Prognostic Significance of Gleason Score Discrepancies between Needle Biopsy and Radical Prostatectomy

Michael Müntener, Jonathan I. Epstein, David J. Hernandez, Mark L. Gonzalgo, Leslie Mangold, Elizabeth Humphreys, Patrick C. Walsh, Alan W. Partin, Matthew E. Nielsen

Research output: Contribution to journalArticlepeer-review

73 Scopus citations


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%), NB<RP (25.0%) or NB>RP (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). NB<RP GS was independently associated with better (pooled HR, 0.76, p = 0.001) BRFS, within and across RP GS strata. Similarly, patients with NB>RP GS had poorer BRFS than patients with NB=RP GS across multiple RP GS strata (≤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.

Original languageEnglish (US)
Pages (from-to)767-776
Number of pages10
JournalEuropean urology
Issue number4
StatePublished - Apr 2008
Externally publishedYes


  • Gleason score
  • Needle biopsy
  • PSA recurrence
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology


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