Abstract
Objectives
Since accurate tumor localization and quantification are essential requisites avoiding prostate cancer overtreatment, we analyzed the impact of core fragmentation and the relation between core biopsy taken and pathological information in regard to cancer extension and aggressiveness (Gleason score).
Methods
One hundred and ninety-nine men submitted to trans-rectal prostate biopsy by the same urologist between October 2006 and October 2008 were included, and the number of cores obtained by biopsy compared to the number of cores examined by the same pathologist.
Results
Total core number obtained by biopsy was 21.54 (±3.56) compared to 24.08 (±4.77) examined by the pathologist, P < 0.01. Dividing prostate gland by areas such as base, mid and apical right and left, all areas showed statistically different core number between biopsy and pathological examination report (P < 0.01). Mean ratio of positive core cancer length was 0.41 (±0.12) and 0.32 (±0.8) comparing individual and overall cores analysis, respectively (P < 0.01). The mean Gleason score in the individual and overall cores analysis were 6.6 (6–9) and 6.3 (6–9), respectively, P < 0.01.
Conclusions
Considering the ongoing trend for earlier diagnosis of increasing numbers of younger men with low-risk prostate cancer, this study is original and demonstrates the possibility of core fragmentation, explaining in part over- and under-staging. One core per container and an overall Gleason score and percentage of adenocarcinoma for each container are encouraged.
Similar content being viewed by others
References
Eggener SE, Scardino PT, Carroll PR et al (2007) Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol 178:2260–2267
Stamey TA (1995) Making the most out of six systematic sextant biopsies. Urology 45:2–12
Presti JC Jr, Chang JJ, Bhargava V et al (2000) The optimal systematic prostate biopsy scheme should include eight rather than six biopsies: results of a prospective clinical trial. J Urol 163:163–167
Eskicorapci SY, Guliyev F, Akdogan B et al (2005) Individualization of the biopsy protocol according to the prostate gland volume for prostate cancer detection. J Urol 173:1536–1540
O’Connell MJ, Smith CS, Fitzpatrick PE et al (2004) et Transrectal ultrasound-guided biopsy of the prostate gland: value of 12 vs. 6 cores. Abdom Imag 29:132–136
Inahara M, Suzuki H, Kojima S et al (2006) Improved prostate cancer detection using systematic 14-core biopsy for large prostate glands with normal digital rectal examination findings. Urology 68:815–819
Ubhayakar GN, Li WY, Corbishley CM et al (2002) Improving glandular coverage during prostate biopsy using a long-core needle: technical performance of an end-cutting needle. BJU Int 89:40–43
Dogan HS, Eskicorapci SY, Ertoy-Baydar D et al (2005) Can we obtain better specimens with an end-cutting prostatic biopsy device? Eur Urol 47:297–301
Häggarth L, Ekman P, Egevad L (2002) A new core-biopsy instrument with an end-cut technique provides prostate biopsies with increased tissue yield. BJU Int 90:51–55
Ozden E, Göğüş C, Tulunay O, Baltaci S (2004) The long core needle with an end-cut technique for prostate biopsy: does it really have advantages compared with standard needles? Eur Urol 45:287–291
Brimo F, Vollmer RT, Corcos J et al (2008) Prognostic value of various morphometric measurements of tumour extent in prostate needle core tissue. Histopathology 53:177–183
Sebo TJ, Bock BJ, Cheville JC, Lohse C, Wollan P, Zincke H (2000) The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol 163:174–178
Cheng L, Jones TD, Pan CX et al (2005) Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens. Mod Pathol 18:1022–1026
Moore RA (1935) The morphology of small prostatic carcinomas. J Urol 33:224–234
Goto Y, Ohori M, Arakawa A et al (1996) Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. J Urol 156:1059–1063
Wise AM, Stamey TA, McNeal JE et al (2002) Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology 60:264–269
Kattan MW, Shariat SF, Andrews B et al (2003) The addition of interleukin-6 soluble receptor and transforming growth factor beta1 improves a preoperative nomogram for predicting biochemical progression in patients with clinically localized prostate cancer. J Clin Oncol 21:3573–3579
Graefen M, Karakiewicz PI, Cagiannos I et al (2002) International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy. J Clin Oncol 20:3206–3212
Gardiner RA, Hamdy FC (2008) Management of low-risk prostate cancer. World J Urol 26:411–414
Epstein JI, Walsh PC, Carmichael M et al (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 271:368–374
D’Amico AV, Whittington R, Malkowicz SB et al (2000) Clinical utility of the percentage of positive prostate biopsies in defining biochemical outcome after radical prostatectomy for patients with clinically localized prostate cancer. J Clin Oncol 18:1164–1172
Freedland SJ, Terris MK, Csathy GS et al (2004) Preoperative model for predicting prostate specific antigen recurrence after radical prostatectomy using percent of biopsy tissue with cancer, biopsy Gleason grade and serum prostate specific antigen. J Urol 171:2215–2220
Epstein JI, Allsbrook WC, Amin MB, Egevad LL, the ISUP Grading Committee (2005) The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 29:1228–1242
Fajardo DA, Epstein JI (2009) Fragmentation of prostatic needle biopsy cores containing adenocarcinoma: the role of specimen submission. BJU Int. Epub ahead of print 2009. doi: 10.1111/j.1464-410X.2009.08737.x
Gupta C, Ren JZ, Wojno KJ (2004) Individual submission and embedding of prostate biopsies decreases rates of equivocal pathology reports. Urology 63:83–86
Author information
Authors and Affiliations
Corresponding author
Additional information
Take Home Message: Core biopsy fragmentation is not uncommon and can lead to prostate cancer up-staging and overtreatment.
Rights and permissions
About this article
Cite this article
Reis, L.O., Reinato, J.A.S., Silva, D.C. et al. The impact of core biopsy fragmentation in prostate cancer. Int Urol Nephrol 42, 965–969 (2010). https://doi.org/10.1007/s11255-010-9720-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-010-9720-0