Introduction

1. No. 012 Lessons from the SA-PCCOC Database:The rate of upgrading of TRUS biopsy results in intermediate risk prostate cancer Jason Lee, Sophie Plagakis Repatriation General Hospital, South Australia Introduction Transrectal ultrasound (TRUS) guided biopsy of the prostate is an important component in the assessment of prostate cancer. It is known to have false negative results as well as false ‘true positive’ results which represent under-grading . These are of particular importance when patients are considered for non-extirpative treatment options, as in Gleason 7 disease, as their histological grade cannot be relied upon to guide decision making. Upgrading has important prognostic significance and is a risk factor for extracapsular extension, seminal vesicle invasion and positive lymph nodes. Results 531 patients, mean age 62.9 years old, mean PSA at diagnosis 8.6 Of the 104 patients upgraded from Gleason 3+4 disease, 14 (13%) patients were found to have Gleason 8-10 disease in their radical prostatectomy specimen. We compared the overall numbers with a subgroup of patients who had ‘low volume’ Gleason 3+4 disease. This was defined as 1 core positive for Gleason 4 or 2 cores positive if more than 10 cores were taken. During our study period the minimum cores taken was 6. The relationship between the interval from biopsy to radical prostatectomy and the incidence of upgrading was analysed in our dataset. Our findings, however, were not statistically significant. Aim To assess the rate of upgrading in Gleason 3+4 prostate cancer – from TRUS biopsy to radical prostatectomy specimen – using data from the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database. • Methods • 531 patients identified in the database from 1996-2010 who had Gleason 7 (either 3+4 or 4+3) on TRUS biopsy and subsequently had a radical prostatectomy. • OACIS and private laboratory data accessed to analyse all TRUS and radical prostatectomy histology reports to supplement PCCOC dataset for number of cores positive for Gleason 4. • The incidence of upgrading of disease in both Gleason 3+4 and 4+3 groups was analysed, using the Gleason 4+3 patients as a comparison group. Furthermore, a specific subgroup analysis of patients with ‘low volume’ Gleason 4 disease was analysed. • Univariate and multivariate analysis was also performed to assess potential risk factors for upgrading which included: PSA, time interval from biopsy to radical prostatectomy, age, total number of cores and total number of cores positive for Gleason 3 and Gleason 4 disease. • Ethics approval attained prior. • Gleason 3+4 prostate cancer was upgraded in our series by 27%, with ‘low volume’ upgrades in 20-29% of patients. • The SA-PCCOC database is well set up to further investigate the link between variables and upgrading, and we intend to explore this in the future. Conclusions References Kattan et al. 1998, A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst. vol 90, no 10, pp766-771. Stark et al. 2009, Gleason score and lethal prostate cancer: does 3+4 = 4+3? J ClinOnc.vol 27, no 21, pp 3459-3464. Acknowledgements South Australia Prostate Cancer Clinical Outcomes Collaborative, Kim Moretti, Carole Pinnock, Tina Kopsaftis, Scott Walsh. Poster presentation sponsor