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Mortality Following Prostate Cancer Recurrence After Radical Prostectomy—Reply
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In Reply: Dr Trainer raises questions related to the differences between biopsy-derived and prostatectomy-derived Gleason scores in our study. The pathological specimens, from both biopsy and radical prostatectomy, were read by the same team of pathologists during the entire study period, not by a single pathologist. However, we agree that differences between biopsy and radical prostatectomy grading are well documented.1-2
We believe that the most likely reason is not the pathologist but rather the limited sampling obtained during biopsy in which only a small number of biopsy cores (6 to 12 from contemporary series, fewer in earlier years) are obtained for examination. This provides very limited tissue for examination, and it is not uncommon to miss higher-grade cancer in the biopsy specimen due to this limited sampling. The role of sampling error is further suggested by a recent study that found that obtaining more biopsy cores (more tissue for the . . . [Full Text of this Article]
Stephen J. Freedland, MD
sfreedl1@jhmi.edu
Elizabeth B. Humphreys, BS;
Leslie A. Mangold, MS;
Alan W. Partin, MD, PhD
Department of Urology
Mario Eisenberger, MD
Department of Urology and Oncology
The James Buchanan Brady Urological Institute
The Johns Hopkins Medical Institution
Baltimore, Md
Frederick J. Dorey, PhD
The Biostatistics Core
University of Southern California Keck School of Medicine
Childrens Hospital Los Angeles
Los Angeles
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