Jang WS, Koh DH, Kim J, et al. - Researchers examined how downgrading and upgrading from needle biopsy (NB) to radical prostatectomy (RP) influence the prognosis of men with Gleason score (GS) 7 prostate cancer (PC). Reviewing the medical records of 3,003 patients with localized PC who underwent RP, they included 692 patients in this study; among these, 389 (56.2%) and 303 (43.8%) patients had RP GS 3 + 4 = 7 and RP GS 4 + 3 = 7 PC, respectively. On the basis of NB and RP GS, they classified 264 (38.1%), 125 (18.1%), 142 (20.5%), and 161 (23.3%) patients as 3 + 4/3 + 4, 4 + 3/3 + 4, 3 + 4/4 + 3, and 4 + 3/4 + 3, respectively. The multivariate analyses revealed a significant association of these groups with biochemical recurrence (BCR) (4 + 3/3 + 4: HR, 1.675; 3 + 4/4 + 3: HR, 1.908; and 4 + 3/4 + 3: HR, 2.699). Findings thereby suggest an independent predictive value of downgrading and upgrading from NB to RP for BCR in men with GS 7 PC, which could be due to the amount of Gleason pattern 4.