Diagnostic accuracy of prostate needle biopsy

The introduction of prostate-specific antigen screening has resulted in stage migration and an increased incidence of localized prostate cancer. In this era of increasing nonpalpable disease, it has become necessary to systematically sample the entire prostate gland. Transrectal ultrasound-guided prostate biopsy procedures have evolved greatly over the past decade from the original sextant biopsy. Technological advances, better understanding of zonal anatomy of the prostate, whole mount sectioning of radical prostatectomy specimens, and computer modeling of localized prostate cancers have all led to extended biopsy core protocols directed at the lateral zones of the gland. These have increased the diagnostic accuracy of needle biopsy and have become a standard regimen. However, it remains controversial how to proceed with repeat biopsy in the face of an initial benign diagnosis, and optimal biopsy strategy remains undefined. It is hoped that quantitative analysis of prostate biopsy histology may eventually provide some prognostic information to guide the patient and urologist in preoperative planning.     

Core biopsy instrument in the diagnosis of prostate cancer: superior accuracy to fine needle aspiration

The recent availability of an automated core biopsy gun has made the performance of core biopsies of the prostate easier and better tolerated. A prospective study was conducted to compare the efficacy of fine needle aspiration to core biopsy with the gun. Among 94 patients subjected to both biopsy techniques at the same visit 30 (32%) had a positive diagnosis of prostate cancer. Core biopsy was positive in these 30 patients (100%), while fine needle aspiration was positive in 21 (70%). This study suggests that core biopsy with the gun is superior to fine needle aspiration in the diagnosis of prostate cancer.     

前列腺穿刺对前列腺癌磁共振影像分期的影响

目的　了解磁共振影像 (MRI)检查前近期行前列腺穿刺对前列腺癌MRI分期的影响。　方法　对 10例高度怀疑前列腺癌拟行穿刺检查的患者 ,穿刺前和穿刺后 1周分别行MRI检查 ,比较穿刺前后MRI临床分期结果。　结果　患者穿刺前MRI分期均为B期 ,穿刺后 6～ 8d(平均 7d)MRI分期除 1例因前列腺外周带界限不清确切分期困难外 (B～C) ,9例均为C期 ,前列腺穿刺后近期由于穿刺局部出血 ,MRI分期较穿刺前高。　结论　前列腺穿刺后 1周内行MRI ,穿刺部位的出血可影响前列腺癌手术前的临床分期 ,对临床上可疑而拟行前列腺穿刺的患者 ,应先行影像学检查 ,以免影响前列腺癌手术前的准确分期。     

How reliable is cancer diagnosis with needle biopsy of the prostate?

Aim of the study was to investigate the reproducibility and the reliability of the morphological diagnosis, of different morphological parameters and representativity of needle biopsy material compared with transurethral resection material. 416 needle biopsies of carcinomas of the prostate were studied by 5 pathologists. 130 biopsies were evaluated twice by the same investigators and 325 at least by one other investigator. In 65 cases, tissue obtained by transurethral resection was evaluated by the same investigator who had seen the biopsy. The diagnosis of carcinoma of the prostate was highly reproducible, only in 2% of the cases the original diagnosis was not confirmed; 5 out of 27 systematically evaluated parameters proved to be very reliable and reproducible, i.e. histological tumor classification, cribriform glands, invasion of perineural spaces, nucleoles, nuclear polymorphism, 8 parameters were sufficiently reproducible and 14 were unreliable among which cytologic differentiation was one. The diagnostic reproducibility between biopsy material and transurethral resection material was only 48.8%. This very low figure can be explained by the marked histologic heterogeneity of the tumors of which only 13% were classified as uniform carcinomas. The conclusions of the investigation are: 1. The diagnosis carcinoma is highly reliable and reproducible in needle biopsies. 2. Needle biopsy tissue is not representative for the entire tumor. 3. Grading of prostate carcinoma is highly subjective and therefore no sound basis for therapy and prognosis in the individual patient.     

Evaluation of gleason classification system in prostate cancer

To compare the relative prognostic accuracy of the Gleason classification, the Whitmore staging, and the Broder grading systems, 111 patients with prostate cancer undergoing radical surgery were assessed utilizing these systems. The assessments were correlated with the presence or absence of disease six months to eight years after surgery. Of the three systems the Gleason classification system was the least accurate.     

