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INFLUENCE OF USING 16-GAUGE NEEDLE ON PROSTATE CANCER DETECTION RATE IN TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY
1157 PROSPECTIVE STUDY OF 645 PATIENTS WITH SIGNIFICANT BENIGN PROSTATIC ENLARGEMENT: COMPLICATIONS AND IMMEDIATE OUTCOME AFTER SUPRAPUBIC PROSTATECTOMY Reich O.1, Gratzke C.1, Schlenker B.1, Seitz M.1, Hermanek P.2, Lack N.2, Burmeister C.2, Zaak D.1, Bachmann A.1, Stief C.G.1 1
University-Hospital Munich - Großhadern, Dept of Urology, Munich, Germany, 2 Bavarian Working Group for Quality Assurance (BAQ), Urology Section, Munich, Germany INTRODUCTION & OBJECTIVES: Suprapubic prostatectomy has been the primary option for patients with significantly enlarged prostate glands due to benign prostatic hyperplasia (BPH) for decades. With regard to new transurethral techniques it still represents the standard technique in the majority of patients with essential symptomatic benign prostatic enlargement. In a prospective multicentre study we analysed complications and immediate postoperative outcomes of open suprapubic prostatectomy. MATERIAL & METHODS: A total of 645 patients (average age 74.2 years) were evaluated prospectively undergoing suprapubic prostatectomy in the state of Bavaria, Germany in 2003. 54 parameters concerning preoperative status, operation details, complications and immediate outcome were documented for each patient. Complete data were available for 620 individuals.
P70 PROSTATE CANCER: BIOPSY ISSUES II Friday, 7 April, 15.45-17.15, Room Concorde 1 / Level 4 1158 DEFINITIVE HISTOLOGICAL DIAGNOSIS ON PROSTATE BIOPSIES IN 3 HOURS: THE FIRST-YEAR EXPERIENCE Nava L.D.1, Freschi M.2, Doglioni C.2, Losa A.1, Scapaticci E.1, Maga T.1, Rigatti P.3, Guazzoni G.1 1
Hospital San Raffaele Turro, Urology, Milan, Italy, 2Hospital San Raffaele, Pathology, Milan, Italy, 3Hospital San Raffaele, Urology, Milan, Italy
INTRODUCTION & OBJECTIVES: Aim of this study was to prospectively evaluate the efficacy and reproducibility of quickly processing prostate core needle biopsies with RHS1®, an automated microwave- vacuum processor. MATERIAL & METHODS: From July 2004 to July 2005 a total of 364 consecutive prostate biopsies were performed for Pca detection in men with PSA levels between 2.5 and 14 ng/ml. The biopsies (mean core number 20, range 14-24) were stretched between two sponges in tissue cassettes, fixed in formalin 4% solution, processed with RHS1® (xylene-free), embedded in paraffin, cut at 3 μ and then stained with Hematoxylin-Eosin. Processing time, as well as time to final histological report, detection rate and percentage of further evaluations required were recorded; furthermore those results were prospectively compared with those registered in a concomitant series of 351 prostate biopsies performed in a similar series of patients, with the same sample technique, in the same period, but processed with the traditional method. Histop athological evaluations were performed by a single pathologist.
RESULTS: 96.1 percent of the men presented with a prostate volume of more than 50 grams, maximal urinary flow was less than 15 ml/s in 87, 4 percent of the patients. 39.4 percent of the patients suffered acute urinary retention before surgery. The most relevant complications were significant urinary tract infection (6.3 percent), surgical revision (5.9 percent), bleeding requiring transfusions (3.9 percent) and failure to void (3.1 percent). The mortality rate for open prostatectomy was 0.2 percent. The resected tissue averaged 81.3 grams. Histologically, incidental carcinoma of prostate was diagnosed in 3.8 percent of the patients.
RESULTS: The overall detection rate for both groups (RHS1® - processed biopsies vs. biopsies traditionally processed) was similar 41% of Pca for both group, 20% of HGPIN vs. 18%, 2.2% of ASAP vs. 2.8%. A comparable quality evaluation was given by the pathologist for both groups, confirmed at an intradepartmental review. No differences in core lengths were recorded pre- and post-processing. The automatic processing time was 75 minutes vs. 14 hours, whereas the time to the definitive diagnosis was 190 minutes (range 145-260) vs. 24 hours. A quick diagnosis was performed in 347/364 pts (95%). In 17 pts additional immunohistochemical evaluations were successively performed without any modification of routinely used methods. All patients could conclude in the same day the diagnostic and staging process.
