Differences In Gleason Score Research Articles

Prostate Cancer: Comparison of Tumor Visibility on Trace Diffusion-Weighted Images and the Apparent Diffusion Coefficient Map

The purpose of our study was to compare the visibility of prostate cancer on trace diffusion-weighted (DW) images and the apparent diffusion coefficient (ADC) map. In this retrospective study, 45 patients with prostate cancer underwent preoperative MRI, including DW imaging (DWI) (b values 0, 500, and 1,000 s/mm(2)). A single observer reviewed the images in conjunction with tumor maps constructed from prostatectomy. For 132 peripheral zone (PZ) tumor foci, the visibility and contrast relative to benign PZ were recorded for T2-weighted imaging, trace DWI b500 images, trace DWI b1,000 images, and ADC maps. Trace DWI b1,000 images and ADC maps were compared in terms of Gleason score, size, normalized T2 signal intensity, ADC, and normalized ADC of visible tumors. For each image set, the percentage of visible tumor foci and contrast relative to benign PZ were as follows: T2-weighted imaging, 80.3% and 0.411; trace DWI b500, 26.5% and 0.131; trace DWI b1,000, 46.2% and 0.119; and ADC maps, 62.1% and 0.309. Forty-seven tumor foci were visible on both trace DWI b1,000 images and ADC maps, 14 only on trace DWI b1,000 images, 35 only on ADC maps, and 36 on neither image set. There was no significant difference in Gleason score, size, normalized T2 signal intensity, ADC, or normalized ADC between tumors visible only on trace DWI b1,000 images and those visible only on ADC maps. Given a greater proportion of tumors visible on the ADC map than trace DWI and greater contrast relative to benign PZ on the ADC map, we suggest that, when performing DWI of the prostate, careful attention be given to the ADC map for tumor identification.

Expressão imunohistoquímica do marcador tumoral CD34 e P27 como fator prognóstico em adenocarcinoma de próstata clinicamente localizado após prostatectomia radical

to analyze the immunohistochemical expression of P27 and CD34 markers as prognostic factors in patients with localized prostate cancer. analysis of 100 patients with localized prostate cancer submitted to curative surgery. We carried out the usual histological preparation, followed by immunohistochemistry to detect the accumulation of P27 and CD34 protein followed by statistical analysis. in the evaluation of P27 marker and on the correlation with the variables we found significant difference in Gleason score with positive expression (positive P27) related to lower mean PSA (p = 0.091), lower Gleason score (p < 0.0001) and smaller tumor area in CD34 (p = 0.036). Regarding the CD34 marker at the tumor area, it was observed that the smaller the positive CD34, the lower the PSA value (p < 0.0001) and lower the Gleason score (r = 0.5726, p < 0.0001), and the higher the positive CD34, the higher the staging (r = 0.3305, p <0.0001) and the chance of recurrence (p = 0.002). Patients with higher stage also displayed larger positive CD34 areas (p < 0.0001). the markers CD34 and P27 are associated with events specific to prostate cancer, however, only CD34 was able to determine the possibility of biochemical recurrence.

138 PRECISE IDENTIFICATION OF PROSTATE CANCER (PCA) PATIENTS WHO COULD BE TREATED WITH FOCAL THERAPY USING CURRENT STANDARD TOOLS IN INITIAL PCA DIAGNOSIS IS NOT POSSIBLE

