Histopathological findings in extended prostate biopsy with PSA ≤ 4 ng/mL

Abstract

Objective: Cancer detection has been reported in up to 27% of patients when lowering the PSA cutoff to 2.5 ng/mL. Although this practice could increase the number of biopsies performed, it also could lead to more frequent detection of significant prostate cancers at an organ-confined stage and/or a less aggressive state. This study describes the incidence of malignancy and tumor characteristics in extended prostate biopsies with PSA ≤ 4 ng/mL. Materials and Methods: Prostate biopsies from 1081 patients where examined, 275 (25.4%) patients had PSA level ≤ 4 ng/mL. Results: Cancer was diagnosed in 32.0% and 35.7% of patients with PSA ≤ 4 ng/mL and > 4 ng/mL, respectively (p = 0.906). The median Gleason score was 7 independent of PSA > or ≤ 4 ng/mL (p = 0.078). The median number of cores positive for tumor was 4 and 3, respectively, for PSA > 4 ng/mL and PSA ≤ 4 ng/mL (p = 0.627). There was a difference in the total percent of tumors involving all cores, 11% and 7% for PSA > or ≤ 4 ng/mL (p = 0.042). Fifty-six patients underwent radical prostatectomy, 12 had PSA ≤ 4 ng/mL. In both groups, a diagnosis of cancer was accurate with no differences in Gleason score, tumor volume or staging for both groups. Conclusion: When PSA is below 4 ng/mL, cancer is detected in a proportion equal to the proportion diagnosed with a PSA > 4 ng/mL, and tumor characteristics are similar between the two groups. Only clinically significant tumors were diagnosed following radical prostatectomy.

Undergrading and understaging in patients with clinically insignificant prostate cancer who underwent radical prostatectomy

“…A study evaluating surgical specimens of patients with PSA less than 4.0 ng/mL revealed extra-prostatic extension or positive margin in 8.3% of cases (13). Likewise, Geary et al (7) found positive surgical margins in 13% of non palpable tumors with PSA between 4 and 10 ng/mL.…”

The incidence of prostate carcinoma on repeated biopsy detected after an initial diagnosis of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation

“…1 U dijagnostici i tretmanu pacijenata sa AP, zadnjih godina veliki značaj se posvećuje premalignim lezijama prostate, zbog njihovog visoko prediktivnog značaja, za nastanak AP, udruženosti sa AP, kao i velikih histopatoloških diferencijalno dijagnostičkih problema u distinkciji sa AP. 4,5,6 Dve najznačajnije moguće premaligne lezije prostate su prostatična intraepitelna neoplazija (PIN) i atipična sitno acinarna proliferacija (ASAP) koja se označava i kao "atipične žlezde suspektne na karcinom". 6,7 PIN se definiše kao "premaligna proliferacija atipičnih duktalnih i acinarnih ćelija".…”

“…Podaci u literaturi ukazuju da detekcija AP na ponovnim biopsijama variara od 21% do 51%, kod pacijenata sa ASAP. 3,4,7,9 Retko su VSPIN i ASAP topografski susedi i nalaz istovremeno obe lezije jedne uz drugu, u biopsijskom uzorku prostate se definiše kao fokalni VSPIN/ASAP. Referisana učestalost ove kombinovane lezije je 1% do 4,4%.…”

“…Prema podacima u literaturi visina detekcije AP na ponovnoj biopsiji se kreće od 21% do 51%, i preporučuju se subsekventne biopsije u lokacijama gde je ASAP bio nađen. 3,4,7,9 U našem materijalu je od 55 sl rebiopsije sa inicijalnom dijagnozom VSPIN ili ASAP, AP je nađen u 26 sl. (47,3 %), što je saglasno podacima u literaturi.…”

What is the fate of repeat biopsies after diagnosis of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation?

“…The clinical importance of ASAP is its high predictive value for Prostate carcinoma (PCa) in subsequent biopsies. It has been reported that the cancer detection rate varies between 21% and 51% on the second biopsy in patients with ASAP (Borboroglu et al, 2000;Leite et al, 2008).…”