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Fine Needle Aspiration in Detection of Prostate Cancer: Comparison with Surgical Biopsy
Accepted 361
362
FINE NEEDLE ASPIRATION IN DETECTION OF PROSTATE CANCER: COMPARISON WITH SURGICAL BIOPSY. *Perinchery Narayan, *Ross Stein and *Britt M. Lljung, San Francisco, CA (Presentation to be made by Dr. Narayan) Fine needle aspiration of prostates (FNA) is advocated as a simple, effective and painless technique to diagnose prostate pathology. Recent reports suggest that the technique is similar if not better than core needle biopsy in accuracy of diagnoses. The purpose of this study was to evaluate the diagnostic accuracy of FNA compared to core biopsy of the prostate. A second objective was to evaluate the efficacy of FNA in diagnosis of Stage A prostate cancer. From August 85 through July 86, 97 patients underwent a total of 112 FNA procedures using the Franzen needle and technique. Seventy of these patients had a simultaneous and/or subsequent surgical biopsy ( core biopsy, transurethral prostatectomy or radical prostatectomy). Results are as follows: 66% (46/70) of patients with FNA had identical results to that of surgical specimens. 5.5"/4 (4/70) of patients with positive }'NA had negative core biopsies. 4.2"/4 (3/70) of patients with positive core biopsies had
CYTOLOGIC GRADING OR PROSTATIC ASPIRATION BIOPSY: A COMPARISON WITH THE GLEASON GRADING SYSTEM. *Layfield, L.J., *Mukamel, E., *Hilborne, L.H., *Hannah, J.
inconclusive FNA results.
B,, *Glasgow, B.J., *Ljung, B.M., deKernion, J.B.
(Presentation to be made by Dr. Layfield) Cytologic grade determined by fine needle aspiration of prostatic carcinoma was compared to the histologic grade in 30 patients undergoing subsequent radical prostatectorny. The degree of cytologic pleomorphism determined by the consensus grade of three observers correctly predicted the Gleason grade sum range in 80% of cases, The cytologic grade was reasonably reproducible with agreement between all three observers in 50% of caa.es and between two of three observers in the remaining cases. The accuracy of predicting the Gleason grade sum of the radical prostatectomy specimen by cytologic examination compared favorably with that achieved by histologic examination of cutting needle biopsy and transurethral resection specimens in the literature.
There were no false positive
FNA's among 16 patients who underwent radical prostatectomy based on positive FNA results. The Gleason grades of patients who were diagnosed by FNA and subsequently had surgery were as follows: Mean Gleason FNA Grade Combined Gleason Grades Well 7,5, , 5.0 5.8 Moderate 7,6,6,6,6,6,5,4 10.0 Poor 10 Forty patients who had transurethral resection of pros-
tate for obstructive symptoms also had an FNA procedure. None had a positive FNA although 3 had Stage A prostate cancer based on the initial and a second staging TURP. In conclusion,
FNA has
seyeral advantages
biopsy in patient tolerance and comfort.
over
However,
core
FNA
diagnostic accuracy may not be superior to core biopsy~
363
364
PROSTATIC ASPIRATION BIOPSY: ASSESSMENT OF ACCURACY BASED ON CONTINUING OBSERVATIONS. John B, Graham, Jeffrey M, Ignatoff, James M. Holland, and *Miriam L. Christ, Chicago IL. (Presentation to be made by Dr, Graham) This is a report of 129 patients who had transrectal fine needle aspiration biopsy (AB) of the prostate performed for palpable abnormalities since 1974. It evaluates the accuracy of AB by comparing positive cytology with histological and clinical evidence of cancer, and assessing negative cytology by long-term followup examinations. Negative core biopsy and conservative prostatectomy specimens were not considered as valid for comparison with cytology. 56 patients had positive, atypical, or suspicious cytology. All were eventually found to have cancer. During the 11 year observation period, 12 of 73 who initially had negative AB were also found to have cancer. While these might have arisen in the interim, we have labelled them as false negatives. The figure may even be higher with longer follow-up. Most of the late discoveries were of low histologic grade. These figures give·a specificity of 100% and a sensitivity of 82%, With the estimated 50% prevalence of cancer in palpable lesions, a negative AB has a predictive value of 84%, we conclude (1) that this test is highly specific and a valuable diagnostic tool; (2) that when reported by experienced cytologists, even suspicious changes are very likely to indicate cancer; and (3) based upon our continued observations of patients after negative AB, that it carries a lower sensitivity percentage than in earlier reports, one similar to perineal core biopsy.
