Namık Kemal Tıp Dergisi (Aug 2017)
Active Follow-Up Decision In Prostate Cancer; How Safe is The Biopsy Gleason Score?
Abstract
Aim:With the invention of prostate specific antigen, incidental prostate cancer rates increased significantly and the patients had to be exposed to unnecessary treatments. For those patients with incidental prostate cancer, active surveillance was introduced in the guidelines and has been applied to the patients. But, the pathological mismatch between the transrectal ultrasonography guided biopsy and the radical prostatectomy specimens may risk the patients who need curative treatment. In this study, we aimed to compare the Gleason scores between radical prostatectomy specimens and transrectal ultrasonography guided biopsy.Material-Methods:The data of the patients, who had radical prostatectomy in our clinic between March 2011 and June 2016, had been retrospectively evaluated. The PSA value before transrectal ultrasonography guided biopsy, biopsy core numbers, cancer positive biopsy core numbers, cancer percentage and Gleason scores at biopsy have been noted, and compared with the Gleason score after radical prostatectomy, tissue cancer ratio in prostatectomy specimen, surgical margins and pathologic stage.Results:The data of 44 patients were evaluated. The Gleason score was 7 at 1 (16,6%) patient in both transrectal ultrasonography guided biopsy and radical prostatectomy.Conclusion:There are differences between transrectal ultrasonography guided biopsy Gleason scores and the radical prostatectomy Gleason scores. This differences especially are obvious in patients with Gleason score <7. The reliability of gleason scores reported by the pathologists might be questionable so, in order to decide active surveillance for patients, other variables (core-tumor ratio, tumor core number, PSA) must also be considered.
