Factors Associated With Upgrades From Biopsy Gleason Grades 1-3 to Radical Prostatectomy Gleason Grades 4-5 in Prostate Cancer Patients

Introduction: Discordances of Gleason grade (GG) between biopsy and radical prostatectomy (RP) of prostate cancer (PCa) patients have raised great concerns. Our study aimed to identify these predictive factors for GG upgrading from biopsy to RP. Methods: We retrospectively reviewed the records of PCa patients receiving RP in our medical center. All patients underwent a standardized 12-core transrectal ultrasound (TRUS)-guided prostate needle biopsy, with site-specific submissions. Pretreatment PSA-related parameters were assessed 2 weeks before the operation. Prostate volume (PV) was calculated from images. Results: 679 patients were enrolled after screening. In the biopsy GG 1-3 group, 91 patients experienced upgrades. The multivariable analysis revealed that total PSA (tPSA) (p value < 0.01) and perineural invasion (p value = 0.01) were significantly associated with the likelihood of upgrading compared to the concordant group. Conclusion: The GG 4 group demonstrated the lowest rate of concordance between biopsy and RP. Our analysis identified tPSA levels and perineural invasion as independent predictors of GG upgrading from biopsy GG 1-3 to RP GG 4-5 in PCa patients.