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Prognostic significance of single positive prostatic biopsy core
513 1sMICRO
FOCAL CANCER ON PROSTATE BIOPSY PREDICTIVE ON “INSIGNIFICANT CANCER” ON RADICAL PROSTATECTOMY SPECIMEN?
514 PROGNOSTIC
SIGNIFICANCE
OF SINGLE
L.‘, Ravery V.‘. Toublanc
PROSTATIC
BIOPSY CORE Mever G.‘, Sabo E.‘, Wald M.‘, Moskovitz
Dumonceau O.‘, Nicolas Boccon-Gibod L.M.’
POSITIVE
B.‘, Nativ 0.’
M.:, Boccon Gibod L.L.‘, ‘Bnai-Zion
1CHU Bichat, Urology, Paris, France, ‘CHU Bichat, Pathology, Hopita Trousseau, Pathology, Paris, France
Paris, France,
Medical
Center, Urology,
INTRODUCTION
INTRODUCTION & OBJECTIVES: To determine to which extent the features of microfocal prostate cancer (Cap) on prostate biopsies (Bx) are predictive on “insignificant CaP” in the radical prostatectomy specimen.
TRUS guided
& OBJECTIVES:
biopsy,
without
account for an increasing with the prognostic
Medical
Prostate cancer diagnosis
significance
has been recently
Center,
94 men who have undergone
were included
in the study. The preoperative
pathological
correlated
findings
to
have dealt
of a single positive biopsy core.
& METHODS:
were
reported
of the number of positive biopsy cores. This significance
MATERIAL findings
based upon
of cases. Several investigations
prostatectomy
with
the final
in patients
surgical
with a single
radical retropubic prostate
pathological positive
biopsy
report.
biopsy
The
core were
compared to those with two or more positive cores. RESULTS:
RESULTS: The mean tumour volume was 0.89 ml (0.003-4.68) 17 pts had a tumour volume ~0.5 ml. 4 pts were upstaged to pT3, 25 upgraded to Gleason over or equal to 7, 33 had multifocal disease, in 30 cancer was present in the contra lateral lobe with Gleason grade 4 tumour in 6 cases. In the 27 patients with a PSA less than 10, these figures were respectively: 2 upstaged to PT3, 16 upgraded to Gleason equal or over 7, 23 multifocal and 21 bilateral turnours.
Israel, Carmel
DRE findings
proportion
study evaluated the prognostic MATERIAL & METHODS: From 1998 to 2002, 445 patients with clinically localized prostate cancer were treated by radical prostatectomy (RP). Among those patients, 38 (TIC 29, T2 a: 9) had in a set of 6 or 10 transrectal ultrasound guided biopsy (TRUS Bx) of the prostate, one single focus of Ca Gleason less than 6, measuring less than 3 mm. Their median serum prostatic specific antigen (PSA) was 8.5 ngiml (range 1.1-35). In 27 pts, PSA was less than IO ng/ml. RP specimens were evaluated according to the Stanford protocol.
Haifa,
Pathology, Haifa, Israel
Single positive biopsy core was found in 26 out of 94 patients. In
this group, prostatic cancer grade determined
by biopsy significantly
correlated
with the grade in the final surgical specimen (P=O.O15). Tumour multifocality, positive surgical margins, and seminal vesicles involvement
were similar in the
single positive core group and the other patients. On the other hand, capsular penetration
was found to be lower in the single positive core group
(I 5%, vs.
32% in the other patients, P=O.O44). CONCLUSIONS: In the absence of an efficient imaging technique able to dooument the actual cancer volume, it is not possible today to rely on PSA and biopsy features to predict accurately the presence of an insignificant prostate cancer. If on biopsy features, bad news are always bad, good news may not be as good as one would like to think so!
CONCLUSIONS:
Prostatic
cancer
grade,
determined
by a single
positive
biopsy core (out of 6- 12 cores) was found to provide reliable information the tumour. A single positive preoperative Icston, but is associated
with lower rate of capsular penetration.
515
516
DO IMPALPABLE PROSTATE CANCERS NOT VISIBLE ON TRANSRECTAL ULTRASOUND DIFFER FROM THOSE VISIBLE?
DISTRIBUTION OF PROSTATE CARCINOMA FOCI - ANALYSIS 8062 PROSTATE BIOPSY CORES IN A VIRTUAL PROSTATE
Hammerer P.‘, Augustin H Graefen Erbersdobler A.‘. Huland H.’
