Analysis of Preoperative Detection for Apex Prostate Cancer by Transrectal Biopsy

Abstract

Background. The aim of this study was to determine concordance rates for prostatectomy specimens and transrectal needle biopsy samples in various areas of the prostate in order to assess diagnostic accuracy of the transrectal biopsy approach, especially for presurgical detection of cancer in the prostatic apex. Materials and Methods. From 2006 to 2011, 158 patients whose radical prostatectomy specimens had been evaluated were retrospectively enrolled in this study. Concordance rates for histopathology results of prostatectomy specimens and needle biopsy samples were evaluated in 8 prostatic sections (apex, middle, base, and transitional zones bilaterally) from 73 patients diagnosed at this institution, besides factors for detecting apex cancer in total 118 true positive and false negative apex cancers. Results. Prostate cancer was found most frequently (85%) in the apex of all patients. Of 584 histopathology sections, 153 (49%) from all areas were false negatives, as were 45% of apex biopsy samples. No readily available preoperative factors for detecting apex cancer were identified. Conclusions. In Japanese patients, the most frequent location of prostate cancer is in the apex. There is a high false negative rate for transrectal biopsy samples. To improve the detection rate, transperitoneal biopsy or more accurate imaging technology is needed.

External validation and comparison of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology in two patient populations: a retrospective cohort study

“…In the present study, the rate of discordance was 36.7% (158 patients) in the combined datasets, which showed a smaller difference than the previous studies (4,11). GS, PSA and clinical stage are cornerstones for treatment decisions in patients with localized prostate cancer and a life expectancy of more than 10 years (4)(5)(6)19). The assessment of clinical and pathological features of prostate cancer that might predict GS upgrading is very important, because GS is considered one of the most significant predictors for prognosis besides pathological stage and the status of surgical margins.…”

“…The assessment of clinical and pathological features of prostate cancer that might predict GS upgrading is very important, because GS is considered one of the most significant predictors for prognosis besides pathological stage and the status of surgical margins. Patients with high-grade prostate cancer have a higher risk for progression (4)(5)(6). Moreover, patients with upgraded tumors are reported to be at an even higher risk of adverse pathologic features after RP (20).…”

Toward an MRI-based nomogram for the prediction of transperineal prostate biopsy outcome: A physician and patient decision tool

“…Furthermore, PSA density (PSAD) has had potential to improve serum PSA specificity whilst preserving sensitivity. Despite this, use in clinical practice is limited and poor uptake may be related to the use of transrectal ultrasound for prostate volume estimation and transrectal biopsy as the reference standard, two techniques subject to human error and inaccuracy [7,8,17]. Separate volume assessments are expensive, inconvenient and uncomfortable for patients.…”

“…As the prostate is approached posteriorly via the rectum, specific anatomical areas are undersampled. The anterior aspect of the prostate is challenging to biopsy, while the detection of apical tumours is limited by the needle angle attainable through the rectum [7,8].…”

Level of Prostate Cancer Diagnosis Using MRI-TRUS Fusion Biopsy in Patients with a Negative History of TRUS Biopsy

“…In the present study, the sensitivity of targeted biopsy was 94.4% and 90% in the diagnosis of prostate cancer at the base and apex, respectively; whereas random biopsy had a sensitivity of 25% and 27.2% in the same regions, respectively. In the study by Sazuka et al (20), results of permanent radical prostatectomy pathology of 158 patients were compared with those of pre-operative TRUS biopsy. In radical prostatectomy, 85% of cancer cases showed the apex involvement.…”