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2010138 PRECISE IDENTIFICATION OF PROSTATE CANCER (PCA) PATIENTS WHO COULD BE TREATED WITH FOCAL THERAPY USING CURRENT STANDARD TOOLS IN INITIAL PCA DIAGNOSIS IS NOT POSSIBLE Jesco Pfitzenmaier, Thomas Höfner, Adel Rabadi, Sascha Pahernik, Axel Haferkamp, Nenad Djakovic, Nina Wagener, Boris Hadaschik, and Markus Hohenfellner Jesco PfitzenmaierJesco Pfitzenmaier More articles by this author , Thomas HöfnerThomas Höfner More articles by this author , Adel RabadiAdel Rabadi More articles by this author , Sascha PahernikSascha Pahernik More articles by this author , Axel HaferkampAxel Haferkamp More articles by this author , Nenad DjakovicNenad Djakovic More articles by this author , Nina WagenerNina Wagener More articles by this author , Boris HadaschikBoris Hadaschik More articles by this author , and Markus HohenfellnerMarkus Hohenfellner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sensitivity of current imaging technologies are still not sufficient to reliable detect and map prostate cancer within the gland. Urologists currently have to rely on standard tools (PSA, DRE, and prostate biopsy) to get an idea of the prostate cancer extent. METHODS We identified 825 patients from our urooncological database that underwent radical prostatectomy after being diagnosed for PCa using prostatic biopsy (median 9 biopsy cores) and PSA value. Differences in Gleason Score (GS) and pathologic stage between the prostate biopsy and surgical specimen were evaluated to define upstaging and upgrading/downgrading. Subgroup analysis were done for patients initially identified with unifocal/unilateral and multifocal prostate cancer. The factors age, number and focality of prostate biopsies, number of positive prostate biopsies, body mass index, prostate volume, PSA value, GS in biopsy and upstaging/upgrading/downgrading were analyzed in a multivariable Cox regression analysis to define independent risk factors for biochemical recurrence of PCa. RESULTS 41.4% of the men experienced a GS upgrade, 15.8% a GS downgrade. 30.8% of patients initially identified with unilateral prostate cancer were upstaged to bilateral or even extracapsular disease, p<0.001.Only 21.7% of patients had initial biopsy proven unifocal/unilateral disease. These men were upstaged in 24.8% and had a pT3/pT4 disease in 9.8%. Patients with multifocal positive prostate biopsies were clinically upstaged in 17.3%. Men who were clinically upstaged had a significantly lower biochemical disease free survival (BDFS at 5 year, men with upstaging BDFS 60.6% vs. 83% in men without upstaging, p<0.001). Multivariable analysis including all above mentioned parameters identified biopsy GS, clinical upstaging and upgrading as independent risk factors for a biochemical recurrence of prostate cancer (GS biopsy HR 4.5, p<0.001; GS upgrade HR 2.5, p=0.017; pT upstage HR 2.6, p=0.002). CONCLUSIONS A considerable number of patients (30.8% in our cohort) diagnosed for unilateral PCa using the PSA value and histological results of median 9 biopsy cores are understaged at the time of initial diagnosis. Physicians should act with caution when considering hemiablative or true focal therapy in these patients. Heidelberg, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e57 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jesco Pfitzenmaier More articles by this author Thomas Höfner More articles by this author Adel Rabadi More articles by this author Sascha Pahernik More articles by this author Axel Haferkamp More articles by this author Nenad Djakovic More articles by this author Nina Wagener More articles by this author Boris Hadaschik More articles by this author Markus Hohenfellner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

143 PATHOLOGICAL OUTCOMES OF PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER WHO COULD BE SCHEDULED FOR ACTIVE SURVEILLANCE OR HEMIABLATIVE THERAPY

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2010143 PATHOLOGICAL OUTCOMES OF PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER WHO COULD BE SCHEDULED FOR ACTIVE SURVEILLANCE OR HEMIABLATIVE THERAPY Thomas Höfner, Jesco Pfitzenmaier, Adel Rabadi, Sascha Pahernik, Axel Haferkamp, Nenad Djakovic, Nina Wagener, Boris Hadaschik, and Markus Hohenfellner Thomas HöfnerThomas Höfner More articles by this author , Jesco PfitzenmaierJesco Pfitzenmaier More articles by this author , Adel RabadiAdel Rabadi More articles by this author , Sascha PahernikSascha Pahernik More articles by this author , Axel HaferkampAxel Haferkamp More articles by this author , Nenad DjakovicNenad Djakovic More articles by this author , Nina WagenerNina Wagener More articles by this author , Boris HadaschikBoris Hadaschik More articles by this author , and Markus HohenfellnerMarkus Hohenfellner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.195AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated the pathological outcomes of PCa patients meeting published criteria for active surveillance who elected immediate radical prostatectomy (RP) to assess possible impreciseness of current standard diagnostics to detect eligible candidates for active surveillance or hemiablative therapy. METHODS We identified 129 out of 825 (15.6%) PCa patients from our institutional urooncological database (1998-2008) that initially met the criteria for active surveillance or hemiablative therapy: Gleason Score <7 in,<3 unilateral positive prostate biopsies and a PSA,<10 ng/ml. The median number of biopsies was 10 (range 4 to 29). All patients underwent RP. Differences in Gleason Score and pathologic stage between prostate biopsy and final pathological report were evaluated to define upstaging and upgrading. The factors age (median 64 years, range: 45-79 years), number of biopsies (median 10, range: 3-29), body mass index (BMI, median 26.8, range: 18.6-38.1), prostate volume (median 35ml, range: 10-200 ml) and initial PSA value (median 6 ng/ml, range: 0.6-9.7 ng/ml) were categorized and analyzed for upstaging and upgrading. RESULTS Only 17.1% of patients had a unilateral low risk prostate cancer on final pathology! Overall 42.6% of the men experienced a Gleason upgrade. 43.4% had to be regarded as intermediate or high risk prostate cancer patients postoperatively (p<0.001). Clinical upstaging had to be stated in 79.2% of the patients. 21.8% of the men showed extracapsular extension. Upgrading was statistically not dependent on age (p=0.86), number of biopsies (p=0.47), BMI (p=0.33), and initial PSA value (p=0.21). There was a trend that the number of men with a Gleason Score upgrade was statistically lower in men with a prostate volume >35ml compared to men with a prostate volume <35ml (p=0.05). Upstaging was statistically not dependent on age (p=0.09), the BMI (p=0.10), prostate volume (p=0.82), and the PSA value (p=0.67), but the number of biopsies (p=0.01) CONCLUSIONS Patients who are diagnosed with low risk unilateral prostate cancer using common diagnostic methods are at high risk of harboring more aggressive and advanced PCa. This should be taken into account when considering patients as candidates for active surveillance or hemiablative therapy. Heidelberg, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e58-e59 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Höfner More articles by this author Jesco Pfitzenmaier More articles by this author Adel Rabadi More articles by this author Sascha Pahernik More articles by this author Axel Haferkamp More articles by this author Nenad Djakovic More articles by this author Nina Wagener More articles by this author Boris Hadaschik More articles by this author Markus Hohenfellner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Histopathological findings in extended prostate biopsy with PSA ≤ 4 ng/mL