Brossner C.‘. Winterholer A.‘, Roehlich M.‘, Dlouhy-SchiitL Sonnleithner M.‘, Grubmiiller K.“, Pummer K.‘, Schuster E.”
M.‘. Palisaar J.‘, llacsc A ‘. Blonski J.
‘University of Hamburg, Dept. of Urology, Hamburg, Germany. ‘Karl-FranzensUniversity Graz, Dept. of Urology, Graz, Austria, ‘University of Hamburg, Institute of Pathology. University of Hamburg, Germany INTRODUCTION & OBJECTIVES: Tic prostate cancers are defined as those tumours, which are identified by needle biopsy (e.g., because of elevated PSA), but not palpable or visible by imaging. However, most urologists will consider impalpable cancers regardless of the findings on transrectal ultrasound (TRUS) as Tic turnours. To determine the value of TRUS for clinical staging, we analysed impalpable cancers due to their findings on TRUS. MATERIAL & METHODS: We analysed 2392 patients, who had undergone radical prostatectomy for localized prostate cancer between 1992 and 2002. Overall, 992 men had an impalpable tumour on digital rectal examination. These turnout-s were divided by normal and abnormal findings on TRUS in two groups. Abnormal findings on TRUS were defined as the presence of hypoechoic areas in the peripheral zone, irregularity of the prostatic capsule and loss of the normal anatomy at the junction of the seminal vesicles. Both groups were compared for differences in clinical (PSA) and pathological (pre- and postoperative Gleason score, pathological stage and cancer volume of the specimen) factors using the ttest as well as chi-square test.
about
biopsy core does not obviate a solitary
OF
E.‘, Serra V.-,
Oberwart Hospital, Urology, Oberwart, Austria, ‘SMZ-Ost, Urology, Vienna, Austria. ‘Mistelbach Hospital, Urology, Mistelbach, Austria, ‘Bozen Hospital, Urology, BolzanolBoren, Italy, ‘Hanusch Hospital, Urology, Vienna, Austria. ‘Krcms Hospital, Urology, Krems, Austria, University of Grar, Urology, Graz, Austria, “University of Vienna, IMC. Vienna, Austria INTRODUCTION & OBJECTIVES: Prostate cancer (PC) is a multifocal disease in most cases and a better understanding of PC distribution pattern might improve PC detection rate by systematic biopsies. Aim of our study was therefore to evaluate the prostate cancer distribution pattern as assessed by systematic transrectal ultrasound guided biopsies in a prostate model. MATERIAL & METHODS: In this prospective, multicentcr study a consecutive series of men who underwent transrectal ultrasound guided prostate biopsies using different biopsy techniques at 6 institutions were included. A prostate model with 20 sectors of similar volume was established and the biopsy cores obtained wcrc associated with these sectors and analysed with respect to PC detection rate.
RESULTS: Overall, 442 (46.9%) men showed normal findings and 500 men (53.1%) abnormal on TRUS. Patients with normal findings had significantly more Gleason scores 56 in the biopsies (81.4% vs. 71.6%; p=O.OOl) as well in the prostatectomy specimens (64.2% vs. 50.8%; p
RESULTS: 904 men (mean 66.8 yrs range 42-86) with a median serum PSA of X.I ng/ml (2.2-940ng/ml) entered this study. A total of 8062 biopsy cores (mean 8.92/patient) were obtained. Each of the peripheral zone sectors hit by biopsies yielded a similar percentage of prostate cancer (p=O.6). There was no increase of cancer toward the lateral sectors compared to midline sectors (p=O.53) of the peripheral zone. Biopsies sampling the peripheral zone from the apex to the base yielded a similar percentage of prostate cancer too (p=O.47).
CONCLUSIONS: Impalpable prostate cancers with normal findings on TRUS differ significantly in favour from those with abnormal findings in pre- and postoperative Gleason score, pathological stage and cancer volume of the prostatectomy specimen. Therefore, TRUS is a valuable tool to refine the staging of impalpable prostate cancers.
CONCLUSIONS: Our data suggest that distribution of cancer foci detected by biopsies in the peripheral zone of the prostate is homogeneous. To increase PC cancer detection rate, a homogenous sampling of the peripheral zone with an increasmg number of biopsy cores seems to be superior to a sampling of certain prostatic regions. European
Urology Supplements
2 (2003) No. 1, pp. 131
FOCAL CANCER ON PROSTATE BIOPSY PREDICTIVE ON “INSIGNIFICANT CANCER” ON RADICAL PROSTATECTOMY SPECIMEN?
