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

Abstract

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.

Specimen Orientation by Marking the Peripheral End: (Potential) Clinical Advantages in Prostate Biopsy

“…This pathological feature could have potential clinical advantage in the surgical management. Ponholzer et al showed that men, with at least one core with cancer at the inked peripheral margin, had a 3.1-fold (95% CI: 1.1–9.9) increased risk for locally advanced tumour stage in the final surgical specimen [7]. …”

“…Therefore, the clinical information provided by individually labelled (cancer site itself) was previously stated not useful and not convenient to justify the increased associated costs [18]. Surprisingly, when Ponholzer et al [7] considered the cancer location within the core (cancer located at the peripheral end of the specimen), they showed a significant correlation to pT3/pT4 stage ( P = 0.04) in multivariate analyses of 100 cases. …”

“…Since transrectal ultrasound biopsy is the worldwide used technique for Pca diagnosis, marking the peripheral end of the core biopsy could easily identify the subcapsular tissue of the peripheral zone just close to the ultrasound probe. Only very few published papers describe the pros and cons of the marking technique [7–10]. …”