Cancer detection has been reported in up to 27% of patients when lowering the PSA cutoff to 2.5 ng/mL. Although this practice could increase the number of biopsies performed, it also could lead to more frequent detection of significant prostate cancers at an organ-confined stage and/or a less aggressive state. This study describes the incidence of malignancy and tumor characteristics in extended prostate biopsies with PSA <or= 4 ng/mL. Prostate biopsies from 1081 patients where examined, 275 (25.4%) patients had PSA level <or= 4 ng/mL. Cancer was diagnosed in 32.0% and 35.7% of patients with PSA <or= 4 ng/mL and >4 ng/mL, respectively (p=0.906). The median Gleason score was 7 independent of PSA > or <or= 4 ng/mL (p=0.078). The median number of cores positive for tumor was 4 and 3, respectively, for PSA >4 ng/mL and PSA <or= 4 ng/mL (p=0.627). There was a difference in the total percent of tumors involving all cores, 11% and 7% for PSA > or <or= 4 ng/mL (p=0.042). Fifty-six patients underwent radical prostatectomy, 12 had PSA <or= 4 ng/mL. In both groups, a diagnosis of cancer was accurate with no differences in Gleason score, tumor volume or staging for both groups. When PSA is below 4 ng/mL, cancer is detected in a proportion equal to the proportion diagnosed with a PSA >4 ng/mL, and tumor characteristics are similar between the two groups. Only clinically significant tumors were diagnosed following radical prostatectomy.

Anterior-predominant Prostatic Tumors: Zone of Origin and Pathologic Outcomes at Radical Prostatectomy

Aggressive screening and prostate needle biopsy protocols have been successful in early detection of low-volume posterior tumors. Consequently, we have observed an increased incidence of anterior-predominant prostate cancers. However, the zones of origin, patterns of spread, and patterns of extraprostatic extension of this group of tumors have not been well studied. Of 1312 radical prostatectomies performed at our institution over a span of 4.5 years, 197 had predominant (largest) tumors anterior to the urethra in whole-mounted radical prostatectomy specimens. Detailed histopathologic analysis of this cohort was undertaken emphasizing the variability in anterior prostatic anatomy from apex through base to determine zone of origin and pathologic staging. Using this approach, 97/197 (49.2%) anterior-predominant tumors (ATs) were assigned to the anterior peripheral zone (APZ), 70 (35.5%) to the transition zone (TZ), 16 (8.1%) were of indeterminate zone, and 14 (7.1%) were of both zones. Comparing APZ and TZ tumors, there were no significant differences in Gleason scores, incidence of extraprostatic extension, overall surgical margin positivity rate, or laterality. Involvement of the anterior fibromuscular stroma was significantly more likely in tumors of TZ origin (P< or =0.01), yet was observed in 50.5% of APZ tumors. Conversely, APZ tumors were more commonly localized within the apical one third of the prostate. Most of the prostates (91.4%) also showed additional PZ tumors, which were occasionally stage determining (7/197; 3.9%). In conclusion, ATs of APZ origin are more prevalent than those arising from the TZ. Contrary to previous reports comparing TZ tumors to all PZ tumors, ATs of both zones exhibit similar grading and staging parameters in this series. Given these similarities, long-term clinical outcomes and future molecular analyses will be necessary to assess whether true differences in biology and behavior exist between tumors of TZ and APZ origin.