514 PROGNOSTIC
SIGNIFICANCE
OF SINGLE
L.‘, Ravery V.‘. Toublanc
PROSTATIC
BIOPSY CORE Mever G.‘, Sabo E.‘, Wald M.‘, Moskovitz
Dumonceau O.‘, Nicolas Boccon-Gibod L.M.’
POSITIVE
B.‘, Nativ 0.’
M.:, Boccon Gibod L.L.‘, ‘Bnai-Zion
1CHU Bichat, Urology, Paris, France, ‘CHU Bichat, Pathology, Hopita Trousseau, Pathology, Paris, France
Paris, France,
Medical
Center, Urology,
INTRODUCTION
INTRODUCTION & OBJECTIVES: To determine to which extent the features of microfocal prostate cancer (Cap) on prostate biopsies (Bx) are predictive on “insignificant CaP” in the radical prostatectomy specimen.
TRUS guided
& OBJECTIVES:
biopsy,
without
account for an increasing with the prognostic
Medical
Prostate cancer diagnosis
significance
has been recently
Center,
94 men who have undergone
were included
in the study. The preoperative
pathological
correlated
findings
to
have dealt
of a single positive biopsy core.
& METHODS:
were
reported
of the number of positive biopsy cores. This significance
MATERIAL findings
based upon
of cases. Several investigations
prostatectomy
with
the final
in patients
surgical
with a single
radical retropubic prostate
pathological positive
biopsy
report.
biopsy
The
core were
compared to those with two or more positive cores. RESULTS:
RESULTS: The mean tumour volume was 0.89 ml (0.003-4.68) 17 pts had a tumour volume ~0.5 ml. 4 pts were upstaged to pT3, 25 upgraded to Gleason over or equal to 7, 33 had multifocal disease, in 30 cancer was present in the contra lateral lobe with Gleason grade 4 tumour in 6 cases. In the 27 patients with a PSA less than 10, these figures were respectively: 2 upstaged to PT3, 16 upgraded to Gleason equal or over 7, 23 multifocal and 21 bilateral turnours.
Israel, Carmel
DRE findings
proportion
study evaluated the prognostic MATERIAL & METHODS: From 1998 to 2002, 445 patients with clinically localized prostate cancer were treated by radical prostatectomy (RP). Among those patients, 38 (TIC 29, T2 a: 9) had in a set of 6 or 10 transrectal ultrasound guided biopsy (TRUS Bx) of the prostate, one single focus of Ca Gleason less than 6, measuring less than 3 mm. Their median serum prostatic specific antigen (PSA) was 8.5 ngiml (range 1.1-35). In 27 pts, PSA was less than IO ng/ml. RP specimens were evaluated according to the Stanford protocol.
Haifa,
Pathology, Haifa, Israel
Single positive biopsy core was found in 26 out of 94 patients. In
this group, prostatic cancer grade determined
by biopsy significantly
correlated
with the grade in the final surgical specimen (P=O.O15). Tumour multifocality, positive surgical margins, and seminal vesicles involvement
were similar in the
single positive core group and the other patients. On the other hand, capsular penetration
was found to be lower in the single positive core group
(I 5%, vs.
32% in the other patients, P=O.O44). CONCLUSIONS: In the absence of an efficient imaging technique able to dooument the actual cancer volume, it is not possible today to rely on PSA and biopsy features to predict accurately the presence of an insignificant prostate cancer. If on biopsy features, bad news are always bad, good news may not be as good as one would like to think so!
CONCLUSIONS:
Prostatic
cancer
grade,
determined
by a single
positive
biopsy core (out of 6- 12 cores) was found to provide reliable information the tumour. A single positive preoperative Icston, but is associated
with lower rate of capsular penetration.
515
516
DO IMPALPABLE PROSTATE CANCERS NOT VISIBLE ON TRANSRECTAL ULTRASOUND DIFFER FROM THOSE VISIBLE?
DISTRIBUTION OF PROSTATE CARCINOMA FOCI - ANALYSIS 8062 PROSTATE BIOPSY CORES IN A VIRTUAL PROSTATE
Hammerer P.‘, Augustin H Graefen Erbersdobler A.‘. Huland H.’
