International Urology and Nephrology

, Volume 42, Issue 4, pp 965–969

The impact of core biopsy fragmentation in prostate cancer

  • Leonardo Oliveira Reis
  • José Alberto Salvo Reinato
  • Daniel Carlos Silva
  • Wagner Eduardo Matheus
  • Fernandes Denardi
  • Ubirajara Ferreira
Urology – Original Paper



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).


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.


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.


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.


Prostate biopsy Up-staging Core fragmentation Low-risk cancer Biopsy artifact 


  1. 1.
    Eggener SE, Scardino PT, Carroll PR et al (2007) Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol 178:2260–2267CrossRefPubMedGoogle Scholar
  2. 2.
    Stamey TA (1995) Making the most out of six systematic sextant biopsies. Urology 45:2–12CrossRefPubMedGoogle Scholar
  3. 3.
    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 163:163–167CrossRefPubMedGoogle Scholar
  4. 4.
    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 173:1536–1540CrossRefPubMedGoogle Scholar
  5. 5.
    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 29:132–136CrossRefGoogle Scholar
  6. 6.
    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 68:815–819CrossRefPubMedGoogle Scholar
  7. 7.
    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 89:40–43CrossRefPubMedGoogle Scholar
  8. 8.
    Dogan HS, Eskicorapci SY, Ertoy-Baydar D et al (2005) Can we obtain better specimens with an end-cutting prostatic biopsy device? Eur Urol 47:297–301CrossRefPubMedGoogle Scholar
  9. 9.
    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 90:51–55CrossRefPubMedGoogle Scholar
  10. 10.
    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 45:287–291CrossRefPubMedGoogle Scholar
  11. 11.
    Brimo F, Vollmer RT, Corcos J et al (2008) Prognostic value of various morphometric measurements of tumour extent in prostate needle core tissue. Histopathology 53:177–183CrossRefPubMedGoogle Scholar
  12. 12.
    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 163:174–178CrossRefPubMedGoogle Scholar
  13. 13.
    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 18:1022–1026CrossRefPubMedGoogle Scholar
  14. 14.
    Moore RA (1935) The morphology of small prostatic carcinomas. J Urol 33:224–234Google Scholar
  15. 15.
    Goto Y, Ohori M, Arakawa A et al (1996) Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. J Urol 156:1059–1063CrossRefPubMedGoogle Scholar
  16. 16.
    Wise AM, Stamey TA, McNeal JE et al (2002) Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology 60:264–269CrossRefPubMedGoogle Scholar
  17. 17.
    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 21:3573–3579CrossRefPubMedGoogle Scholar
  18. 18.
    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 20:3206–3212CrossRefPubMedGoogle Scholar
  19. 19.
    Gardiner RA, Hamdy FC (2008) Management of low-risk prostate cancer. World J Urol 26:411–414CrossRefPubMedGoogle Scholar
  20. 20.
    Epstein JI, Walsh PC, Carmichael M et al (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 271:368–374CrossRefPubMedGoogle Scholar
  21. 21.
    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 18:1164–1172PubMedGoogle Scholar
  22. 22.
    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 171:2215–2220CrossRefPubMedGoogle Scholar
  23. 23.
    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 29:1228–1242CrossRefPubMedGoogle Scholar
  24. 24.
    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
  25. 25.
    Gupta C, Ren JZ, Wojno KJ (2004) Individual submission and embedding of prostate biopsies decreases rates of equivocal pathology reports. Urology 63:83–86CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  • Leonardo Oliveira Reis
    • 1
  • José Alberto Salvo Reinato
    • 1
  • Daniel Carlos Silva
    • 1
  • Wagner Eduardo Matheus
    • 1
  • Fernandes Denardi
    • 1
  • Ubirajara Ferreira
    • 1
  1. 1.Urologic Oncology DivisionState University of Campinas – UNICAMPCampinasBrazil

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