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I just picked this from Pubmed (see below). There are many more studies about grading like this. The average of such studies is about 50% concordance between biopsy and RP specimen, 40% undergrading and 10% overgrading. Very, very poor. What strikes me in this particular study is the concluding comment. Yes they do it a bit better now but still 25% of Gleason scores is wrong. How dare they say this is reassuring for patients!
Urology. 2008 Feb 14 [Epub ahead of print] Links
Trends in Gleason Score: Concordance Between Biopsy and Prostatectomy over 15 Years.Rajinikanth A, Manoharan M, Soloway CT, Civantos FJ, Soloway MS.
Departments of Department ofUrology.
OBJECTIVES: To assess the changes in the concordance rate of prostate biopsy and radical prostatectomy (RP) Gleason score (GS) over 15 years. METHODS: We reviewed 1670 consecutive patients who underwent RP between 1992 and 2006. We excluded patients who underwent neoadjuvant hormone therapy or salvage RP, or who had incomplete data. Patients who had RP during 1992 through 1996, 1997 through 2001, and 2002 through 2006 were assigned to groups 1, 2, and 3, respectively. All clinical and pathological data were collected retrospectively. We defined overgrading as a biopsy GS higher than the RP Gleason score. Undergrading was a biopsy GS less than the RP Gleason score. The GS concordance between biopsy and RP was evaluated by kappa coefficient. RESULTS: A total of 1363 patients satisfied the inclusion criteria. Biopsy and RP Gleason score categories correlated exactly in 937 (69%) men. Gleason undergrading occurred in 361 (26%) men and overgrading in 65 (5%). The exact correlation of GS between biopsy and RP was 58%, 66%, and 75% in groups 1, 2, and 3, respectively. The most common discordant finding was undergrading of the biopsy specimen. The number of cases with exact correlation was highest in GS 7 (78%). Undergrading was more in GS 6 or less (35%) and overgrading was more in the GS 8 through 10 (35%) category. CONCLUSIONS: This large, single institutional study confirms increasing concordance of Gleason scores in prostate needle biopsies and surgical specimens. This is reassuring for patients assessing various treatment options for prostate cancer.
PMID: 18279938 [PubMed - as supplied by publisher]
Perhaps these researchers would also be reassured if they knew that pilots showed an increased concordance with regard to safe landings and only got the landing wrong 25% of the time. I wonder how many people would fly if there was in fact an error rate like that in flying??
But jokes aside, I’d be interested to know if there has been any ‘migration’ of Gleason Scores in the last decade in Europe, to your knowledge. I had noticed from the input into the Yana site and from discussions on Lists that the Gleason Scores seemed to be getting higher.
When I was diagnosed the ‘norm’ was a GS 5 or 6 (and this was before PSA testing really took off, so there were not as many early stage diagnoses as there are now) yet now it is rare to see a 5 (and Dave M says that his specialist says that a 5 is not regarded as cancer!!) and the norm is 3+4 = 7 and 4+3=7. There is an excellent article at Insights - Migration which describes this phenomenon of "migration".
People should be aware of the fact, especially when looking at old studies and making comparisons of outcomes and options based on Gleason Scores.
Guys, I'm not very good with statistics or figures, so be patient with me.
What I saw in the figures from Henk's Pub Med extract was that in recent years (2002 to 2006) there has been an "exact correlation" of GS between biopsy and RP of 75% over all. That looks good to me because a man can fairly safely say that if he is diagnosed with PC at a certain GS then that is most likely what he has. Then he can go on to take Henk's advice and WW until he either does or does not get symptoms. Or he can go on to one of the treatments we all know about.
Terry's example of how a pathologist would feel if he took a flight knowing that the pilot only had a 25% success rate in landing, is not quite fair in this case. If a pilot only had that chance of landing safely, the patient would stand a good chance of dying on touch down. However a 25% error in GS between biopsy and RP is not likely to kill the patient, but it will give him a 75% chance of deciding on an appropriate course of action.
In relation to our recent discussion with California David, the Pub Med piece says that undergrading was more likely in GS 6 or less (35%). In the document Terry linked to they refer to the advisability (in a slightly different context, it is true) of having different pathologists review specimens.
So my point here is that biopsy GS grades ARE sufficient to be a guide to action (especially when coupled with percentages of numbers of needles involved). It may be however that the action we should be guided to is more Active Surveillance than surgery or radiation, whereas most of us - me included - possibly come off AS too soon.
Like I say I am not too good with these statistical things so I would be very grateful if one of you could point out what I may be missing here.