What is the role of postradiation therapy grading for prostate cancer?

Updated: Dec 30, 2020
  • Author: Kenneth A Iczkowski, MD; Chief Editor: Liang Cheng, MD  more...
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Answer

Answer

Postradiotherapy grading of cancer was not endorsed by the International Consultation Meeting on Prostatic Intraepithelial Neoplasia & Pathologic Staging of Prostatic Carcinoma, November 1995. This issue remains controversial, with conflicting data. [20] The Gleason score in needle biopsy specimens from nonirradiated prostates matches the score by ±1 in the prostatectomy specimen 74% of the time. [21] A Mayo Clinic study evaluating patients treated with radiation and salvage prostatectomy showed a mean Gleason score of 6.2 in biopsy samples and 6.8 in prostatectomy samples. [22]

However, other studies have shown posttherapy upgrading. Siders and Lee found a 24% increase in the number of poorly differentiated tumors (Gleason score 8-10) after radiotherapy. [23]

The strongest argument for grading is for doing so by multivariate analysis; Gleason score and deoxyribonucleic acid (DNA) ploidy predicted cancer-specific survival in the Mayo Clinic study. [22]


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