies of risk stratification and patient counseling after surgery.