CONCLUSIONS: In a large-scale, multicentre prospective study including 44 urologic departments in Bavaria, prospective data concerning complications and early postoperative outcome in patients treated with suprapubic prostatectomy was generated. This data yields relevant information for urologists in decision making for the appropriate surgical option in patients with significant benign enlargement of the prostate.
CONCLUSIONS: The first year experience confirms the validity of this new automated microwave- vacuum device to process in a short time prostate biopsies. RHS1® resulted at least as effective as the traditional processing method and could guarantee a new time-effective standard to spare time, costs and stress for the patients. Being a xylene-free method, handling of the specimens is simplified and safer. RHS1® allows a better quality of service with a oneday diagnosis.
1159 EVALUATION OF 16-GAUGE NEEDLE FOR PROSTATE BIOPSY Fink K., Hutarew G., Szlauer R., Goetschl R., Schmeller N.T. Salzburger Landeskliniken, Urologie, Salzburg, Austria INTRODUCTION & OBJECTIVES: Aim of the study was to evaluate the efficiency of a prostate biopsy using 16 gauge needle in comparison to standard 18 gauge. MATERIAL & METHODS: A total of 36 specimens after radical prostatectomy were used and two sets of prostate biopsies were performed on each specimen with ultrasound guidance. First a ten-core biopsy that adds four cores from the far lateral areas of the prostate to the commonly used sextant biopsy was performed
1160 INFLUENCE OF USING 16-GAUGE NEEDLE ON PROSTATE CANCER DETECTION RATE IN TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY Inal G., Onur K., Tas M., Oztekin V., Kosan M., Ozturk B. Ankara Numune Education and Research Hospital, 2nd Urology, Ankara, Turkey INTRODUCTION & OBJECTIVES: In the present study, we compared the prostate cancer (Pca) detection rates and performances of 18 gauge and thicker 16 gauge needles with morbidity rates. MATERIAL & METHODS: Patients (n= 140) were randomised into two groups. In-group 1 (n=70), biopsies were obtained with 16 gauge needles while in-group 2 (n=70) 18 gauge needles were used for the biopsies. With the guidance of transrectal ultrasound (TRUS), systematic 10 core prostate biopsies (sextant + 4 laterals) obtained from each patient. Biopsy specimens were evaluated for diagnosis, presence of fragmentation, lack of tissue, different tissue types and small biopsy (core length < 5mm) rates.
needle. Both needles had a stroke length of 22 mm and a cutting length of 19 mm.
RESULTS: The groups were similar according to the mean patient age, mean PSA value and mean prostate volume (p> 0.05 for all). Empty biopsy rates and small tissue obtaining rates were lower in 16 gauge groups than in 18 gauge groups (p< 0.05). There was no statistically significant difference in fragmentation rates between the groups (Table 1).
Data were analysed separately for sextant and ten-core biopsy.
TABLE I: Specimen quality for analysis
using an 18 gauge needle. Then this ten-core biopsy was repeated using a 16 gauge
16 gauge (Mean cores %)
18 gauge (Mean cores %)
Fragmentation
25.9
32.9
0.08
Different tissue
0.71
0.48
0.66
Empty biopsy
0.71
2.9
0.04
Tissue< 5 mm long
2.85
11.46
0.00
RESULTS: Sextant biopsy and 18 gauge needle found 21 (58.3%) cancers whereas
Criteria
sextant technique and 16 gauge needle found 29 (80.5%) cancers. Difference is significant (p=0.002). 4 biopsies out of the lateral parts of the prostate using 18 gauge needle found 14 tumours, 7 were additional tumours. Therefore ten-core biopsy using 18 gauge needle revealed 28 (77.8%) tumours. 4 biopsies out of the lateral parts of the prostate using 16 gauge needle found 15 tumours, 3 were additional tumours. Therefore ten-core biopsy using 16 gauge needle revealed 32 (88.9%) tumours. In this ex vivo model the use of a 16 gauge needle resulted in a 14.3% better cancer detection (p= 0.05). CONCLUSIONS: Using thicker 16 gauge needle for prostate biopsy is able to improve cancer detection. Eur Urol Suppl 2006;5(2):312
P*
* Mann-Whitney U test Overall there was no significant difference between groups 1 and 2 on Pca detection rates (p >0.05). When the patients were evaluated according to digital rectal examination (DRE) findings, prostatic volumes and different prostate specific antigen (PSA) ranges, Pca detection rates of the groups were also found similar (p>0.05 for all). CONCLUSIONS: Retrieving more tissue with thicker needle in biopsy procedure was not found more effective for increasing Pca detection rates than using standard calibre needle by taking 10 cores. However, the similarity in morbidity and patient discomfort between the groups and opportunity of getting better and more tissue with 16 gauges than 18 gauge needles can give a good chance for better pathologic analysis.