Brossner C.‘. Winterholer A.‘, Roehlich M.‘, Dlouhy-SchiitL Sonnleithner M.‘, Grubmiiller K.“, Pummer K.‘, Schuster E.”
M.‘. Palisaar J.‘, llacsc A ‘. Blonski J.
‘University of Hamburg, Dept. of Urology, Hamburg, Germany. ‘Karl-FranzensUniversity Graz, Dept. of Urology, Graz, Austria, ‘University of Hamburg, Institute of Pathology. University of Hamburg, Germany INTRODUCTION & OBJECTIVES: Tic prostate cancers are defined as those tumours, which are identified by needle biopsy (e.g., because of elevated PSA), but not palpable or visible by imaging. However, most urologists will consider impalpable cancers regardless of the findings on transrectal ultrasound (TRUS) as Tic turnours. To determine the value of TRUS for clinical staging, we analysed impalpable cancers due to their findings on TRUS. MATERIAL & METHODS: We analysed 2392 patients, who had undergone radical prostatectomy for localized prostate cancer between 1992 and 2002. Overall, 992 men had an impalpable tumour on digital rectal examination. These turnout-s were divided by normal and abnormal findings on TRUS in two groups. Abnormal findings on TRUS were defined as the presence of hypoechoic areas in the peripheral zone, irregularity of the prostatic capsule and loss of the normal anatomy at the junction of the seminal vesicles. Both groups were compared for differences in clinical (PSA) and pathological (pre- and postoperative Gleason score, pathological stage and cancer volume of the specimen) factors using the ttest as well as chi-square test.
about
biopsy core does not obviate a solitary
OF
E.‘, Serra V.-,
Oberwart Hospital, Urology, Oberwart, Austria, ‘SMZ-Ost, Urology, Vienna, Austria. ‘Mistelbach Hospital, Urology, Mistelbach, Austria, ‘Bozen Hospital, Urology, BolzanolBoren, Italy, ‘Hanusch Hospital, Urology, Vienna, Austria. ‘Krcms Hospital, Urology, Krems, Austria, University of Grar, Urology, Graz, Austria, “University of Vienna, IMC. Vienna, Austria INTRODUCTION & OBJECTIVES: Prostate cancer (PC) is a multifocal disease in most cases and a better understanding of PC distribution pattern might improve PC detection rate by systematic biopsies. Aim of our study was therefore to evaluate the prostate cancer distribution pattern as assessed by systematic transrectal ultrasound guided biopsies in a prostate model. MATERIAL & METHODS: In this prospective, multicentcr study a consecutive series of men who underwent transrectal ultrasound guided prostate biopsies using different biopsy techniques at 6 institutions were included. A prostate model with 20 sectors of similar volume was established and the biopsy cores obtained wcrc associated with these sectors and analysed with respect to PC detection rate.
RESULTS: Overall, 442 (46.9%) men showed normal findings and 500 men (53.1%) abnormal on TRUS. Patients with normal findings had significantly more Gleason scores 56 in the biopsies (81.4% vs. 71.6%; p=O.OOl) as well in the prostatectomy specimens (64.2% vs. 50.8%; p
RESULTS: 904 men (mean 66.8 yrs range 42-86) with a median serum PSA of X.I ng/ml (2.2-940ng/ml) entered this study. A total of 8062 biopsy cores (mean 8.92/patient) were obtained. Each of the peripheral zone sectors hit by biopsies yielded a similar percentage of prostate cancer (p=O.6). There was no increase of cancer toward the lateral sectors compared to midline sectors (p=O.53) of the peripheral zone. Biopsies sampling the peripheral zone from the apex to the base yielded a similar percentage of prostate cancer too (p=O.47).
CONCLUSIONS: Impalpable prostate cancers with normal findings on TRUS differ significantly in favour from those with abnormal findings in pre- and postoperative Gleason score, pathological stage and cancer volume of the prostatectomy specimen. Therefore, TRUS is a valuable tool to refine the staging of impalpable prostate cancers.
CONCLUSIONS: Our data suggest that distribution of cancer foci detected by biopsies in the peripheral zone of the prostate is homogeneous. To increase PC cancer detection rate, a homogenous sampling of the peripheral zone with an increasmg number of biopsy cores seems to be superior to a sampling of certain prostatic regions. European
Urology Supplements
2 (2003) No. 1, pp. 131