BERKELEY, CA (UroToday.com) - Several studies have demonstrated that a Gleason score determined by biopsy is notably inaccurate when predicting the Gleason grading compared to the prostatectomy specimen. This discordance is related to the fact that prostate cancer is multifocal, with a heterogeneous population of tumour cells, and has a significant impact on treatment decisions, particularly when the choice of treatment is between active surveillance and curative therapy.
It is understandable to think that more biopsies will increase the concordance between the biopsy specimen when compared with the surgical pathological specimen. It makes sense to believe that the greater the number of cylinders extracted, the greater the probability of there being concordance.
However, in our study the Gleason correlation values were not improved when 12 or more cores were collected and the concordance rate reached a plateau phase. In spite of not finding other studies giving results reaching this phase, the European Association of Urology’s 2011 guidelines recommended reducing the number of cores obtained compared to the guidelines of 2008.
All this suggests that a change in currently available prostate diagnostic tools is necessary, such as using < 12-core transrectal ultrasound-guided prostate needle biopsy and promoting the use of magnetic resonance imaging (MRI) to detect prostate cancer, its spread, or even to direct prostate biopsy extraction with or without ultrasound fusion software. Another suggested change would be considering re-biopsying patients one year after diagnosis to reduce the proportion of understaged patients if the urologist suspects undergrading and the proposed treatment for the patient is active surveillance.
Written by:
M. Luisa Nieto Morales, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Diagnostic Imaging Department, Nuestra Señora de Candelaria University Hospital, Carretera del Rosario, 145 Santa Cruz de Tenerife 38010, Spain
Improving the Gleason grading accuracy of transrectal ultrasound-guided biopsy - Abstract
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