University-Hospital Munich - Großhadern, Dept of Urology, Munich, Germany, 2 Bavarian Working Group for Quality Assurance (BAQ), Urology Section, Munich, Germany INTRODUCTION & OBJECTIVES: Suprapubic prostatectomy has been the primary option for patients with significantly enlarged prostate glands due to benign prostatic hyperplasia (BPH) for decades. With regard to new transurethral techniques it still represents the standard technique in the majority of patients with essential symptomatic benign prostatic enlargement. In a prospective multicentre study we analysed complications and immediate postoperative outcomes of open suprapubic prostatectomy. MATERIAL & METHODS: A total of 645 patients (average age 74.2 years) were evaluated prospectively undergoing suprapubic prostatectomy in the state of Bavaria, Germany in 2003. 54 parameters concerning preoperative status, operation details, complications and immediate outcome were documented for each patient. Complete data were available for 620 individuals.
P70 PROSTATE CANCER: BIOPSY ISSUES II Friday, 7 April, 15.45-17.15, Room Concorde 1 / Level 4 1158 DEFINITIVE HISTOLOGICAL DIAGNOSIS ON PROSTATE BIOPSIES IN 3 HOURS: THE FIRST-YEAR EXPERIENCE Nava L.D.1, Freschi M.2, Doglioni C.2, Losa A.1, Scapaticci E.1, Maga T.1, Rigatti P.3, Guazzoni G.1 1
Hospital San Raffaele Turro, Urology, Milan, Italy, 2Hospital San Raffaele, Pathology, Milan, Italy, 3Hospital San Raffaele, Urology, Milan, Italy
INTRODUCTION & OBJECTIVES: Aim of this study was to prospectively evaluate the efficacy and reproducibility of quickly processing prostate core needle biopsies with RHS1®, an automated microwave- vacuum processor. MATERIAL & METHODS: From July 2004 to July 2005 a total of 364 consecutive prostate biopsies were performed for Pca detection in men with PSA levels between 2.5 and 14 ng/ml. The biopsies (mean core number 20, range 14-24) were stretched between two sponges in tissue cassettes, fixed in formalin 4% solution, processed with RHS1® (xylene-free), embedded in paraffin, cut at 3 μ and then stained with Hematoxylin-Eosin. Processing time, as well as time to final histological report, detection rate and percentage of further evaluations required were recorded; furthermore those results were prospectively compared with those registered in a concomitant series of 351 prostate biopsies performed in a similar series of patients, with the same sample technique, in the same period, but processed with the traditional method. Histop athological evaluations were performed by a single pathologist.
RESULTS: 96.1 percent of the men presented with a prostate volume of more than 50 grams, maximal urinary flow was less than 15 ml/s in 87, 4 percent of the patients. 39.4 percent of the patients suffered acute urinary retention before surgery. The most relevant complications were significant urinary tract infection (6.3 percent), surgical revision (5.9 percent), bleeding requiring transfusions (3.9 percent) and failure to void (3.1 percent). The mortality rate for open prostatectomy was 0.2 percent. The resected tissue averaged 81.3 grams. Histologically, incidental carcinoma of prostate was diagnosed in 3.8 percent of the patients.
RESULTS: The overall detection rate for both groups (RHS1® - processed biopsies vs. biopsies traditionally processed) was similar 41% of Pca for both group, 20% of HGPIN vs. 18%, 2.2% of ASAP vs. 2.8%. A comparable quality evaluation was given by the pathologist for both groups, confirmed at an intradepartmental review. No differences in core lengths were recorded pre- and post-processing. The automatic processing time was 75 minutes vs. 14 hours, whereas the time to the definitive diagnosis was 190 minutes (range 145-260) vs. 24 hours. A quick diagnosis was performed in 347/364 pts (95%). In 17 pts additional immunohistochemical evaluations were successively performed without any modification of routinely used methods. All patients could conclude in the same day the diagnostic and staging process.
CONCLUSIONS: In a large-scale, multicentre prospective study including 44 urologic departments in Bavaria, prospective data concerning complications and early postoperative outcome in patients treated with suprapubic prostatectomy was generated. This data yields relevant information for urologists in decision making for the appropriate surgical option in patients with significant benign enlargement of the prostate.
