To evaluate how accurate a 12-core transrectal biopsy derived low-risk prostate cancer diagnosis is for an active surveillance programme by comparing the histological outcome with that from confirmatory transperineal sector biopsy.
The cohort included 166 men diagnosed with low volume Gleason score 3+3 prostate cancer on initial transrectal biopsy who also underwent a confirmatory biopsy. Both biopsy techniques were performed according to standard protocols and samples were taken for histopathology analysis. Subgroup analysis was performed according to disease severity at baseline to determine possible disease parameters of upgrading at confirmatory biopsy.
After confirmatory biopsy, 34% demonstrated Gleason score upgrade, out of which 25% were Gleason score 3+4 and 8.5% primary Gleason pattern 4. Results remained consistent for the subgroup analysis and a weak positive association, but not statistically significant, between prostate specific antigen (PSA), age, and percentage of positive cores, and PCa upgrading at confirmatory biopsy was found.
In our single centre study, we found that one-third of patients had higher Gleason score at confirmatory biopsy. Furthermore 8.5% of these upgraders had a primary Gleason pattern 4. Our results together with previously published evidence highlight the need for the revision of current guidelines in prostate cancer diagnosis for the selection of men for active surveillance.
Ecancermedicalscience. 2016 Apr 14*** epublish ***
Cecilia Bosco, Gabriele Cozzi, Janette Kinsella, Roberto Bianchi, Peter Acher, Benjamin Challacombe, Rick Popert, Christian Brown, Gincy George, Mieke Van Hemelrijck, Declan Cahill
King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK., European Institute of Urology, Division of Urology, Milan, Italy., Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK., Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK., Southend University Hospital NHS Foundation Trust, Southend SS0 0RY, UK., Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK., Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK., King's College Hospital NHS Foundation Trust, London SE5 9RS, UK., King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK; Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK., King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK., Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK.