Biopsy vs Surgery Results

There are a number of studies. I give some citations below. Note that in general, 3+3 and 3+4 are more likely to be upgraded (because pattern 4 was under-sampled),whereas 4+4 is more likely to be downgraded (because only one or two 4+4 cores overestimated the true Gleason score).

I was in the latter group, 4+4 at biopsy and 3+4 in my pathology.

Schreiber D, Wong AT, Rineer J, Weedon J, Schwartz D. Prostate biopsy concordance in a large population-based sample: a Surveillance, Epidemiology and End Results study. J Clin Pathol. 2015 Jun;68(6):453-7. doi: 10.1136/jclinpath-2014-202767. Epub 2015 Mar 11. Erratum in: J Clin Pathol. 2015 Jul;68(7):e2. doi: 10.1136/jclinpath-2014-202766corr1. PMID: 25762729.

Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol. 2012 May;61(5):1019-24. doi: 10.1016/j.eururo.2012.01.050. Epub 2012 Feb 8. PMID: 22336380; PMCID: PMC4659370.

Athanazio D, Gotto G, Shea-Budgell M, Yilmaz A, Trpkov K. Global Gleason grade groups in prostate cancer: concordance of biopsy and radical prostatectomy grades and predictors of upgrade and downgrade. Histopathology. 2017 Jun;70(7):1098-1106. doi: 10.1111/his.13179. Epub 2017 Mar 28. PMID: 28370140.

Gleason group concordance between biopsy and radical prostatectomy specimens: A cohort study from Prostate Cancer Outcome Registry – Victoria
Sue M Evans 1,∗, Varuni Patabendi Bandarage 1, Caroline Kronborg 2, Arul Earnest 1, Jeremy Millar 1, David Clouston 3

The Gleason score from a prostate biopsy matches the final score from a radical prostatectomy about 60% to 75% of the time,

Upgrading (Higher score at surgery): The final pathology specimen shows a higher, more aggressive Gleason score than the initial biopsy in about 20% to 35% of cases. This often happens when a biopsy needle misses the most aggressive part of a tumor.
https://www.cancer.org/cancer/diagnosis-staging/tests/pathology-reports/prostate-pathology/prostate-cancer-pathology.html
Downgrading (Lower score at surgery): The final pathology shows a lower Gleason score than the biopsy in less than 5% to 10% of cases.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4939641/

@ireland1964
It is why many of us agree with our medical doctors to have a Decipher or similiar test. Those test determine if your cancer is low risk, intermediate, or high risk.

The amount of biopsies is decided by the urologist. My Mayo urologist uses what they call MRI/fusion/biopsies. They use (per my urologist) the MRI (mine was with contrast) to guide the urologist to the areas of suspicion. It is not full proof but urologist will decide where to biopsy.

Have you talked to your doctors about test like Decipher for a better diagnoses of the risk level of your P.C. if you have had a biopsy?

“Downgrading (Lower score at surgery): The final pathology shows a lower Gleason score than the biopsy in less than 5% to 10% of cases.”

I must be one of the lucky ones, mine went from a Gleason 3+5=8 intermediate unfavorable to a 3+4=7 intermediate favorable.

@jc76 I’m waiting on my Prolaris test results but I understand this or the Decipher tells me how aggressive the cancer is and not the current stage it is now as determined by the biopsy.

@jeffmarc Those stats seem horrible to me if you’re trying to make treatment decisions.
Do you think it’s more due to missed biopsy samples or pathology readings?

The Gleason Method relates to an eyeball estimate of RISK of metastasis. ARTERRA uses AI to compare hopefully a good sample of tissue... (IMHO: ...per a 3T-multiparametric dye enhanced MRI, ideally read not by general radiologist but rather one who is steeped in GU rad-pathology. A subsequent CT-MRI fusion perineal targeted biopsy would be preferred. It has fewer infections and can visualize the anterior of the prostate though an infrequent disease site.

Mentioned earlier in a post: Post & Pre-surgical prostate gland only samples were concordant 60-75%, (15-25% worse if corrected (worse minus better) but still it is an estimate of RISK of metastasis. The studies incidentally were summarized from far earlier data sets. Their publication dates occurred probably a decade later than the raw data.

In the interim PSMA PET CT scan 'ruling in' or 'ruling out' of 'mets' (...for the most part) have become almost universally applied in follow-up to increasing classical Gleason RISK of metastasis in gland contained findings. DECIPHER genomic tests, ARTERRA,
AI review of biopsy, even AI review of MRIs [deepviewimaging.com] can help in the decision process. Other intraglandular features & considerations remain such as tumor burden: amount and size, cribriform types of '4' Gleason, intraductal, extension into seminal vessels, etcetera. These all are factors that can now be taken into consideration by an 'at arm's length' GU medical oncologist. Let us realize that employees of corporations of even the best institutions tow the line and are often in the rear guard, i.e. , looking in dollar incentivized rear view therapeutic mirrors. The specter of micro-mets in low burden disease can be addressed with annual
mpMRIs and quarterly PSA tests. Spot radiotherapy would be an option in that unlikely outcome.

@ireland1964
That is my understanding as well.

I always bring up the Decipher test because it has such a dramatic affect on my treatment plan. When I got the biopsy report the R/Os said I was at intermediate risk and the plan was to do 20 rounds of photon radiation with hormone treatment. But he added want to order a Decipher test. I did not know what a Decipher test back at that time (3.5 years ago).

The Decipher test came back low risk not intermediate risk and it changed my treatment plan to radiation only.

@ireland1964
When they do a biopsy, it only gets about 1% of the prostate tissue. As you can imagine there’s 99% more of the prostate that was not examined. The only way to do that is to have a prostatectomy. People who pick radiation is their primary treatment never know their real Gleason score.

@jc76 I know the worlds not perfect but it really all comes down to testing to help guide our treatment decisions.
I just received notice my Prolaris came back at 4.1 and unfavorable interm risk. Will have to get clarification on how I went from 3+4 stage T1c Group 2 biopsy and originally given the option for active surveillance, to this report saying surgery or radiation is the only option.
Makes me think surgery is probably best option given the fact there’s a decent chance the cancer is actually worse