Comparison of Gleason Scores from Sextant Prostate Biopsies and Radical Prostatectomy Specimens

Altay, Barış; Kefi, Aykut; Nazlı, Oktay; Killi, Refik; Semerci, Bülent; Akar, İlker

doi:10.1159/000050937

Cited by 15 publications

(10 citation statements)

References 22 publications

(16 reference statements)

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“…Smaller lesions are less likely to be detected and would also have lower likelihood of clinical signifi cance [ 22 -24 ] . This has been reported previously, though it was noted to be dependent on the biopsy scheme [ 15,16,25,26 ] . While it is conceivable that treating the DV only by focal therapy is suffi cient for good outcomes, it is equally likely the small DG lesions, which are more frequently missed, are inevitably responsible for prostate cancer morbidity and mortality.…”

Section: Discussionsupporting

confidence: 72%

“…consistently low levels of accuracy that did not exceed those found in our study [ 3,8,11,12,20,21,25,26 ] . A previous study reported that increasing the number of cores taken per biopsy increases the detection rate of prostate cancer [ 25 ] .…”

Section: Discussioncontrasting

confidence: 54%

“…Interestingly, we were unable to identify any diagnostic, clinical or pathological factors that were significantly associated with better DG identification. Various biopsy schemes have been evaluated, all with consistently low levels of accuracy that did not exceed those found in our study [3,8,11,12,20,21,25,26]. A previous study reported that increasing the number of cores taken per biopsy increases the detection rate of prostate cancer [25].…”

Section: Discussionmentioning

confidence: 41%

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Transrectal ultrasonography‐guided biopsy does not reliably identify dominant cancer location in men with low‐risk prostate cancer

Washington¹,

Bonham

Whitson³

et al. 2011

BJU International

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What ' s known on the subject? and What does the study add?The widespread use of serum PSA testing followed by TRUS-guided biopsy have resulted in profound prostate cancer stage migration with many patients presenting with focal rather than multifocal disease. There is increasing interest in the use of focal rather than whole-gland treatment. However, current biopsy schemes may still miss cancer or, even when cancer is identifi ed, its extent or grade might not be accurately characterized. In order for focal therapy to be effective, the area of highest tumour volume and/or grade needs to localized accurately. The aim of this study was to assess how well biopsy, as currently performed, locates the focus of highest prostate cancer volume and/or grade. OBJECTIVE• To evaluate the ability of transrectal ultrasonography (TRUS)-guided extended core biopsy to identify the dominant tumour accurately in men with early stage prostate cancer. PATIENTS AND METHODS• Patients with early stage, low-risk prostate cancer who subsequently underwent radical prostatectomy (RP) and had complete surgical specimens were identifi ed.• Re-review was performed by a single uropathologist using ImageJ software to identify tumour location, dominant grade (DG) and dominant volume (DV).• Pathology fi ndings were then compared with biopsy results. RESULTS• A total of 51 men with early stage, low-risk prostate cancer, who had undergone RP, had complete specimens for review and a median of 15 biopsy cores taken for diagnosis and grading.• Sixteen men had a single diagnostic biopsy, 21 had one repeat biopsy, and 14 had two or more repeat biopsies.• Compared with surgical fi ndings, biopsy correctly identifi ed the sextant with the largest tumour volume in 55% (95% CI 0.5 -0.6) of specimens and the highest grade in 37% (95 CI 0.3 -0.5).• No demographic or clinical factors were signifi cantly associated with identifi cation of DG. Interval between last biopsy and RP, total tissue length taken and total length of tumour identifi ed were signifi cantly associated with correct identifi cation of DV. CONCLUSIONS• Our fi ndings show that TRUS-guided biopsy detects and localizes DV better than it does DG.• Even with an extended scheme, TRUS-guided biopsy does not reliably identify dominant cancer location in this low-risk cohort of men with early stage prostate cancer.• TRUS-guided biopsy may perform better in similar men with low stage, but higher volume disease. KEYWORDShumans , male , prostatic neoplasms/ pathology , prostatic neoplasms/surgery Study Type -Diagnostic (exploratory cohort) Level of Evidence 2b

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Section: Discussionsupporting

confidence: 72%

Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 41%

See 1 more Smart Citation

Transrectal ultrasonography‐guided biopsy does not reliably identify dominant cancer location in men with low‐risk prostate cancer

Washington¹,

Bonham

Whitson³

et al. 2011

BJU International

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show abstract

“…In fact, various studies have recently reported that the Gleason score of biopsy specimens was identical to the score of prostatectomy specimens in less than 50% of cases examined [14,15]. This discordance may possibly explained by several factors, such as pathological interpretation bias and different procedure of systematic biopsy.…”