How Can Men Destined for Biochemical Failure After Androgen Deprivation and Radiotherapy Be Identified Earlier?

The significance of prostate-specific antigen (PSA) increases during the recovery of androgen after androgen deprivation therapy (ADT) and radiotherapy for prostate cancer is not well understood. This study sought to determine whether the initial PSA increase from undetectable after completion of all treatment predicts for eventual biochemical failure (BF). Between July 1992 and March 2004, 163 men with a Gleason score of 8-10 or initial PSA level >20 ng/mL, or Stage T3 prostate cancer were treated with radiotherapy (median dose, 76 Gy) and ADT and achieved an undetectable PSA level. The first detectable PSA level after the cessation of ADT was defined as the PSA sentinel rise (SR). A PSA-SR of >0.25, >0.5, >0.75, and >1.0 ng/mL was studied as predictors of BF (nadir plus 2 ng/mL). Cox proportional hazards models were used for univariate and multivariate analyses for BF adjusting for pretreatment differences in Gleason score, stage, PSA level (continuous), dose (continuous), and ADT duration (<12 vs. > or = 12 months). Of the 163 men, 41 had BF after therapy. The median time to BF was 25 months (range, 4-96). The 5-year BF rate stratified by a PSA-SR of < or = 0.25 vs. >0.25 ng/mL was 28% vs. 43% (p = 0.02), < or = 0.5 vs. >0.5 ng/mL was 30% vs. 56% (p = 0.0003), < or = 0.75 vs. >0.75 ng/mL was 29% vs. 66% (p < 0.0001), and < or = 1.0 vs. >1.0 ng/mL was 29% vs. 75% (p < 0.0001). All four PSA-SRs were independently predictive of BF on multivariate analysis. The PSA-SR predicts for BF. A PSA-SR of >0.5 ng/mL can be used for early identification of men at greater risk of BF.

MP-14.17: Is there any difference in Gleason score between prostate biopsy and prostatectomy specimen?

The growth of prostate carcinoma incidence is evident as the population grows older. If the CaP is detected in time, there exist various treatment strategies. One of the curative treatment possibilities is the retropubic radical prostatectomy (RRP). Apart from the clinical stage, histopathological grading (Gleason score) plays a crucial role in the indication for the surgical treatment and potential subsequent therapy (hormonal/radiotherapy).

Correlation of Gleason Scores Between Needle-Core Biopsy and Radical Prostatectomy Specimens in Patients with Prostate Cancer

The histologic grade of a prostate needle-core biopsy specimen can determine whether a patient with prostate cancer is a candidate for radical prostatectomy or other treatment. Incorrect histologic grading can result in inappropriate treatment and possible liability. Thus, we conducted this study to determine the histologic-grading accuracy of prostate cancer needle-core biopsy specimens. Fifty-two patients with localized prostate cancer treated with radical prostatectomy were included in the study. The overall correlation between Gleason scores for needle-biopsy and prostatectomy specimens was evaluated by analyzing the following parameters: biopsy-core number; accurate biopsy-core length; prostate volume; and preoperative, serum prostate-specific antigen (PSA) level. A "downgrade" was defined as the Gleason score for the prostatectomy specimen being greater than that for the biopsy specimen, whereas an "upgrade" was defined as the converse. No difference in Gleason scores was noted for 31% of specimens, whereas a downgrade was noted for 40%, and an upgrade for 29%. The accuracy of Gleason scores for biopsy specimens taken by the sextant systemic-biopsy method increased when specimens were >15 mm in length. No correlation was noted between difference in Gleason scores and biopsy-core number, prostate volume, and preoperative serum PSA level. The accuracy of Gleason scores determined by needle biopsy in patients with prostate cancer seems to be unreliable. Therefore, further evaluation of patients is necessary. No correlations were noted between biopsy-measured errors in Gleason score and biopsy number, prostate volume, or preoperative serum PSA level.

