Underestimation of Prostate Cancer Grade in Transperineal Fusion Biopsy and Its Predictive Factors…

Cohort studyJournal of clinical medicine· Apr 2026

Underestimation of Prostate Cancer Grade in Transperineal Fusion Biopsy and Its Predictive Factors: Correlation of Biopsy Findings with Post-Da Vinci Radical Prostatectomy Specimens.

Hubert Andrzej Krzepkowski, Tomasz Ząbkowski, Maciej Walędziak … Tomasz Syryło

Genitourinary PathologyCohort studyPrognosisQ2IF 3.5

Prostate biopsy underestimated tumor grade in nearly 30% of patients

Underestimation of Prostate Cancer Grade in Transperineal Fusion Biopsy and Its Predictive Factors: Correlation of Biopsy Findings with Post-Da Vinci Radical Prostatectomy Specimens.

Hubert Andrzej Krzepkowski … Tomasz Syryło

Journal of clinical medicine · Apr 2026 · Q2 in General Medicine

Background

An accurate preoperative assessment of prostate cancer malignancy is crucial for risk stratification and selection of the optimal treatment strategy.

Purpose

This study assessed the concordance of Gleason scores between MRI-TRUS fusion biopsy and radical prostatectomy specimens, and identified clinical and histopathological factors associated with post-procedural Gleason score upgrading.

Methods

This retrospective analysis involved patients who underwent transperineal MRI-TRUS fusion biopsy followed by radical prostatectomy from 2020 to 2025.

n = 603 patients

Results

prostate cancer turned out more aggressive than the biopsy suggested

53.1%

Concordance

29.9%

Upgrading

17.1%

Downgrading

More results

Higher Gleason scores on biopsy were independently associated with a lower risk of upgrading in the entire cohort and in both PSA subgroups.

Larger tumor extent on biopsy was associated with a lower risk of upgrading, with heterogeneous dependencies between prostate lobes.

More results

The other clinical parameters showed no independent association with upgrading.

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Conclusion · 1 of 2

Gleason score upgrading remains common after radical prostatectomy.

Conclusion · 2 of 2

The risk of this progression is primarily related to the histopathological features of the biopsy rather than to baseline clinical parameters, reflecting the limitations of biopsy as a sampling method and the biological heterogeneity of prostate cancer.

Underestimation of Prostate Cancer Grade in Transperineal Fusion Biopsy and Its Predictive Factors: Correlation of Biopsy Findings with Post-Da Vinci Radical Prostatectomy Specimens.

Underestimation of Prostate Cancer Grade in Transperineal Fusion Biopsy and Its Predictive Factors: Correlation of Biopsy Findings with Post-Da Vinci Radical Prostatectomy Specimens.

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