Section: Discussionmentioning

confidence: 98%

Predicting the Extent of Prostate Cancer Using a Combination of Serum Prostate-Specific Antigen-Alpha<sub>1</sub>-Antichymotrypsin Complex and Systematic Biopsy

Hara¹,

Yamanaka²,

Ono³

et al. 2002

Urol Int

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Objective: The objective of the present study was to evaluate the usefulness of the combined systematic biopsy with serum prostate-specific antigen-α₁-antichymotrypsin complex (PSA-ACT) level to predict the extent of prostate cancer. Materials and Methods: Sixty-two patients with clinically organ-confined disease who underwent radical prostatectomy were evaluated for serum PSA and PSA-ACT levels, systematic biopsy, and the pathological stage. Results: The incidence of extraprostatic disease in patients with more than half the biopsy cores positive or ≧8 ng/ml PSA-ACT was significantly higher than those with less than half positive or <8 ng/ml PSA-ACT, respectively, whereas cancer in bilateral lobes or ≧10 ng/ml PSA could not be used as a predictor of extraprostatic disease. Furthermore, in those with more than half the biopsy cores positive and ≧8 ng/ml PSA-ACT or those with more than half the biopsy cores positive and ≧10 ng/ml PSA, extraprostatic disease was significantly more common than in those with less than half positive and <8 ng/ml PSA-ACT or those with less than half positive and <10 ng/ml PSA, respectively. However, the incidence of extraprostatic disease predicted by these three variables was not significantly better than those by the two variables (percentage positive biopsy cores plus serum PSA-ACT or PSA). Conclusions: The combined systematic biopsy with serum PSA-ACT or PSA could be used as a useful predictor for the extent of prostate cancer. Patients with more than half the biopsy cores positive and ≧8 ng/ml PSA-ACT or ≧10 ng/ml PSA could avoid a prostatectomy because there is a high probability that they have extraprostatic disease.

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“…The Gleason score combined with the determination of serum PSA and the findings of the standard digital prostate exam can predict the tumor stage and the occurrence of lymph node metastasis (Landis,1977). However, studies have shown discrepancies between biopsy score and score of tissue specimens submitted to anatomopathological analysis following radical prostatectomy (Altay, 2001;Gregori, 2001;Prost,2001). The under-estimation of the Gleason score after a biopsy is a common occurrence in patients with prostate adenocarcinoma, with rates reported in the literature ranging from 32.4 to 46.6% (Tavangar, 2004;Montesino,2004).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factor of Prostate Adenocarcinoma before and after Radical Prostatectomy at a University Hospital

Junior¹

2015

ijSciences

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Abstract:Introduction: Gleason score is a prognostic factor that assists in the determination of treatment for prostate cancer. The aim of the present study was to investigate the prognostic factor of prostate adenocarcinoma related to the Gleason score before (biopsy) and after radical prostatectomy (RP). Methods: A total of 206 patients with localized prostate adenocarcinoma submitted to RP between 2001 and 2008 at a university hospital were analyzed. Results: The predominant total Gleason score was 6 after biopsy and 7 following RP. The 3+3 pattern after biopsy and 3+4 pattern after RP. Biochemical recurrence was found following RP in 34.9% of cases. In 49% of cases, the Gleason score was lower after biopsy than after RP (p < 0.0005). Considering the group with biochemical recurrence, disagreement was found between the Gleason scores after biopsy and post-radical prostatectomy among 68% of the patients and the Gleason score was lower after biopsy than after post-radical prostatectomy in 18.4% (p = 0.62). Conclusions: The correlation between the Gleason score during prostate biopsy and the score of the specimen submitted to anatomopatological analysis following RP was an important prognostic factor of prostate adenocarcinoma before and after RP and should be considered when choosing the treatment approach. Keywords: adenocarcinoma, prostatic neoplasms, prognosis, prostatectomy IntroductionProstate adenocarcinoma is the second most frequent malignant tumor in men. It is considered cancer of senior citizens, as three quarters of cases occur at the age of 65 years or older. In Brazil, the increase in the incidence of prostate adenocarcinoma, with an estimated 52,350 new cases in 2010, may be partially explained by advancements in diagnostic methods and improvements in the quality of information systems (Brasil, 2010).

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Comparison of Gleason Scores from Sextant Prostate Biopsies and Radical Prostatectomy Specimens

Cited by 15 publications

References 22 publications

Transrectal ultrasonography‐guided biopsy does not reliably identify dominant cancer location in men with low‐risk prostate cancer

Transrectal ultrasonography‐guided biopsy does not reliably identify dominant cancer location in men with low‐risk prostate cancer

Predicting the Extent of Prostate Cancer Using a Combination of Serum Prostate-Specific Antigen-Alpha<sub>1</sub>-Antichymotrypsin Complex and Systematic Biopsy

Prognostic Factor of Prostate Adenocarcinoma before and after Radical Prostatectomy at a University Hospital

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