THE VALUE OF PROSTATIC SPECIFIC ANTIGEN IN THE MANAGEMENT OF ADENOCARCINOMA OF THE PROSTATE. Joseph E. Oesterling*, Debra J. Bruzek*, Daniel W. Chan*, Jonathan I. Epstein*, Allyn W. Kimball, Jr.*, Robert C, Rock*, Charles B, Brendler, and Patrick C. Walsh, Baltimore, MD (Presentation to be made by Dr. Oesterling) The usefulness of prostatic specific antigen (FSA) to predict final pathologic stage (FPS) and to detect residual tumor following radical prostatectorny was studied in 72 patients. PSA was determined preoperatively by a monoclonal immunoradiometric assay (TandemR Hybritech, Inc,) All pathologic specimens were examined for capsular penetration (CP), seminal vesicle involvement (SVI), and lymph node involvement (LNI). PSA was found to correlate directly with CP (p < 0.02) but not with SVI (p = 0.17) or LNI (p = 0,73). The diagnostic accuracy of an elevated PSA level was 63% for CP, 49% for SVI, and 47% for LNI, To establish the usefulness of PSA as a tumor marker for detecting residual cancer following prostatectomy, the halflife of PSA was determined. PSA levels were measured for 8 consecutive days postoperatively in 24 patients with pathologically confined cancer. Using a multiple regression model, the half-life was calculated to be 3.15 + 0.09 days. Because PSA is produced exclusively by prostatiC tissue, the equation: PSA(t)=PSA(2)e-0.219671 (t-2), can be used to predict the PSA value at time, t. A measured level that is higher than the predicted value indicates residual disease. 53 patients have been monitored postoperatively using PSA (mean followup: 18 mo.; range: 2 mo. - 48 mo.). Forty-six (87%) have undetectable PSA levels, Of the 7 men with a measurable PSA level, 3 have known metastatic cancer, and 4, while not having any clinical recurrence, did have advanced pathological disease at the time of prostatectorny (3 - positive lymph nodes; 1 - extensive CF with SVI), These findings suggest: 1) PSA is not sufficiently reliable to predict final pathologic stage on an individual basis. 2) PSA can be used to detect residual disease following radical prostatectorny and subsequent recurrence of tumor.
194A
362
FINE NEEDLE ASPIRATION IN DETECTION OF PROSTATE CANCER: COMPARISON WITH SURGICAL BIOPSY. *Perinchery Narayan, *Ross Stein and *Britt M. Lljung, San Francisco, CA (Presentation to be made by Dr. Narayan) Fine needle aspiration of prostates (FNA) is advocated as a simple, effective and painless technique to diagnose prostate pathology. Recent reports suggest that the technique is similar if not better than core needle biopsy in accuracy of diagnoses. The purpose of this study was to evaluate the diagnostic accuracy of FNA compared to core biopsy of the prostate. A second objective was to evaluate the efficacy of FNA in diagnosis of Stage A prostate cancer. From August 85 through July 86, 97 patients underwent a total of 112 FNA procedures using the Franzen needle and technique. Seventy of these patients had a simultaneous and/or subsequent surgical biopsy ( core biopsy, transurethral prostatectomy or radical prostatectomy). Results are as follows: 66% (46/70) of patients with FNA had identical results to that of surgical specimens. 5.5"/4 (4/70) of patients with positive }'NA had negative core biopsies. 4.2"/4 (3/70) of patients with positive core biopsies had
CYTOLOGIC GRADING OR PROSTATIC ASPIRATION BIOPSY: A COMPARISON WITH THE GLEASON GRADING SYSTEM. *Layfield, L.J., *Mukamel, E., *Hilborne, L.H., *Hannah, J.
inconclusive FNA results.
B,, *Glasgow, B.J., *Ljung, B.M., deKernion, J.B.
(Presentation to be made by Dr. Layfield) Cytologic grade determined by fine needle aspiration of prostatic carcinoma was compared to the histologic grade in 30 patients undergoing subsequent radical prostatectorny. The degree of cytologic pleomorphism determined by the consensus grade of three observers correctly predicted the Gleason grade sum range in 80% of cases, The cytologic grade was reasonably reproducible with agreement between all three observers in 50% of caa.es and between two of three observers in the remaining cases. The accuracy of predicting the Gleason grade sum of the radical prostatectomy specimen by cytologic examination compared favorably with that achieved by histologic examination of cutting needle biopsy and transurethral resection specimens in the literature.
