Understanding pitfalls of grading prostate carcinoma between biopsy and prostatectomy

I enthusiastically read the interesting manuscript by Gansler et al. This is a well-designed study incorporating the largest number of Gleason score (GS) 8 prostate adenocarcinoma (PCa) cases in National Cancer Registry Database (NCDB). Among 72,556 PCa patients, the authors excerpted 5,474 cases with GS8 on biopsy, PSA ≤20 ng/mL and clinical stage cT <3, and compared the GS modifications between the initial needle biopsy (NB) and the subsequent radical prostatectomy (RP).