The Prognostic Significance of Post-Irradiation Biopsy Results in Patients with Prostatic Cancer

Abstract

To evaluate the prognostic significance of post-irradiation biopsy results in patients with prostatic cancer, we reviewed the records of 803 patients who had been treated with pelvic lymph node dissection, radioactive gold seed implantation and external beam irradiation. Of the patients 124 had 1 or more biopsies within 6 to 36 months after completion of radiotherapy when there was no evidence of local or distant recurrence of tumor. Patients were followed for a mean of 64 months (range 14 to 175 months) and received no other therapy before relapse. Over-all, 43 of these patients (35 per cent) had a positive biopsy result. The incidence of positive biopsy results correlated directly with the initial stage of the tumor, ranging from 22 per cent of stage B1N to 50 per cent of stage C1 lesions. However, biopsy results did not correlate with the grade of the tumor. Local recurrence and distant metastases were much more common among patients with a positive biopsy result (p equals 0.0006). Local recurrence developed in 58 per cent of the patients with a positive biopsy by 5 years and in 82 per cent by 10 years. Of those in whom all biopsies were negative only 18 per cent had local recurrence by 5 years and 32 per cent by 10 years. Biopsy results retained their prognostic significance even among the more favorable subset of patients whose pelvic lymph nodes were negative initially and those with a normal prostatic examination at biopsy. These results indicate that a post-irradiation prostate biopsy 6 to 36 months after completion of treatment can be used to determine the efficacy of a particular radiotherapeutic regimen as well as the success or failure of radiotherapy in an individual patient.

Treatment of Localized Prostatic Carcinoma Using the Transrectal Ultrasound Guided Transperineal Implantation Technique

“…Scardino has shown a local tumor recurrence of 45% 'hen post-treatment (Gold 198 + external radiotherapy) iopsies were positive, compared to 11 % when biopsies ere negative [24]. Unfortunately the relationship beveen biopsy findings and the incidence of distant metasjses in his pNO group was not further evaluated.…”

Radical Perineal vs. Retropubic Prostatectomy: A Review of Optimal Application and Technical Considerations in the Utilization of These Exposures

“…Scardino et al [20], as well as others, documented the adverse prognostic outcome associated with postradiation positive biopsies. Lee et al [21] demonstrated that pros tatic ultrasonography can be used to guide biopsies in patients who have previously undergone interstitial brachytherapy for management of localized prostate cancer.…”

Management of radiation failure for localized prostate cancer

“…About 20% of patients with positive postradiation prostate biopsies have no evidence of disease at 10 y follow-up. 7,31 Undoubtedly, some positive biopsies may detect clinically latent cancers. Equally important is the almost 30% incidence of local and distant recurrences occurring in those with negative postradiation biopsies.…”