Extended and saturation needle biopsy for the diagnosis of prostate cancer

The diagnosis of prostate cancer hinges on the use of systematic ultrasound-guided transrectal needle biopsy. The choice of technique is important, especially for patients with a history of a negative biopsy. Saturation biopsy can be considered for patients at risk of cancer who are willing to accept the side effects and who understand that clinically insignificant cancers can be detected. For patients with previous negative sextant biopsies, expanding the zones sampled and increasing the number of biopsy cores can help detect significant cancers while they are still confined. However, as extended biopsy becomes more commonly performed for initial diagnosis, there likely will be less need for saturation biopsy protocols.     

The relationship of prostate gland volume to extended needle biopsy on prostate cancer detection

PURPOSE: We investigated the relationship between prostate volume and cancer detection by needle biopsy, and determined the effect of an increased number of cores on the sampling error of needle biopsy on large prostate glands. MATERIALS AND METHODS: The study cohort included 750 consecutive patients who underwent first time transrectal ultrasound guided prostate needle biopsy from January 1995 to August 2001. Prostate volumes were divided into quartiles (13 to 34, 34.1 to 45, 45.1 to 64 and 64.1 to 244 cc). Multivariate analysis controlling for age, prostate specific antigen (PSA) and biopsy indication was performed to determine the effect of the number of cores and prostate volume on prostate cancer detection. RESULTS: Patients diagnosed with prostate cancer were older (p = 0.0035) and had higher PSA levels (p = 0.0002) than those with no cancer on biopsy. Decreasing cancer detection rates were seen with increasing prostate volume (p = 0.0074). The OR of detection for each additional core was 0.99 (95% CI 0.93, 1.06), suggesting that increasing the number of biopsy cores did not increase the rate of prostate cancer detection. Multivariate analysis revealed that patients with larger prostates had the same, or possibly lower, cancer detection rate as the number of biopsy cores was increased. Patients with larger prostates were older (p <0.0001), had higher PSA levels (p <0.0001) and were even more likely to have undergone biopsy for increased PSA rather than abnormal digital rectal examination alone (p <0.0001). CONCLUSIONS: Our study suggests that the lower cancer detection rate for men with large prostates may be due to a decrease in the use of increased serum PSA for prostate cancer detection in larger prostates in addition to other factors such as sampling error. Increased serum PSA levels in cases of larger prostates, although a risk factor for prostate cancer warranting biopsy, may also be due to nonmalignant sources such as benign prostatic hyperplasia.     

Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy

PURPOSE: We examined the concordance of Gleason scores in prostate needle biopsy specimens and the corresponding radical retropubic prostatectomy specimens in a cohort of patients grouped according to the number of cores obtained during diagnostic needle biopsy. MATERIALS AND METHODS: We reviewed clinical and pathological data on a cohort of 466 men diagnosed with localized prostate cancer by needle biopsies who underwent radical retropubic prostatectomy between January 1, 1990 and July 31, 2001. Two study groups were identified, including 126 patients diagnosed with prostate cancer by extended needle biopsies (10 or more cores) and 340 diagnosed with cancer by nonextended needle biopsies (9 or fewer cores). Mean age was 60 years and median prostate specific antigen was 5.8 ng./ml. The median number of cores in the extended and nonextended biopsy groups was 12 and 6, respectively. The concordance of Gleason score in the needle biopsy and prostatectomy specimens was compared and correlated with the number of cores on needle biopsy. RESULTS: In the whole cohort 311 patients (67%) had identical Gleason scores on the needle biopsy and prostatectomy specimens, while 53 (11%) were over graded and 102 (22%) were under graded on needle biopsy. In patients who underwent extended needle biopsies the accuracy rate for Gleason scoring was 76% with 10% over and 14% under graded. The highest accuracy rates were in patients with 13, 14 and 16 cores (89%, 87% and 100%, respectively). No patients in the extended needle biopsy group had a discrepancy of more than 2 Gleason units in grade in the biopsy and surgical specimens. In those who underwent nonextended needle biopsies the accuracy rate for Gleason scoring was 63% with 12% over and 25% under graded. There were significantly different rates of accuracy (p = 0.008) and under grading (p = 0.01) in the 2 needle biopsy groups. Patients with a needle biopsy Gleason score of less than 7 had significantly higher concordance with the prostatectomy Gleason score when extended biopsies were done compared with nonextended biopsies (p = 0.001). CONCLUSIONS: Prostate cancer grading by extended needle biopsy is a better predictor of the final Gleason score than nonextended needle biopsy, as determined by radical prostatectomy histological evaluation. Therefore, extended prostate needle biopsy provides better guidance to determine the appropriate treatment in patients with prostate cancer.     

