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Introduction
Prostate cancer (CaP) is the most common malignancy in men and the second cause of cancer-related mortality after lung cancer (1). The diagnosis of CaP is mainly performed by digital rectal examination (DRE), serum prostate-spesific antigen (PSA) measurement and transperineal or transrectal ultrasound-guided biopsies. Prostate needle biopsy is one of the most common procedures performed in the common urological clinical practice; it is estimated that, in the U.S. alone, at least 800,000 prostate biopsies are performed annually (2).
Prostate biopsy has evolved over the years, starting from the technique described by Astraldi in 1937 (3) until the sextant prostate biopsy, described by Hodge et al in 1989 (4). Prostatic needle biopsy is currently considered the gold standard for the diagnosis of CaP and may be performed transrectally or transperineally, guided by ultrasound. The detection rates of these two techniques are comparable (5,6) and there is no final consensus regarding the optimal number of samples, although the British Prostate Testing for Cancer and Treatment Study has recommended 10 core biopsies (7), with antibiotic therapy, commonly quinolone, under local anesthesia.
The International Society of Urological Pathology (ISUP) Conference was held in March, 2005 in San Antonio, Texas (8), during which a panel of international expert uropathologists updated the Gleason grading, in order to increase the reproducibility and reliability of the evaluation of the biopsy specimens. A correct assignment of the Gleason score (GS) may be crucial in terms of prognostic and therapeutic management of CaP. Several studies have assessed the effect of the ISUP Conference on the concordance of Gleason pattern and the possible change of prognostic group.
Billis et al (9) evaluated 172 patients who underwent prostate needle biopsy and subsequent radical prostatectomy and described a significant effect of the ISUP Conference modifications on the evaluation of the Gleason patterns and the resulting change in prognostic group. Following re-evaluation of the specimens, an increase by 1 or even 2 score points was observed in 16.8 and 0.6% of the cases, respectively.
Furthermore, 26.7% of the ‘reassigned’ patients had a higher preoperative PSA level, a larger tumor, more frequent positive surgical margins and higher-stage pathological disease. After the re-evaluation, a higher number of patients was assigned to the prognostic group of GS 8–10, exhibiting, at follow-up,...