A single positive prostate biopsy in six does not predict a low‐volume prostate tumour

Abstract

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.

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

“…2) suggested that approximately 12% of men with small-volume disease had positive surgical margins at radical prostatectomy (risk, 11.7%; 95% confidence interval, 8.3%-16.3%). Even when the definition was restricted further by a maximum Gleason score of 6, the proportion of patients with EPE ranged between 4% and 45% (median, 14%) 22,25,33 and between 7% 25 and 9% 22 of patients had positive margins.…”

‘Insignificant’ prostate cancer on biopsy: pathologic results from subsequent radical prostatectomy

“…We retrieved citations discussing histopathologic correlates of the subsequent RP specimen in patients undergoing surgery for 'insignificant' CaP on biopsy [2][3][4]11,[15][16][17][18][19] (Table 1). Definitions of 'insignificance' on biopsy varied between citations, from disease involving a single core 18 to disease of o0.5 mm total core length of Gleason sum p6. 17 Specific note was made of ultimate tumor volume within the gland in these cases as well as extracapsular extension (ECE) and frequency of positive surgical margins on subsequent RP specimens.…”

“…[14][15][16][17][18][19][20][21] These are the circumstances when decisions are made by physicians and patients with respect to therapy -specifically low risk therapy in many cases. If the construct of 'insignificance' on biopsy is not borne out on subsequent histopathologic examination, then low-risk therapy is less appropriate an option.…”

Screening for Prostate Cancer - More Questions than Answers

“…This ratio, however, was reduced to 10% by taking a second set of sextant biopsies. Ravery et al stressed the fact that a single positive biopsy in six does not predict a low-volume prostate cancer on an individual basis (138). Twenty-four radical prostatectomies were performed for prostate cancer detected with one positive biopsy out of six.…”