UROLOGICAL SURVEY
Urological Oncology
Prostate cancer detection rate in patients with repeated extended 21-sample needle biopsy
Campos-Fernandes JL, Bastien L, Nicolaiew N, Robert G, Terry S, Vacherot F, Salomon L, Allory Y, Vordos D, Hoznek A, Yiou R, Patard JJ, Abbou CC, de la Taille A
Department of Urology, CHU Mondor, Créteil, France
Eur Urol. 2009; 55: 600-6
BACKGROUND: Prevalence of prostate cancer (PCa) after a negative first extended prostate needle biopsy protocol is unknown.
Objective: To evaluate the prevalence of significant PCa in patients who have had a negative first extended prostate biopsy protocol.
DESIGN, SETTING, AND PARTICIPANTS: Between March 2001 and May 2007, 2500 consecutive patients underwent an extended protocol of 21 biopsies. Of 953 patients who had a negative first extended prostate biopsy procedure, 231 patients underwent a second or more set of 21-core biopsies. Indications for repeated biopsies were persistently elevated prostate-specific antigen (PSA), PSA increase during the follow-up, or prior prostatic intraepithelial neoplasia (PIN), or atypical small acinar proliferation (ASAP). INTERVENTION: All participants underwent at least two extended prostate needle biopsy protocols.
MEASUREMENTS: Clinical and pathologic factors (age, PSA, PSA doubling time, PIN, ASAP, digital rectal exam DRE) were analyzed for their ability to predict positive biopsy, and tumour parameters were assessed in patients undergoing radical prostatectomy.
RESULTS AND LIMITATIONS: Second, third, and fourth extended 21-sample biopsy procedures yielded a diagnosis of PCa in 18%, 17%, and 14% of patients respectively. Patients with prior PIN had 16% risk of prostate cancer; patients with ASAP had a 42% risk. The mean number of positive cores was 2.19. Prostate volume and PSA density were statistically significant predictors of positive biopsy (p<0.05). For the 43 patients who underwent radical prostatectomy, pathologic findings revealed mean Gleason score of 6.7 (6-8), pT2a-c in 72%, pT3a in16%, and pT4 in 7%. Mean cancer volume was 1.15 cc and 85.2% of tumours were clinically significant (tumour volume > 0.5 cc, Gleason > or = 7 and/or pT3).
CONCLUSIONS: Negative first extended biopsies should not reassure a patient of not having PCa. However, prostate cancers detected after two or more sets of extended procedures, appear to be localized (intracapsular disease) and well-differentiated prostate cancers, although they are still clinically significant.
Editorial Comment
The authors report on a large series of extended 21-sample needle biopsies in 2500 consecutive patients with suspect prostate cancer.
There are several interesting issues for the clinician. First, this procedure was done in an outpatient 2-hour setting with local anesthesia. Next, the results show that with each new round of biopsies roughly 15% of cancers are detected (18%, 17%, 14% for the second, third and forth biopsy procedure, respectively). This leads to the conclusion that in case of continued suspicion the urologist and his/her patient should not give up. Notably, most of these cancers were significant (82.5%). Of the 58 cancers diagnosed, 65% had PSA levels between 4 and 10 ng/ml. Seventy-six percent and 10% had biopsy Gleason sum 6 and 7a (3+4), respectively. Interestingly, of those 43 patients from this group who underwent radical prostatectomy 30% had Gleason sum score 6 and roughly 60% had Gleason sum score 7a, again suggesting an undergrading in core biopsies.
There are much more details and I recommend the paper for reading.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de
Publication Dates
-
Publication in this collection
07 Dec 2009 -
Date of issue
Oct 2009
