Precision of preoperative assessment of malignancy degree and prostate cancer stage

Introduction. Despite the continuous improvement of preoperative examination methods, changes in the requirements for interpretation of the results of pathomorphological examination, the frequency of the difference in staging and evaluation of the degree of differentiation of prostate cancer before and after radical prostatectomy remains high. Materials and methods. A retrospective clinical study included 563 patients (mean age 61.3 years) with histologically verified localized and locally advanced prostate cancer. All patients underwent transrectal multifocal biopsy of the prostate under ultrasound guidance and then, during the period from January 2012 to March 2014, robot-assisted (n=490) or retropubic (n=73) radical prostatectomy in the urology clinic of A.I.Evdokimov Moscow State University. The percentage of tumor malignancy and disease stage difference before and after radical prostatectomy was calculated using a joint allocation table. Results. The frequency of Gleason scores before and after surgery was: for the sum of points (3+3) 6 - 55.0% (out of 285 only in 194 cases), (3+4) 7 - 39.6%, (4+3) 7 - 45.6%, 8 - 32.0%, 9 - 57.1%, respectively. The overall frequency of the Gleason score before the operation and the Gleason score after the operation was 48.7% (in 253 cases). Reduction in Gleason score was recorded in 12.9% of patients, increase in 38.2%. The stages of the disease - the T2c coincidence was less than 50%. In almost 40% of cases, a higher stage of the disease, pT3a, was diagnosed. In 1/4 of patients, the clinical stage of T3a was pT3b. The coincidence of the clinical and pathomorphological stage of the disease was recorded in only 1/4 of the patients participating in the study. Conclusions. The formation of the clinical stage of prostate cancer and the determination of the degree of malignancy of the disease in the preoperative period do not correspond to postoperative in about 50% of cases. It is necessary to take this fact into account when forming therapeutic tactics and to work on further improving the methods of preoperative examination of patients with prostate cancer.

prostate canser, radiacal prostatectomy, pathomorphology