CONCLUSIONS: The first year experience confirms the validity of this new automated microwave- vacuum device to process in a short time prostate biopsies. RHS1® resulted at least as effective as the traditional processing method and could guarantee a new time-effective standard to spare time, costs and stress for the patients. Being a xylene-free method, handling of the specimens is simplified and safer. RHS1® allows a better quality of service with a oneday diagnosis.
1159 EVALUATION OF 16-GAUGE NEEDLE FOR PROSTATE BIOPSY Fink K., Hutarew G., Szlauer R., Goetschl R., Schmeller N.T. Salzburger Landeskliniken, Urologie, Salzburg, Austria INTRODUCTION & OBJECTIVES: Aim of the study was to evaluate the efficiency of a prostate biopsy using 16 gauge needle in comparison to standard 18 gauge. MATERIAL & METHODS: A total of 36 specimens after radical prostatectomy were used and two sets of prostate biopsies were performed on each specimen with ultrasound guidance. First a ten-core biopsy that adds four cores from the far lateral areas of the prostate to the commonly used sextant biopsy was performed
1160 INFLUENCE OF USING 16-GAUGE NEEDLE ON PROSTATE CANCER DETECTION RATE IN TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY Inal G., Onur K., Tas M., Oztekin V., Kosan M., Ozturk B. Ankara Numune Education and Research Hospital, 2nd Urology, Ankara, Turkey INTRODUCTION & OBJECTIVES: In the present study, we compared the prostate cancer (Pca) detection rates and performances of 18 gauge and thicker 16 gauge needles with morbidity rates. MATERIAL & METHODS: Patients (n= 140) were randomised into two groups. In-group 1 (n=70), biopsies were obtained with 16 gauge needles while in-group 2 (n=70) 18 gauge needles were used for the biopsies. With the guidance of transrectal ultrasound (TRUS), systematic 10 core prostate biopsies (sextant + 4 laterals) obtained from each patient. Biopsy specimens were evaluated for diagnosis, presence of fragmentation, lack of tissue, different tissue types and small biopsy (core length < 5mm) rates.
needle. Both needles had a stroke length of 22 mm and a cutting length of 19 mm.
RESULTS: The groups were similar according to the mean patient age, mean PSA value and mean prostate volume (p> 0.05 for all). Empty biopsy rates and small tissue obtaining rates were lower in 16 gauge groups than in 18 gauge groups (p< 0.05). There was no statistically significant difference in fragmentation rates between the groups (Table 1).
Data were analysed separately for sextant and ten-core biopsy.
TABLE I: Specimen quality for analysis
using an 18 gauge needle. Then this ten-core biopsy was repeated using a 16 gauge
16 gauge (Mean cores %)
18 gauge (Mean cores %)
Fragmentation
25.9
32.9
0.08
Different tissue
0.71
0.48
0.66
Empty biopsy
0.71
2.9
0.04
Tissue< 5 mm long
2.85
11.46
0.00
RESULTS: Sextant biopsy and 18 gauge needle found 21 (58.3%) cancers whereas
Criteria
sextant technique and 16 gauge needle found 29 (80.5%) cancers. Difference is significant (p=0.002). 4 biopsies out of the lateral parts of the prostate using 18 gauge needle found 14 tumours, 7 were additional tumours. Therefore ten-core biopsy using 18 gauge needle revealed 28 (77.8%) tumours. 4 biopsies out of the lateral parts of the prostate using 16 gauge needle found 15 tumours, 3 were additional tumours. Therefore ten-core biopsy using 16 gauge needle revealed 32 (88.9%) tumours. In this ex vivo model the use of a 16 gauge needle resulted in a 14.3% better cancer detection (p= 0.05). CONCLUSIONS: Using thicker 16 gauge needle for prostate biopsy is able to improve cancer detection. Eur Urol Suppl 2006;5(2):312
P*
* Mann-Whitney U test Overall there was no significant difference between groups 1 and 2 on Pca detection rates (p >0.05). When the patients were evaluated according to digital rectal examination (DRE) findings, prostatic volumes and different prostate specific antigen (PSA) ranges, Pca detection rates of the groups were also found similar (p>0.05 for all). CONCLUSIONS: Retrieving more tissue with thicker needle in biopsy procedure was not found more effective for increasing Pca detection rates than using standard calibre needle by taking 10 cores. However, the similarity in morbidity and patient discomfort between the groups and opportunity of getting better and more tissue with 16 gauges than 18 gauge needles can give a good chance for better pathologic analysis.