Objective      To investigate the  predictive factors of postoperative upgrading of Gleason score by assessment of discrepancy between preoperative biopsy Gleason score (bGS) and Gleason score after radical prostatectomy in the patients with prostate cancer. Methods       This study comprised a retrospective analysis of 123 patients who underwent radical prostatectomy after diagnosed with low and intermediate risk prostate cancers proved by transrectal ultrasonography (TRUS)guided prostate biopsy in our hospital from January 2005 to May 2016. Correlation analysis was performed between postoperative upgraded Gleason score and preoperative parameters including age

total prostate specific antigen (tPSA) and ratio of free to total PSA (fPSA/tPSA)

prostate volume

prostate specific antigen density (PSAD)

ratio of positive to total number of biopsy cores taken

positive margin rate (%)

bGS and clinical stage. Results           Sixty-six out of 123 patients (53.7%) had consistent Gleason score assessed by preoperative biopsy and postoperative radical prostatectomy. The Gleason score was downgraded in 10 patients (8.1%) and upgraded in 47 patients (38.2%) after radical prostatectomy. The prostate volume

PSAD and bGS were significantly correlated with the upgrading of Gleason score after operation (P0.05). However

only PSAD (P=0.01) and bGS (P=0.03) were independent predictors of Gleason score upgrading revealed by logistic regression analysis. Furthermore

analysis of receiver operating characteristic (ROC) curve showed that in the patients having bGS of 7 and PSAD0.282 ng/(mL·g）

the possibility of Gleason score upgrading was increased associated with clinical significance (sensitivity 78.2%

specificity 70.4%). Likewise

in the patients with bGS≤6 and PSAD0.265 ng/(mL·g）

clinically upgrading of Gleason score was strongly possible (sensitivity 77.1%

specificity 68.0%). Conclusion      PSAD and bGS are independent predictors of Gleason score upgrading after radical prostatectomy. PSAD is closely related with upgrading of Gleason score after operation. Taking consideration of PSAD and biopsy Gleason score together may contribute to more accurate treatment decisions for patients with prostate cancer.