Open Access Highly Accessed Research article

Importance and determinants of Gleason score undergrading on biopsy sample of prostate cancer in a population-based study

Elisabetta Rapiti1*, Robin Schaffar1, Christophe Iselin2, Raymond Miralbell3, Marie-Françoise Pelte4, Damien Weber3, Roberto Zanetti5, Isabelle Neyroud-Caspar1 and Christine Bouchardy1

Author Affiliations

1 Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva, 55 boulevard de la Cluse, 1205 Geneva, Switzerland

2 Division of Urology Surgery, Geneva University Hospitals, rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland

3 Division of Radiation Oncology, Geneva University Hospitals, avenue de la Roseraie 53, 1205 Geneva, Switzerland

4 Division of Clinical Pathology, Geneva University Hospitals, rue Michel-Servet 1, 1206 Geneva, Switzerland

5 Piedmont Cancer Registry, CPO, Torino, Italy

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BMC Urology 2013, 13:19  doi:10.1186/1471-2490-13-19

Published: 11 April 2013



In this population-based study, we investigated the degree of concordance between Gleason scores obtained from prostate biopsies and those obtained from prostatectomy specimens, as well as the determinants of biopsy understaging.


We considered for this study all 371 prostate cancer patients recorded at the Geneva Cancer Registry diagnosed from 2004 to 2006 who underwent a radical prostatectomy. We used the kappa statistic to evaluate the Gleason score concordance from biopsy and prostatectomy specimens. Logistic regression was used to determine the parameters that predict the undergrading of the Gleason score in prostate biopsies.


The kappa statistic between biopsy and prostatectomy Gleason score was 0.42 (p < 0.0001), with 67% of patients exactly matched, and 26% (n = 95) patients with Gleason score underestimated by the biopsy. In a multi-adjusted model, increasing age, advanced clinical stage, having less than ten biopsy cores, and longer delay between the two procedures, were all independently associated with biopsy undergrading. In particular, the proportion of exact match increased to 72% when the patients had ten or more needle biopsy cores. The main limitation of the study is that both biopsy and prostatectomy specimens were examined by different laboratories.


The data show that concordance between biopsy and prostatectomy Gleason scores lies within the classic clinical standards in this population-based study. The number of biopsy cores appears to strongly impact on the concordance between biopsy and radical prostatectomy Gleason score.

Prostate cancer; Gleason score; Biopsy; Prostatectomy; Population-based study; Biopsy undergrading