Risk factors for Gleason score upgrading following radical prostatectomy: a review of the current literature

Abstract

INTRODUCTION: Gleason score discordance can confound optimal treatment allocation of patients diagnosed with prostate cancer and place these patients at risk of worse oncological outcomes. Its prevalence remains endemic; its exact causation remains unknown. The objective of this review was to examine the observational studies of patient cohorts who have undergone radical prostatectomy with the aim of identifying any preoperative variables that may be associated with an upgrade in final prostatectomy Gleason score. EVIDENCE ACQUISITION: A non-systematic review of English articles from 2010 to present was performed through a MEDLINE search. Search terms included Gleason score, pathological, upgrade and radical prostatectomy. EVIDENCE SYNTHESIS: All studies included for review were retrospective analyses of radical prostatectomy series that examined factors associated with Gleason score discordance. CONCLUSIONS: The various studies found that Gleason score upgrading remains highly prevalent, and that some association can be seen with greater percent positive cores, longer biopsy core lengths, smaller prostate glands, higher percent tumour volume per gland, PSA density and visible lesions on mp-MRI.