Prediction of potentially insignificant prostate cancer in men undergoing radical prostatectomy for clinically organ‐confined disease

The objectives of the present study were to characterize, according to tumor significance, the clinicopathological features of patients with prostate cancer who underwent radical prostatectomy, and to determine useful parameters for predicting insignificant disease before surgery. In this series, we included 195 patients who underwent radical prostatectomy for clinically organ-confined prostate cancer at our institution between January 1999 and November 2003. Several clinicopathological factors were analyzed, focusing on whether the largest tumor volume in radical prostatectomy specimens was >/=0.5 cm(3) or <0.5 cm(3), which is the criterion defined to distinguish insignificant cancer from significant cancer. Potentially insignificant cancer was detected in 28 of 195 patients (14.4%). There were significant differences between patients with insignificant disease and those with significant disease in serum prostate specific antigen (PSA) as well as all biopsy parameters, with the exception of biopsy Gleason score. Furthermore, final pathological examination demonstrated that these two patient groups showed significant differences in Gleason score and the incidence of extraprostatic disease extension. Pearson's correlation analysis showed that tumor volume in the prostatectomy specimens was significantly associated with serum PSA and all biopsy parameters; however, each of the correlations was comparatively weak. There was no single parameter that could viewed as a useful predictor of tumor significance. The best model for predicting insignificant tumor was the combined use of biopsy Gleason score <7 and percent of positive biopsy core (PPBC) <15%; however, the further addition of serum PSA <10 ng/mL to these two parameters failed to enhance the predictive value of cancer significance. These findings indicate that clinicopathological findings suggesting favorable features are well observed in patients with potentially insignificant prostate cancer compared to those with significant prostate cancer, and the combination of a biopsy Gleason score <7 and PPBC <15% might be useful as a predictor of insignificant disease.

Gleason Score 7 Prostate Cancer on Needle Biopsy: Is the Prognostic Difference in Gleason Scores 4 3 and 3 4 Independent of the Number of Involved Cores?

We addressed whether Gleason score 3 + 4 = 7 and 4 + 3 = 7 cancers on needle biopsy behave differently and whether this behavior is independent of the number of cores involved by cancer. If it is not an independent predictor of prognosis, one may report Gleason score 7 cancer with the number of positive cores without regard to whether the primary pattern was 3 or 4. This practice would remove a source of poor interobserver reproducibility when grading prostate cancer on needle biopsy. We identified 537 patients with Gleason score 7 tumors on biopsy. The results of patient preoperative digital rectal examination, serum prostate specific antigen (PSA) measurement and age were used to predict 4 outcomes based on assessment of the corresponding radical prostatectomy specimens, including 1) pathological stage (organ confined, focal extraprostatic extension, nonfocal extraprostatic extension or seminal vesicle-lymph node involvement), 2) organ confinement (yes/no), 3) Gleason score and 4) surgical margin status (positive/negative) Multivariate regression of postoperative Gleason score groups against all 5 input variables (3 + 4 versus 4 + 3, number of positive cores, PSA, age and digital rectal examination) yielded a statistically significant positive correlation with preoperative PSA (p <0.001) and preoperative Gleason scores of 4 + 3 versus 3 + 4 on biopsy (p <0.001). Pathological stage correlated with preoperative PSA (p <0.001), Gleason score 4 + 3 disease (p = 0.016), positive digital rectal examination (p <0.001) and 3 or more positive cores (p = 0.016). Positive surgical margins were predicted only by preoperative PSA (p = 0.001). Because the biological behavior of biopsy Gleason score 3 + 4 or 4 + 3 of Gleason score 7 cancer differs regardless of the number of cores involved, future nomograms predicting pathological stage would benefit from examining 3 + 4 and 4 + 3 disease separately.

Gleason Score 7 Prostate Cancer on Needle Biopsy: Is the Prognostic Difference in Gleason Scores 4 3 and 3 4 Independent of the Number of Involved Cores?

Gleason Score 7 Prostate Cancer on Needle Biopsy: Is the Prognostic Difference in Gleason Scores 4 3 and 3 4 Independent of the Number of Involved Cores?

DOES INCREASED NEEDLE BIOPSY SAMPLING OF THE PROSTATE DETECT A HIGHER NUMBER OF POTENTIALLY INSIGNIFICANT TUMORS?

