Objective To evaluate whether a single positive prostate biopsy in six systematic transrectal ultrasonography (TRUS)‐guided biopsies is predictive of a small tumour volume in a subsequent radical prostatectomy (RP) specimen.
Patients and methods Of 158 patients submitted to RP for T1–T2 prostate cancer, 15.2% had one positive biopsy. The rate of positive margins (M+) and extracapsular involvement (C+) were assessed on the RP specimen in those with one positive biopsy (group I) and in those diagnosed by more than one positive biopsy (group II). The percentage of those with post‐operative biological progression (P+), having a prostate‐specific antigen (PSA) level>0.1 ng/mL, was evaluated in both groups. The Gleason scores in biopsies and specimens were also compared. Fifteen patients diagnosed by a single positive biopsy were management conservatively.
Results The percentage of patients who were categorized C+, M+ and P+ was 29.2, 16.7 and 26% in group I and 70, 46.5 and 49.5%, respectively, in group II. All patients with <10% of the biopsy core length invaded by cancer had intracapsular (P2) disease, whereas if all the core length was invaded by tumour, all patients had extracapsular (P3) disease. The Gleason scores for biopsy cores and whole specimens were identical in 38.7% of the cases; the Gleason score was underestimated on biopsy in 48.4% of cases. In the group treated conservatively, nine of 15 patients were in biological progression, with a mean follow‐up of 22 months.
Conclusion A single positive needle‐biopsy in six systematic TRUS‐guided prostate biopsies is not predictive of low‐volume prostate cancer on an individual basis and does not guarantee a favourable outcome after RP.
To evaluate retrospectively the ef®cacy of adjuvant radiation therapy (ART) in patients with T1 ± T2 prostate cancer (CaP) in whom extracapsular cancer (pT3) was detected after radical prostatectomy (RP), together with biochemical failure characterized by a recurrent level of serum prostate-speci®c antigen (PSA) b 0.1 ngamL.Twenty-two patients with T1 ± T2 CaP treated by RP who subsequently were found to have pT3 CaP with (13) or without (9) positive surgical margins andaor seminal vesicle invasion, exhibited biochemical failure characterized by a recurrent level of serum PSA, 2 ± 40 (mean: 25) months after RP and were treated with ART (65 Gy). Bone and CT scans were negative in every patient, 15 of whom were submitted to TRUS biopsy (Bx) of the anastomosis (resection site), which was positive in 8. Patients were followed up for between 6 and 60 (mean: 32.5) months.Transient side effects (urgency, proctitis, diarrhea) were experienced by 9 patients after ART. A decrease in serum PSA was observed in 19 patients; however, only 14 of these achieved an undetectable level (`0.1 ngamL) on one or more occasions after completion of ART (in 12 cases this was after 3 months). Of the 14 patients, 8 achieved a persistently unmeasurable PSA level at a mean follow-up of 20.4 (range: 9 ± 48) months. There was no difference between patients in whom an undetectable level of serum PSA was attained and those in whom it was not, with regard to specimen pathology, PSA doubling time, timing of ART, and the result of Bx. Patients who achieved an undetectable PSA had a lower mean PSA at the time of ART (1.1 vs 2.9 ngamL, P`0.05) and a lower preoperative mean PSA.Although ART for biochemical failure after RP may lead to undetectable PSA levels in a signi®cant proportion of patients for a signi®cant period of time, a longer follow-up shows that such unmeasurable levels persist in only 36.4% of such patients.
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