. 38%; P<0.01). In 233 patients, the biopsy Gleason score did not include 4 or 5 components. Upgrading to 4 or 5 in 1 of the components was noted in 32 patients (14%). Multivariate analysis revealed that upgrading is associated with preoperative serum PSA (odds ratio 1.05; P<0.05) and the percentage of positive cores in the biopsy (odds ratio 1.47; P<0.001).