Accuracy of transrectal ultrasound guided prostate biopsy: Histopathological correlation to matched prostatectomy specimens

Abstract

Background : The Gleason grading system is currently the world's most commonly used histological system for prostate cancer. It provides significant information about the prognosis. Therefore, Gleason score is accepted as an important factor in therapeutic decision-making for prostate cancer. This retrospective study assessed the correlation of transrectal ultrasound (TRUS) guided biopsy and radical prostatectomy specimens in terms of Gleason scores. Methods : We reviewed the records of 103 patients who underwent radical prostatectomy due to clinically localized prostate cancer. The Gleason scores of the TRUS biopsies were compared with the respective Gleason scores of surgical specimen.Results : In 28.7% of cases, the TRUS biopsy score was the same as that of the radical prostatectomy specimen. The most significant discordance was the upgrading of well-differentiated tumors after surgery in 71.7% of cases. However, in 81.8% of cases with high Gleason score on TRUS, biopsy was correlated with poorly differentiated tumor after surgery. Conclusions : Well-differentiated tumors on TRUS biopsy did not correlate with the grades of final pathology in the majority of cases; however, a high Gleason score on TRUS biopsy usually indicated a poorly differentiated tumor on prostatectomy specimen. Therefore, the treatment algorithms for particularly well-differentiated tumors should not be deduced from biopsy histology alone.

External validation and comparison of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology in two patient populations: a retrospective cohort study

“…A discordance in GS between biopsy and RP pathology has been reported by several recent studies (7)(8)(9)(10). In the present study, the rate of discordance was 36.7% (158 patients) in the combined datasets, which showed a smaller difference than the previous studies (4,11).…”

“…Transrectal ultrasound (TRUS)-guided sextant or systematic prostate biopsy is the clinical standard for definitive diagnosis of prostate cancer (3). The Gleason sum (GS) derived from such biopsy specimens is crucial for appropriate treatment selection and is an independent prognostic factor for progression Several nomograms for predicting the probability of GS upgrading between biopsy and RP pathology have been developed, because many clinicians would like to know the probability before choosing treatment for patients with prostate cancer (9)(10)(11)(12). However, some nomograms consisted of routinely unavailable clinical variables, and they demonstrated lower predictive accuracy and poor calibration on external validation (13).…”

Computer-aided Detection of Prostate Cancer with MRI

“…In addition, the biopsy, which samples a small portion of the prostate, might not represent the whole gland efficiently. Traditionally, it is believed that Gleason score in systematic random TRUS-guided biopsy tends to downgrade the surgical specimen, because a less differentiated pattern may not have been sampled in the biopsy [169, 170]. Systematic random TRUS-guided biopsies often require repeated biopsy procedures, which are associated with discomfort and potential morbidity [171].…”

Biopsies Performed at Tertiary Care Centers are Superior to Referral Biopsies in Predicting Pathologic Gleason Sum

“…[1][2][3][4] Previous reports suggest that up to 43% of men with lowgrade prostate cancer (PCa) at biopsy will receive a diagnosis of high-grade PCa at RP. [5][6][7][8] Pathologic Gleason sum represents a better predictor of biochemical recurrence (BCR) than biopsy Gleason sum. 9,10 A high RP Gleason sum is associated with a higher rate of postoperative BCR and worse PCa-specific survival.…”