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

Johnstone, Peter A.S.; Rossi, Peter J.; Jani, Ashesh B.; Master, Viraj A.

doi:10.1038/sj.pcan.4500963

Cited by 29 publications

(19 citation statements)

References 48 publications

(49 reference statements)

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“…The results of biopsy do not correlate well with the existence of insignificant cancer in the prostatectomy specimen, and cannot predict the final histological grade, size of tumor, its extracapsular extension, the existence of positive margins, or lymph node involvement [29,30]. As those cancers can be identified only in the postoperative specimen, many patients undergo radical prostatectomy unnecessarily or are included prematurely into the active surveillance group losing a chance for a timely treatment [27,32].Prostate cancer is known for its tremendous histological and biological variability [31][32][33][34][35]. To score both differentiation of cancer cells and their organization into tissue structures of the higher order, such as glands or layers and to classify that variability, the concept of grading was established in tumor pathology.…”

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confidence: 98%

On the relationship between tumor structure and complexity of the spatial distribution of cancer cell nuclei: A fractal geometrical model of prostate carcinoma

et al. 2014

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confidence: 98%

On the relationship between tumor structure and complexity of the spatial distribution of cancer cell nuclei: A fractal geometrical model of prostate carcinoma

et al. 2014

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“…The identification of only a single, or unilateral, focus on traditional sextant or extended 12-core biopsy is not sufficient to exclude contralateral disease and cannot provide reliable, accurate prognostic information. Johnstone et al [15] found that conventional prostate biopsy (6–12 cores) in 11 reported series comprising almost 800 patients with minimal unilateral disease on biopsy was unreliable compared to final pathology. Final pathologic assessment of prostatectomy specimens revealed a maximum tumor volume >10 cc in 3 series, extraprostatic extension in 10.5% of cases, a median positive surgical margin rate of 10.5%, subsequent discovery of Gleason grade 4 disease in 14% of patients, and bilateral disease in almost 80% of cases.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Transperineal Mapping Biopsy Results with Whole-Mount Radical Prostatectomy Pathology in Patients with Localized Prostate Cancer

et al. 2014

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Objective. We sought to evaluate the accuracy of transperineal mapping biopsy (TMB) by comparing it to the pathology specimen of patients who underwent radical prostatectomy (RP) for localized prostate cancer. Methods. From March 2007 to September 2009, 78 men at a single center underwent TMB; 17 of 78 subsequently underwent RP. TMB cores were grouped into four quadrants and matched to data from RP whole-mount slides. Gleason score, tumor location and volume, cross-sectional area, and maximal diameter were measured; sensitivity and specificity were assessed. Results. For the 17 patients who underwent RP, TMB revealed 12 (71%) had biopsy Gleason grades ≥ 3 + 4 and 13 (76%) had bilateral disease. RP specimens showed 14 (82%) had Gleason scores ≥ 3 + 4 and 13 (76%) had bilateral disease. Sensitivity and specificity of TMB for prostate cancer detection were 86% (95% confidence interval [CI] 72%–94%) and 83% (95% CI 62%–95%), respectively. Four quadrants negative for cancer on TMB were positive on prostatectomy, and six positive on TMB were negative on prostatectomy. Conclusion. TMB is a highly invasive procedure that can accurately detect and localize prostate cancer. These findings help establish baseline performance characteristics for TMB and its utility for organ-sparing strategies.

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“…However, it is uncertain to what extent clinically insignificant tumors are being diagnosed and over-treated [22] . Recently several authors reported that most PCs found to be insignificant on biopsy were found to be significant in the subsequent prostatectomy specimen [1,23] .…”

Section: Discussionmentioning

confidence: 99%

“…The discrepancy between minimal disease on biopsy and disease found in the subsequent prostatectomy specimen, in terms of the size and grade of tumor, extracapsular extension or positive margins, has led several authors to dispute the existence of clinically insignificant impalpable tumors of the prostate [1] . Notably, prostate cancers (PCs) do not act predictably and vary between those that are aggressive and lethal and those that are…”

Section: Introductionmentioning

confidence: 99%

Do Clinically Insignificant Tumors of the Prostate Exist?

et al. 2008

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Background: The discrepancy between minimal disease on biopsy and disease found in the subsequent prostatectomy specimen, in terms of the size and grade of tumor, extracapsular extension or positive margins, led several authors to dispute the existence of clinically insignificant impalpable tumors of the prostate. However, considering that prostate-specific antigen (PSA) is an indicator of prostate malignancy and since many impalpable prostatic carcinomas (PCs) are detected by a combination of PSA, transurethral ultrasound and needle biopsy (T1c), in the era of PSA screening, it is expected that most of the impalpable tumors found incidentally at transurethral resection of the prostate (stage T1a/b), could be clinically insignificant. Aim: The aim of this study was to identify the characteristics of latent, impalpable PCs and to analyze the incidence of clinically insignificant PCs among hypothetical stage T1 prostate cancers in tumors found incidentally at postmortem examination. Methods: We examined 40 cases of impalpable PCs found in 212 prostate autopsy specimens of men between 30 and 98 years of age who died of diseases other than carcinoma of the prostate and related conditions. Results: Most of T1 histological PCs (57.5%) had a Gleason score between 2 and 4, while 30% had Gleason score between 5 and 6. Only 5 (12.5%) had a Gleason score above 7. Twenty-nine of 40 stage T1 histological cancers (67.5%) had volume of <1 cm³. The highest volume tumors were those of intermediate and high grade (Gleason sums 5–8). Among tumors with volumes of <1 cm³, 96.55% were confined within the prostatic capsule. Conclusions: The majority of impalpable PCs were low-volume, well-differentiated tumors corresponding to clinically insignificant neoplasms. Similar characteristics could be attributed to most of the impalpable carcinomas detected after prostatectomy in clinical practice.

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

Cited by 29 publications

References 48 publications

On the relationship between tumor structure and complexity of the spatial distribution of cancer cell nuclei: A fractal geometrical model of prostate carcinoma

On the relationship between tumor structure and complexity of the spatial distribution of cancer cell nuclei: A fractal geometrical model of prostate carcinoma

Comparison of Transperineal Mapping Biopsy Results with Whole-Mount Radical Prostatectomy Pathology in Patients with Localized Prostate Cancer

Do Clinically Insignificant Tumors of the Prostate Exist?

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