Is an Extended Prostate Biopsy Scheme Associated with an Improvement in the Accuracy Between the Biopsy Gleason Score and Radical Prostatectomy Pathology? A Multivariate Analysis - Beyond the Abstract

Prostate cancer (PCa) is the most common malignancy in elderly males in Europe and in the USA (1,2). New imaging modalities have provided useful information in the management of patients with PCa. For example the multiparametric magnetic resonance imaging (mpMRI) of the prostate and subsequent TRUS-targeted biopsies of possible suspicious gland sites. It can be very helpful in special cases (for example constant increase of PSA levels, negative DRE findings and prior negative sets of prostate biopsy) to achieve the optimal therapy-option. (3)

The incidence in Northern and Western Europe is over 200 / 100,000, and the rate of the newly detected PCa is continuously increasing.  (1) The PCa screening is one of the most controversial topics of the urological field. Pathological digital rectal examination (DRE) and prostate-specific antigen (PSA) levels give suspect of PCa. The exact diagnosis and the decision of the further PCa-therapy depend on the histopathological verification of an adenocarcinoma in prostate biopsy (PB) samples or operative specimens. The management of patients receiving a non-operative therapy (for example high intensity focused ultrasound (HIFU) or brachytherapy alone) depends on the PSA value and greatly on the PB Gleason Score (GS). (4) Patients, who had general sextant prostate biopsy, have up to a 1-in-3 chance to have a significant upgrading (SU) in the final pathological report.  (5,6)

Recent clinical study has investigated whether an extended PB scheme is associated with an improvement in the accuracy between the PB GS and radical prostatectomy (RP) pathology. Over and above it tried to identify probable preoperative variables that stratified patients likely to harbor SU.

The data of the five hundred and thirty-eight patients diagnosed with PCa, who underwent RP and exhibited a SU were retrospectively reviewed. The patients were divided into 3 groups: Group-A, who underwent a 6-core (lateral) PB (36%), Group-B who underwent a 12-core (lateral-medial) PB (28.9%) and Group-C (34.9%) who underwent an 18-core (lateral-mediolateral-medial) PB. 

The interpretational bias of the pathologists is a very sensitive and complex issue. The exact interpretation of the biopsy specimen requires a deep experience. That is why all PB cores were analyzed by a highly experienced single pathologist. A multivariate analysis was conducted (PSA level, clinical T-Stage, volume of the prostate gland and duration from PB to RP). 

The conclusion of the study is that an extended prostate biopsy scheme is associated with a significant improvement in the accuracy between the PB GS and RP pathology.  Prostate volume >35 ml in patients who undergo a 6- or 12-core prostate biopsy is the only preoperative variable that stratifies patients likely to harbor SU.

Written by: 
Sandor Poth MD, Department of Urology, Malteser Kliniken Rhein Ruhr, Krefeld, Germany
Vahudin Zugor PD MD, Department of Urology, University Hospital of Cologne, Cologne, Germany

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