The continuing role of fine-needle aspiration of the prostate gland into the 21st century: A tribute to Torsten Löwhagen

Abstract

A brief review of the history of transrectal fine-needle aspiration (FNA) of the prostate gland is reported in this article; the authors'experience of FNA during the last 20 yr is described also. Despite the worldwide acceptance of the thin-needle core approach, the use of transrectal FNA of palpable abnormalities of the prostate still is advocated because it is cheaper, faster, easier to perform, and results in lower morbidity than any other technique so far developed. High sensitivity, specificity, and efficacy account for its reliability. Appropriate training in performing transrectal FNA of the prostate and in interpreting the smears is, of course, essential. Transrectal FNA should be the initial diagnostic procedure for suspected prostatic cancer and will continue to be a useful diagnostic tool in the 21st century.

Does imprint cytology improve the accuracy of transrectal prostate needle biopsy?

“…The Gleason score of our biopsy specimens ranged from 6 to 7 in most cases (54.3%), and from 8 to 9 in others (45.7%); results similar to those of Maksem and Johenning . We agree with Pérez‐Guillermo et al that imprint cytology can easily recognize moderately or poorly differentiated prostate carcinoma . Imprint cytology of prostate core needle biopsy specimens can provide a reasonably accurate Gleason score in the vast majority of prostate carcinomas.…”

“…In recent years, the number of prostate needle biopsies due to elevated prostatic specific antigen (PSA) and/or abnormal findings on digital rectal examination has increased dramatically and resulted in increased detection of prostate cancer in its early stages . Transrectal ultrasound (TRUS)‐guided core needle biopsy of the prostate and histologic examination of the specimens has helped urologists in their diagnosis of prostatic malignancy . An accurate diagnosis made from the initial biopsy specimen helps to prevent repeat biopsies and minimizes false‐negative findings …”

Prostate Biopsy Techniques

“…Considerable concern remains regarding the ability of fi nger-guided FNA to achieve adequate sensitivity, speci fi city, and ef fi cacy for prostate cancer detection in the era of ultrasound-guided biopsies. There is also signi fi cant controversy in interpreting the smears, as to whether FNA is as reliable as core biopsy for grading purposes [ 6,7 ] .…”

α‐Methylacyl‐CoA racemase (AMACR) in fine‐needle aspiration specimens of prostate lesions

“…Despite its advantages like lower costs and a lower frequency of complications, minimal discomfort for patients, and a fast, accurate diagnosis, it is underestimated and underused. 15 Indications for FNA are palpable abnormalities of prostate, abnormal ultrasound findings, elevated serum PSA, unknown primary carcinoma, and evaluation of response to therapy. Guided FNA of lymph nodes is performed in clinical staging of prostate carcinoma.…”