Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: The study of prostate cancer–specific mortality following biochemical recurrence after radical prostatectomy by Dr Freedland and colleagues1 addresses the relationship between serum prostate-specific antigen kinetics and prostate cancer behavior. It also brings forth the difference in Gleason scores obtained from biopsy specimens and those calculated from prostatectomy specimens. For example, Gleason score categories of 2 through 6, 7, and 8 through 10 from the biopsy scores divided the groups into 47%, 39%, and 14%, respectively. In contrast, the prostatectomy-derived scores divided the same groups into 14%, 51%, and 34%, respectively. Although scores from 7 of the biopsy specimens were not available, even if these had all been scored in the 2 through 6 range, substantial differences would still exist. It is not clear whether all of the scoring was done by the same pathologist. Up-scoring from biopsy to prostatectomy specimens is a well-documented phenomenon2 but is not often emphasized in medical articles. Explanations for the discrepancies involve sampling differences and interpersonal reproducibility variations in grading and scoring.3- 5
Trainer TD. Mortality Following Prostate Cancer Recurrence After Radical Prostectomy. JAMA. 2005;294(23):2969-2970. doi:10.1001/jama.294.23.2969-a