There were no false positive
FNA's among 16 patients who underwent radical prostatectomy based on positive FNA results. The Gleason grades of patients who were diagnosed by FNA and subsequently had surgery were as follows: Mean Gleason FNA Grade Combined Gleason Grades Well 7,5, , 5.0 5.8 Moderate 7,6,6,6,6,6,5,4 10.0 Poor 10 Forty patients who had transurethral resection of pros-
tate for obstructive symptoms also had an FNA procedure. None had a positive FNA although 3 had Stage A prostate cancer based on the initial and a second staging TURP. In conclusion,
FNA has
seyeral advantages
biopsy in patient tolerance and comfort.
over
However,
core
FNA
diagnostic accuracy may not be superior to core biopsy~
363
364
PROSTATIC ASPIRATION BIOPSY: ASSESSMENT OF ACCURACY BASED ON CONTINUING OBSERVATIONS. John B, Graham, Jeffrey M, Ignatoff, James M. Holland, and *Miriam L. Christ, Chicago IL. (Presentation to be made by Dr, Graham) This is a report of 129 patients who had transrectal fine needle aspiration biopsy (AB) of the prostate performed for palpable abnormalities since 1974. It evaluates the accuracy of AB by comparing positive cytology with histological and clinical evidence of cancer, and assessing negative cytology by long-term followup examinations. Negative core biopsy and conservative prostatectomy specimens were not considered as valid for comparison with cytology. 56 patients had positive, atypical, or suspicious cytology. All were eventually found to have cancer. During the 11 year observation period, 12 of 73 who initially had negative AB were also found to have cancer. While these might have arisen in the interim, we have labelled them as false negatives. The figure may even be higher with longer follow-up. Most of the late discoveries were of low histologic grade. These figures give·a specificity of 100% and a sensitivity of 82%, With the estimated 50% prevalence of cancer in palpable lesions, a negative AB has a predictive value of 84%, we conclude (1) that this test is highly specific and a valuable diagnostic tool; (2) that when reported by experienced cytologists, even suspicious changes are very likely to indicate cancer; and (3) based upon our continued observations of patients after negative AB, that it carries a lower sensitivity percentage than in earlier reports, one similar to perineal core biopsy.
THE VALUE OF PROSTATIC SPECIFIC ANTIGEN IN THE MANAGEMENT OF ADENOCARCINOMA OF THE PROSTATE. Joseph E. Oesterling*, Debra J. Bruzek*, Daniel W. Chan*, Jonathan I. Epstein*, Allyn W. Kimball, Jr.*, Robert C, Rock*, Charles B, Brendler, and Patrick C. Walsh, Baltimore, MD (Presentation to be made by Dr. Oesterling) The usefulness of prostatic specific antigen (FSA) to predict final pathologic stage (FPS) and to detect residual tumor following radical prostatectorny was studied in 72 patients. PSA was determined preoperatively by a monoclonal immunoradiometric assay (TandemR Hybritech, Inc,) All pathologic specimens were examined for capsular penetration (CP), seminal vesicle involvement (SVI), and lymph node involvement (LNI). PSA was found to correlate directly with CP (p < 0.02) but not with SVI (p = 0.17) or LNI (p = 0,73). The diagnostic accuracy of an elevated PSA level was 63% for CP, 49% for SVI, and 47% for LNI, To establish the usefulness of PSA as a tumor marker for detecting residual cancer following prostatectomy, the halflife of PSA was determined. PSA levels were measured for 8 consecutive days postoperatively in 24 patients with pathologically confined cancer. Using a multiple regression model, the half-life was calculated to be 3.15 + 0.09 days. Because PSA is produced exclusively by prostatiC tissue, the equation: PSA(t)=PSA(2)e-0.219671 (t-2), can be used to predict the PSA value at time, t. A measured level that is higher than the predicted value indicates residual disease. 53 patients have been monitored postoperatively using PSA (mean followup: 18 mo.; range: 2 mo. - 48 mo.). Forty-six (87%) have undetectable PSA levels, Of the 7 men with a measurable PSA level, 3 have known metastatic cancer, and 4, while not having any clinical recurrence, did have advanced pathological disease at the time of prostatectorny (3 - positive lymph nodes; 1 - extensive CF with SVI), These findings suggest: 1) PSA is not sufficiently reliable to predict final pathologic stage on an individual basis. 2) PSA can be used to detect residual disease following radical prostatectorny and subsequent recurrence of tumor.
194A