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Int J Clin Exp Pathol 2010;3(4):401-407
Review Article
Current prostate biopsy protocol cannot reliably identify patients for focal therapy:
correlations of low-risk prostate cancer on biopsy with radical prostatectomy findings
Philip Quann, David F. Jarrard, Wei Huang
Department of Pathology and Laboratory Medicine, Department of Urology, University of Wisconsin School of Medicine, Madison, WI, USA.
Received March 5, 2009; accepted March, 2010; available online March, 2010
Abstract: Focal therapy appears to be an attractive alternative approach for patients with localized prostate cancer (PCa). Identifying suitable
candidates is crucial to the success of focal therapy. Currently, standard transrectal ultrasound (TRUS)-guided prostate biopsy remains the
widespread approach to evaluate patient suitability. In this study, we evaluated the ability of current biopsy protocols to predict cancer
characteristics in radical prostatectomy (RP) specimens. We reviewed 4437 cases from 2000 to 2008 in our PowerPath database, and
identified 158 patients with low-risk cancer, defined as a pre-biopsy PSA level ≤ 10 ng/mL, unilateral, low tumor volume (≤5%) and low to
intermediate Gleason score (GS≤6) on first positive prostate biopsy. The pathological characteristics of subsequent RP specimens were
reviewed. We found that, of 158 patients with these criteria, 117 (74%) had bilateral cancer, 49 (31%) had increased tumor volume (≥ 10%), and
46 (29%) were upgraded to GS ≥ 7 at RPs. When patients were stratified by total biopsy core numbers, extended biopsy core protocols were
not significantly more reliable in identifying unilateral and low volume prostate cancer patients. One core positive on biopsy was not significantly
superior to two positive cores in predicting unilateral, low volume, low stage cancer at prostatectomy. These findings indicate that current
standard prostate biopsy protocols have limited accuracy in identifying candidates for focal therapy. (IJCEP1003004).
Keywords: Prostate cancer, focal therapy, biopsy, prostatectomy
Full text PDF
Address all correspondence to:
Wei Huang, MD
Department of Pathology and Laboratory Medicine
University of Wisconsin School of Medicine,
Madison, WI, USA.
E-mail: whuang23@wisc.edu
Review Article
Current prostate biopsy protocol cannot reliably identify patients for focal therapy:
correlations of low-risk prostate cancer on biopsy with radical prostatectomy findings
Philip Quann, David F. Jarrard, Wei Huang
Department of Pathology and Laboratory Medicine, Department of Urology, University of Wisconsin School of Medicine, Madison, WI, USA.
Received March 5, 2009; accepted March, 2010; available online March, 2010
Abstract: Focal therapy appears to be an attractive alternative approach for patients with localized prostate cancer (PCa). Identifying suitable
candidates is crucial to the success of focal therapy. Currently, standard transrectal ultrasound (TRUS)-guided prostate biopsy remains the
widespread approach to evaluate patient suitability. In this study, we evaluated the ability of current biopsy protocols to predict cancer
characteristics in radical prostatectomy (RP) specimens. We reviewed 4437 cases from 2000 to 2008 in our PowerPath database, and
identified 158 patients with low-risk cancer, defined as a pre-biopsy PSA level ≤ 10 ng/mL, unilateral, low tumor volume (≤5%) and low to
intermediate Gleason score (GS≤6) on first positive prostate biopsy. The pathological characteristics of subsequent RP specimens were
reviewed. We found that, of 158 patients with these criteria, 117 (74%) had bilateral cancer, 49 (31%) had increased tumor volume (≥ 10%), and
46 (29%) were upgraded to GS ≥ 7 at RPs. When patients were stratified by total biopsy core numbers, extended biopsy core protocols were
not significantly more reliable in identifying unilateral and low volume prostate cancer patients. One core positive on biopsy was not significantly
superior to two positive cores in predicting unilateral, low volume, low stage cancer at prostatectomy. These findings indicate that current
standard prostate biopsy protocols have limited accuracy in identifying candidates for focal therapy. (IJCEP1003004).
Keywords: Prostate cancer, focal therapy, biopsy, prostatectomy
Full text PDF
Address all correspondence to:
Wei Huang, MD
Department of Pathology and Laboratory Medicine
University of Wisconsin School of Medicine,
Madison, WI, USA.
E-mail: whuang23@wisc.edu
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