SUMMARY
Introduction: Differences in Gleason grade in transrectal ultrasonography (TRUS) biopsies and radical prostatectomy (RP) specimens are well documented in literature. Keeping in view the limitations of Gleason grading system, Epstein JI grade group system was introduced. Various other parameters also have a significant role in predicting the pathological stage, extraprostatic extension, status of surgical margins and metastatic disease in regional lymph nodes. RP is performed at limited centres in Pakistan. Till date, no comparison of the histopathological findings in 12-core TRUS and RP specimens had been performed at the national level. Our study is aimed at generating local data in this context. Materials and Methods: This was a crosssectional study and non-probability consecutive sampling was performed. It was conducted at Histopathology Department, Shifa International Hospital, Islamabad, from January 2008 to December 2014. Gleason scores of 20 RP specimens were compared to Gleason scores of TRUS biopsies of same patients. Concordance in Gleason score and grade groups with laterality, perineural invasion was also studied. Results: Out of 20 RP cases, 40% (n = 8) had a Gleason score of 6, 30% (n = 6) had score 7, 20% (n = 4) had score 8 and 15% (n = 3) had score 9. Compared to the TRUS biopsy, RP Gleason score was concordant in 11 cases (55%), higher in 7 cases (35%) and lower in 2 cases (10%). TRUS involvement was unilateral in 10 cases (50%) and bilateral in 10 cases (50%). However, bilateral involvement of RP specimen was seen in 14 cases (70%) and unilateral in 6 cases (30%). Thus, better tumour yield was observed in RP specimens i.e., bilateral involvement in RP specimens was found in additional 5 cases (25%). Perineural involvement was higher in RP specimen i.e., 12 cases (60%), compared to 5 cases (25%) in TRUS biopsies. Its concordance was significantly higher in those with Gleason score of equal to or more than 7 (83%) and low in score less than score 7 (17%). Conclusion: When comparing RP to initial TRUS biopsies, Gleason score was upgraded in 35% and downgraded in 10% of cases. Bilateral involvement in 25% of cases of RP specimens was underestimated as unilateral involvement in TRUS biopsies. Perineural involvement with high Gleason score was also seen.