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Abstract
Purpose: To characterize missed prostate tumors and their cumulative volume with various biopsy regimens to determine optimal biopsy schemes. Methods: We performed 6, 12 and 18-core needle biopsies on 165 and 36-core biopsies on 47 autopsy prostates, respectively. The 6-core biopsy included 6 cores from the mid peripheral zone (MPZ), the 12-core biopsy included 6 cores from the MPZ and lateral PZ (LPZ), and the 18-core biopsies included 6 cores from the MPZ, LPZ and central zone (CZ). The 36-core biopsies included 12 cores in each of these 3 areas. We analyzed the sensitivity of biopsies at each site and evaluated the cumulative volume of cancers and tumor foci missed. Results: Whole-mount analysis identified 59 cancers, 110 tumor foci, and a total cumulative tumor volume of 43 cm3. The percentage of tumor foci and corresponding cumulative volume missed with 6, 12, 18 and 36-core biopsies were of 79% and 58%, 64% and 48%, 57% and 26%, and 42% and 17%, respectively (p 0.05). 12-core biopsies from the MPZ and LPZ performed best for clinically significant cancers detection. However, increasing the number of cores over the 6-core biopsy cutoff increased solely the detection of tumor foci 0.5 cm3. Conclusion: Twelve biopsies from the MPZ and LPZ detected most of the clinically significant cancers while missing most of the tumor foci. These missed tumors represented only a small amount of the overall cancer volume.
Highlights
The trend among clinicians has been performed more prostate biopsies to detect more prostate cancers
Pathologic evaluation of step sectioned prostates identified 59 prostates with cancer, and 110 tumor foci with a cumulative volume of 43 cm3
In the sub group of 47 autopsied glands biopsied with 36-core saturation biopsies, 12 cancers and 22 tumor foci were identified on step sectioned prostates, with a cumulative tumor volume of 4.7 cm3
Summary
The trend among clinicians has been performed more prostate biopsies to detect more prostate cancers. Sextant biopsies have been all but abandoned, and most studies recommend extended biopsy protocols of 12 cores [1,2,3] These efforts have undoubtedly led to increased detection of cancer, they have led to the over diagnosis of small and well-differentiated tumors, designated as clinically insignificant [4,5]. Even undetected, they may not be of immediate threat, and should they be detected, not to be managed with radical and possibly morbid treatment.
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