Extended and Saturation Prostatic Biopsy in the Diagnosis and Characterisation of Prostate Cancer: A Critical Analysis of the Literature

The purpose of this study is to report our method in detecting prostate cancer (PCa) using an 18-core transrectal ultrasound (TRUS) prostate biopsy (PB) schema, in combination with additional targeted cores from suspicious images in conventional (e-cMRI) and functional (e-fMRI) endorectal magnetic resonance imaging (e-MRI) of the prostate. From 2004 to 2008, 260 consecutive patients with a clinical suspicion of PCa underwent PB and were prospectively studied. e-cMRI and e-fMRI was performed in all patients before PB. The patients were divided into two groups (A and B) according to the results of their radiological findings (group A ¼ suspicious findings, group B ¼ non-suspicious findings). After the images were processed, an 18-core TRUS-guided PB was performed. When a patient exhibited a suspicious site on e-cMRI and e-fMRI images, three additional targeted PBs were obtained from that site. In group A, 17.5% of PCa was detected by the 18-core PB and 56.5% of PCa was detected by the targeted cores. The overall PCa detection rate (18 þ targeted cores) was 73.9%. The overall specificity was 73.9%. In group B, overall false-positive detection rate reached 19.2%, with the overall sensitivity being 80.8%. The method described above is not only practical but also a promising modality in PCa detection. As seen, PCa was optimally detected when combining the 18-core and targeted-core PB schema together. Non-suspicious images do not rule out the probability of PCa, thus justifying a PB in these patients as well.

Section: Discussionmentioning

confidence: 99%

Prostate cancer detection using an extended prostate biopsy schema in combination with additional targeted cores from suspicious images in conventional and functional endorectal magnetic resonance imaging of the prostate

Engelhard

Zugor

et al. 2009

“…Correlation analyses have shown that patients with a predicted insignificant cancer at biopsy frequently showed tumors with more advanced stage and grade at radical prostatectomy (RP) pathological examination. 4 Attempts of thorough pathological mapping of the prostate have been made with saturation transrectal and transperineal prostate biopsies. 5 However, even these procedures might miss up to 40% of cancer foci.…”

Section: Introductionmentioning

confidence: 99%

Multiparametric MRI is helpful to predict tumor focality, stage, and size in patients diagnosed with unilateral low-risk prostate cancer

Delongchamps

Beuvon

Eiss³

et al. 2011

To study the staging accuracy of multiparametric magnetic resonance imaging (MRI) in patients showing unilateral low-risk cancer on prostate biopsy. A total of 58 consecutive patients with lowrisk cancer (D'Amico classification) and unilateral cancer involvement on prostate biopsies were included prospectively. All patients underwent multiparametric endorectal MRI before radical prostatectomy, including T2-weighted (T2W), diffusion-weighted (DW) and dynamic contrast enhanced (DCE) sequences. Each gland was divided in eight octants. Tumor foci 40.2 cm 3 identified on pathological analysis were matched with MRI findings. Pathological examination showed tumor foci 40.2 cm 3 in 50/58 glands (86%), and bilateral tumor (pathological stageXpT2c) in 20/58 (34%). For tumor detection in the peripheral zone (PZ), T2W þ DWI þ DCE performed significantly better than T2W þ DWI and T2W alone (Po0.001). In the transition zone (TZ), only T2W þ DWI performed better than T2W alone (P ¼ 0.02). With optimal MR combinations, tumor size was correctly estimated in 77% of tumor foci involving more than one octant. Bilateral tumors were detected in 80% (16/20) of cases. In patients with unilateral low-risk prostate cancer on biopsy, multiparametric MRI can help to predict bilateral involvement. Multiparametric MRI may therefore have a prognostic value and help to determine optimal treatment in such patients.

“…[7][8][9] However, over-and, particularly, understaging are major limitations in PC treatment and a variety of strategies have been investigated to improve staging accuracy, among them being various aspects of PB pathology examination. 10 Herein, we present a novel and simple method to potentially improve the predictive value of PB by marking the peripheral end (PE) of each PB specimen after biopsy by ink. The hypothesis behind our study is that cancer confined to the prostate is less likely to be PE positive ( Figure 1a) whereas a non-organ-confined tumour (postoperative tumour (pT)3/pT4) is more likely to be PE positive (Figure 1b).…”

Section: Introductionmentioning

confidence: 99%

Prostate cancer at the peripheral end of a prostate biopsy specimen as assessed by a novel marking technique may indicate increased risk of locally advanced disease

Ponholzer

Rauchenwald

Rainer-Concin

et al. 2010

The objective of this study was to test a novel technique of processing a prostate biopsy (PB) specimen by marking its peripheral end (PE) as a predictive tool for locally advanced prostate cancer (PC) or margin-positive resection (R1) after radical prostatectomy (RP). Prospective evaluation of a consecutive cohort of men who underwent PB and subsequent RP was carried out. Transrectal ultrasound-guided 10-20 core PB was performed according to a standardized protocol. Each biopsy core was inked at the PE and classified as PE positive or negative. The study cohort comprised 100 men with a mean age of 62.3 years (41-75 years). Overall, PE-positive cores were found in 71 men, postoperative tumour (pT)3/pT4 stages were diagnosed in 33 men and R1 status in 45 men after RP. In univariate analysis, the presence of at least one PE-positive core was correlated to an increased risk for pT3/pT4 stage (relative risk (RR): 3.15; 95% confidence interval (95% CI): 1.1-9.9; P ¼ 0.03) and R1 status (RR: 2.9; 95% CI: 1.1-7.5; P ¼ 0.03). In multivariate analysis including Gleason score, total number of positive cores, PE positivity and PSA, PE positivity was correlated to pT3/pT4 stage (P ¼ 0.04). In conclusion, PC at the PE of a PB specimen predicts nonorgan-confined tumour stage in subsequent prostatectomy. This simple, new technique may contribute to increasing the accuracy of risk stratification for curative treatment of PC.