Several studies have documented that increased biopsy sampling, that is 6 versus 12 biopsy cores, can detect more prostate cancer. It is unknown whether increased sampling of the prostate will detect a higher number of potentially insignificant tumors. We searched the surgical pathology files at The Johns Hopkins Hospital for patients in whom prostate needle biopsy was performed by a single urologist between April 1993 and April 2000, and subsequently underwent radical prostatectomy. Patients who underwent radical prostatectomy and had 8 core biopsies or less between March 1994 and August 1999 were also studied. Clinically significant tumors were defined as those with volume greater than 0.5 cc, Gleason score 7 or greater or nonorgan confined disease. A total of 297 patients with a mean age of 60 years (range 36 to 75) were evaluated. Group 1 consisted of 107 men with 8 core biopsies or less, including 51 with 6, and group 2 comprised 190 men with 9 cores or greater, including 145 with 12. The 2 groups were equal in regard to prostate specific antigen, age, digital rectal examination and transrectal ultrasound gland volume at biopsy. The only difference between the groups was a higher number of cores with cancer in group 2 (mean 2.8 versus 2.1, p = 0.0006). Of the patients who underwent radical prostatectomy 59.6% had Gleason score 6 or less, 26.3% 3+4, 6.7% 4+3 and 7.4% 8 to 9. There were 12.4% of patients with positive margins, 36.4% extraprostatic extension, and 5.4% seminal vesicle invasion and/or lymph node metastasis. Tumor volumes averaged 1.1 cc (range 0.01 to 10.7) and 60.9% of tumors were greater than 0.5 cc. Clinically significant tumors were seen in 77.4% of patients in group 1 and 74.6% in group 2. There was no significant difference in Gleason score, margin status, tumor volume, seminal vesicle invasion, or lymph node metastasis between groups 1 and 2, or in a subset analysis of men with 6 versus 12 core biopsies. However, patients in whom cancer was diagnosed with 9 core biopsies or greater were more likely to have organ confined disease (p = 0.02). Although increased sampling of the prostate does not increase the detection of potentially insignificant tumors, it does appear to detect earlier stage cancer.

Predictive accuracy of transrectal ultrasound-guided prostate biopsy: correlations to matched prostatectomy specimens

Objectives. To characterize observed differences in Gleason score between prostate biopsy and corresponding radical retropubic prostatectomy (RRP) specimens. Methods. One hundred consecutive clinically localized prostate cancers diagnosed by transrectal ultrasound-guided biopsy (TRUS-Bx) and treated with RRP were reviewed. All specimens were evaluated in blinded review by a single expert uropathologist and contrasted with the initial histologic analysis, performed by multiple pathologists. Results. Mean Gleason score of TRUS-Bx specimens for blinded review and at initial evaluation were 6.6 ± 0.1 and 6.0 ± 0.1 ( P < 0.001). Corresponding RRP values were 6.8 ± 0.1 and 6.5 ± 0.1 ( P < 0.03). Differences in Gleason score between TRUS-Bx and RRP at initial evaluation were significant ( P < 0.02), but not in blinded review ( P = NS). In blinded review, TRUS-Bx correctly predicted RRP histology for 88% of men with lesions scored as Gleason 5 to 7 and 41% of men with well- (Gleason score of 2 to 4) or poorly differentiated (Gleason score of 8 to 10) lesions ( P < 0.01). Conclusions. TRUS-Bx does not accurately reflect RRP histology when predicting well- or poorly differentiated lesions. Prostate cancer treatment algorithms should not be predicated upon biopsy histology alone. Histologic interpretation is more accurate and precise when performed by a single experienced uropathologist.

Selective Sampling of Yellow Prostate Chips: A Specific Method for Detecting Prostatic Adenocarcinoma

Yellow chips were sought in 206 transurethral resection specimens of prostate. 18 (9%) contained yellow chips, and 46 (22%) prostatic adenocarcinomas were present. Yellow chips showed a specificity of 100% (95% confidence interval, CI 98-100%), a sensitivity of 39% (95% CI 25-55%), and a positive predictive value of 100% (95% CI 82-100%) for prostatic adenocarcinoma. Yellow chips were more easily recognized in poorly fixed specimens. On comparing prostatic adenocarcinomas with or without yellow chips, there was no significant difference in Gleason score or percentage of chips infiltrated by tumour. Complete sampling of prostate chips may be unnecessary, if yellow chips are present and selectively sampled. Naked-eye detection of prostatic adenocarcinoma may be increased by examining the tissue before fixation.