Transrectal fine-needle aspiration and truecut needle biopsy of the prostate: a blinded comparison of accuracy

Transrectal needle aspiration biopsy and core biopsy of the prostate were performed simultaneously on 88 men with prostatic nodules. Cytologic and histologic assessments were made in a blinded, independent fashion, and the results were compared. All patients with positive findings on aspiration also had positive findings on core biopsy, for a positive predictive value for aspiration of 100%. However, five negative and six "insufficient" results obtained by aspiration were positive on core biopsy, for a negative predictive value for aspiration of 88%. This experience support the use of needle aspiration as an initial diagnostic maneuver in the assessment of prostatic nodules.     

Sharpin蛋白在前列腺癌中的表达及其与Gleason评分、t—PSA关系的研究

目的探讨Sharpin蛋白在人不同前列腺癌细胞株中与前列腺癌组织中的表达及其与Gleason评分、血清PSA的关系。方法采用实时荧光定量PCR法,检测Sharpin在DUl45、PC-3和LNCaP3种常见的前列腺癌细胞株和RWPE．1正常前列腺上皮细胞株中的表达。同时采用免疫组织化学方法检测Sharpin在前列腺增生及前列腺癌组织中的表达,并探讨与临床病理特征的关系。结果Sharpin在3种前列腺癌细胞株中的mRNA水平（1．62±0．31,1．36±0．23,2．1±0．1）要明显高于正常前列腺上皮细胞RWPE-1（0．6±0．11）。免疫组织化学结果示Sharpin在前列腺癌组织中高表达,前列腺癌中的阳性表达率远远高于前列腺增生组织,平均染色得分也要远远高于前列腺增生组织。另外,Sharpin在前列腺癌组织中的表达与患者的Gleason评分和术前血清的t-PSA密切相关,均呈正相关（P〈0．05）。结论Sharpin可能是前列腺癌的肿瘤相关抗原,sharpin的表达可能具有评估前列腺癌患者病情、指导临床治疗方案的指导及判断预后及复发的作用。     

Distorted rectal tissue on prostate needle biopsy: a mimicker of prostate cancer

Rectal tissue is often seen in needle biopsies of the prostate gland. On rare occasion distorted rectal glands can mimic prostatic adenocarcinoma, an issue not previously addressed in the peer-reviewed literature. We evaluated 16 prostate needle biopsies received in consultation where the submitting pathologist questioned whether a focus of rectal tissue was prostate cancer. In addition to the distorted architecture, features mimicking prostate cancer included: (1) blue-tinged intraluminal mucinous secretions in 10 cases (63%), (2) prominent nucleoli in 6 cases (37%), (3) mitotic activity in 6 cases (37%), (4) extracellular mucin in 5 cases (31%), and (5) adenomatous changes of the rectal tissue in 1 case (6%). Immunohistochemical results further mimicked prostate cancer with negative stains for the basal cell markers high-molecular weight cytokeratin (n=6) and p63 (n=4), and positive stains for racemase in 4 of 5 biopsies. Diagnostic clues to recognizing that these foci were distorted rectal fragments were the presence of (1) lamina propria in 12 cases (75%), (2) rectal tissue located on a detached fragment of tissue in 10 biopsies (63%), (3) associated inflammation in 10 cases (63%), (4) goblet cells in 7 cases (44%), and (5) muscularis propria in 6 cases (37%). In 2 cases, there was negative staining for prostate specific antigen (PSA) and in 1 case negative staining for cytokeratin 7 and positivity for cytokeratin 20. Rectal glands are associated with many of the classical features of prostate cancer, and immunohistochemistry may be misleading. Recognition of these features mimicking prostate cancer and awareness of other findings that are diagnostic of rectal tissue on biopsy can prevent a misdiagnosis of atypical prostate glands or prostate cancer.     

Combined use of transurethral resection and needle biopsy in the diagnostics of carcinoma of the prostate

On suspicion of prostatic tumour, the authors performed a combination of transurethral resection and needle biopsy to form a safe histological diagnosis as well as to apply an adequate therapy. Transurethral resection combined with needle biopsy is to be performed if patients present with dysuric complaints, and if tumour can be suspected on rectal palpation or based on the clinical picture. This intervention ensures an unequivocal diagnosis and eliminates the urinary obstruction. They also dealt with cases, in which only needle biopsy or transurethral resection could help in forming the correct diagnosis.