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The role of transrectal saturation biopsy in tumour localization: pathological correlation after retropubic radical prostatectomy and implication for focal ablative therapy
Author(s) -
Abdollah Firas,
Scattoni Vincenzo,
Raber Marco,
Roscigno Marco,
Briganti Alberto,
Suardi Nazareno,
Gallina Andrea,
Capitanio Umberto,
Freschi Massimo,
Salonia Andrea,
Cestari Andrea,
Guazzoni Giorgio,
Rigatti Patrizio,
Montorsi Francesco
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09876.x
Subject(s) - ablative case , radical retropubic prostatectomy , medicine , pathological , prostatectomy , urology , biopsy , prostate , radiology , radiation therapy , cancer
Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? The traditional transrectal sextant and extended biopsy schemes demonstrated low accuracy in predicting unilateral prostate cancer on radical prostatectomy specimens. We examined the accuracy of an initial saturation biopsy (24‐core) to predict unilateral prostate cancer on radical prostatectomy specimens. OBJECTIVE• To evaluate the accuracy of an initial 24‐core prostate biopsy scheme (PBx24) in predicting unilateral prostate cancer (PCa) in radical prostatectomy (RP) specimens.PATIENTS AND METHODS• Between 2005 and 2008, 203 consecutive patients underwent PBx24 followed by RP for PCa. The area under the curve (AUC) was used to evaluate the accuracy of unilateral PCa on PBx24 to predict unilateral PCa in RP specimens. • The positive predictive value (PPV) and negative predictive value (NPV) were also calculated. Moreover, in patients with unilateral PCa on biopsy, univariable and multivariable logistic regression analyses tested the relationship between the presence of unilateral PCa in an RP specimen and the variables: age, prostate‐specific antigen (PSA), total prostate volume, clinical stage, primary Gleason grade, secondary Gleason grade and the number of positive cores.RESULTS• PCa cores were unilateral in 115 patients (56.7%) on biopsy. Of those, only 26 (22.6%) had unilateral PCa in the RP specimen (AUC, 72.9%; PPV, 22.6%; NPV, 98.8%). In patients with clinically low‐risk tumours, only 17 of 63 (27%) had a unilateral PCa on PBx24 and in the RP specimen (AUC, 59.1%; PPV, 27.0%; NPV, 100.0%). • None of the examined variables was an independent predictor of the presence of unilateral PCa in the RP specimen (all P > 0.05).CONCLUSIONS• Initial PBx24 is not sufficiently accurate to be dependable as a method of predicting tumour laterality in RP specimens. Therefore, the use of PBx24 to guide hemi‐ablation therapy of PCa may lead to mistreatment in a considerable proportion of patients. • Moreover, none of the routinely available clinical and pathological characteristics appears to improve the ability of unilateral PCa on biopsy to predict unilateral PCa in the RP specimen.