Is Biopsy Gleason Score Independently Associated With Biochemical Progression Following Radical Prostatectomy After Adjusting for Pathological Gleason Score?

Nicholas J. Fitzsimons, Joseph C. Presti, Christopher J. Kane, Martha K. Terris, William J. Aronson, Christopher L. Amling, Stephen J. Freedland

Research output: Contribution to journalArticle

21 Scopus citations


Purpose: Biopsy Gleason score is known to be associated with prostate specific antigen failure following radical prostatectomy. However, it is unclear whether it remains associated with outcome after surgery when the pathological Gleason score is known. Materials and Methods: We determined the association between biopsy Gleason score and biochemical progression after correcting for preoperative and postoperative characteristics, including pathological Gleason score, in 1,931 men treated with radical prostatectomy between 1988 and 2005 in the Shared Equal Access Regional Cancer Hospital Database Study Group database. Gleason score was examined as a categorical variable of 2 to 6, 3 + 4 and 4 + 3 or greater. Results: Higher biopsy Gleason scores were positively associated with extracapsular extension (p <0.001), positive surgical margins (p <0.001), seminal vesicle invasion (p <0.001), positive lymph nodes (p <0.001) and biochemical progression (log rank p <0.001). After adjusting for only preoperative characteristics biopsy Gleason 3 + 4 and 4 + 3 or greater were associated with increased risk of biochemical progression compared to biopsy Gleason 6 or less (p = 0.001 and <0.001, respectively). After further adjusting for multiple pathological characteristics, including pathological Gleason score, the association between higher biopsy Gleason score and progression was little changed, in that men with biopsy Gleason 3 + 4 and 4 + 3 or greater were significantly more likely to experience progression (p = 0.001 and <0.001, respectively). Furthermore, when stratified by pathological Gleason score, higher biopsy Gleason scores were associated with an increased risk of biochemical progression in each pathological Gleason score category (log rank p ≤0.007). Conclusions: Biopsy Gleason score remained strongly associated with progression even when the pathological Gleason score was known and controlled for. If confirmed at other centers, incorporation of biopsy Gleason score into postoperative nomograms designed to estimate the progression risk might improve model precision.

Original languageEnglish (US)
Pages (from-to)2453-2458
Number of pages6
JournalJournal of Urology
Issue number6
StatePublished - Dec 1 2006



  • biopsy
  • disease progression
  • prostate
  • prostatectomy
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology

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