Predictive value of prostatic adenocarcinoma after a negative prostate biopsy

Abstract

OBJECTIVE To investigate the predictive value (PV) for all prostate cancers and for clinically significant cancer undiagnosed after a 10‐core biopsy protocol, as the 10‐core transrectal ultrasonography‐guided biopsy is considered the standard technique of prostatic biopsy due to its high rate of detection of prostatic adenocarcinoma. PATIENTS AND METHODS In all, 132 consecutive radical prostatectomy (RP) specimens, with their corresponding 10‐core biopsies, were reviewed. Cases with unilateral core involvement by prostate cancer were retained for study. Morphometric analysis was conducted on the biopsy‐negative hemi‐prostates to determine the PV of the biopsy protocol with respect to the size, position and clinical significance of the lesion. RESULTS In all, 70 resected prostates (RP) had unilateral core involvement by prostate cancer. In 38 cases, there was cancer in the biopsy‐negative hemi‐prostates (group 1); in the remaining 32 the hemi‐prostates were free of cancer (group 2). Group 1 was categorized by morphometric criteria. Specifically, 23 cases had one to eight foci of prostate cancer in the posterior nontransitional zone (NTZ) (group 1a), while 15 had two to six foci of prostate cancer in the transitional zone (TZ), or the anterior horn (AH) of the peripheral zone or the TZ and AH (group 1b). There were two cases with clinically significant prostate cancer in group 1a, and six in group 1b. CONCLUSIONS The PV of a negative five‐core biopsy protocol on a hemi‐prostate is 54% for prostate cancer and 11% for clinically significant prostate cancer. Most clinically significant prostate cancers were in the AH/TZ of the prostate.

Residual Tumor Potentially Left Behind After Local Ablation Therapy in Prostate Adenocarcinoma

“…12 In a recent study a negative 5-core biopsy on 1 side of the gland underdiagnosed prostate carcinoma in 54% and underdiagnosed clinically significant prostate carcinoma in 11% of the hemi-prostates. 1 Most of the clinically significant cancers that were not detected on biopsy were in the anterior horn of the peripheral zone and transition zone.…”

“…1 However, an increasing number of radical prostatectomy specimens have minimal, potentially insignificant cancer, and these men may not have derived optimal benefited from definitive therapy. [2][3][4] Unilateral cryosurgery has recently been proposed and applied as a focal treatment for prostate cancer when on biopsy disease is confined to 1 prostate lobe.…”

Residual Tumor Potentially Left Behind After Local Ablation Therapy in Prostate Adenocarcinoma

“…12 In recent study a negative 5-core biopsy on 1 side of the gland underdiagnosed prostate carcinoma in 54% and underdiag nosed clinically significant prostate carcinoma in 11% of the hemi-prostates. 1 Most of the clinically significant cancers that were not detected on biopsy were in the anterior horn of the peripheral zone and transition zone.…”

Características clínicas e histopatológicas del cáncer de próstata diagnosticado a partir de la tercera biopsia

“…A pesar de ello, existe un porcentaje de tumores que no se diagnostican. En recientes estudios se ha descrito que entre un 10-54% de cánceres de próstata pueden pasar desapercibidos en la primera biopsia 10-11 y de éstos un 11% será clínicamente significativo 12 .…”