Evaluation of the pathologic results of prostate biopsies in terms of age, Gleason score and PSA level: Our experience and review of the literature (original) (raw)
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Anticancer Research, 2012
Aim: We retrospectively analyzed the risk associated with undergrading Gleason score 6 (GS6) prostate cancer (PCa) at biopsy, in patients with preoperative PSA levels of 2-3,99 and 4-10 ng/ml. Patients and Methods: A total of 674 patients with needle biopsy-diagnosed GS6 PCa, who underwent radical prostatectomy (RP) between 1995 and 2011, were evaluated. Patients were stratified by preoperative PSA levels into low PSA (2-3,99 ng/ml) and an intermediate PSA of 4-10 ng/ml. Subsequently, the percentage of patients with extracapsular disease (pathological stage ≥pT3a) and/or positive surgical margins was determined among those whose RP GS was still 6 and compared to undergraded cases. Results: Out of 674 patients with needle biopsy-diagnosed GS6 PCa, 36.2% had no difference between biopsy and RP GS while 11.4% had been overgraded and 52.4% of patients were undergraded at biopsy. Stratified according to preoperative PSA levels, there was a significantly higher incidence of undergrading in the intermediate PSA group. Among those with ≥pT3a tumors, 74.1 % were undergraded in needle biopsy, out of which 67.7% had intermediate PSA levels and 32.3% low PSA levels. Among patients with R1 resections 75.1 % were underdiagnosed, out of which 75.9% had intermediate PSA levels. Stratifying these data according to preoperative PSA levels, ≥pT3a tumors and R1 resection were found significantly more often in the intermediate-PSA group. Conclusion: The incidence of adverse pathological findings, including extraprostatic extension and positive surgical margins, is significantly higher in patients with undergraded biopsy GS6. Low preoperative PSA levels improved the correlation between primary and final GS and led to the reduction of unfavorable pathological findings. Prostate cancer (PCa) is the leading cancer in occurrence in men and the second most common cause of cancer-related mortality among male patients. Well-established risk factors for PCa development are race, advanced age and heredity (1, 2). Moreover, a history of prostatitis or sexually transmitted disease is known to increase the risk for developing PCa (1, 2). Since 1993, screening of men for PCa is a well-established tool in Tyrol in Austria that has significantly reduced the PCa mortality rate in Tyrol (3, 4). The diagnostic workup of patients includes measurement of prostate-specific antigen (PSA) and digital rectal examination, followed by a transrectal ultrasoundguided biopsy in suspicious cases (4). Prostate biopsy consequently results in a determination of histopathological Gleason score (GS), one of the critical predictors of prognostic outcome and therapeutic options in patients (5). In general, the Gleason grading system is the standard histological classification for grading adenocarcinoma of the prostate on core biopsy and operative specimens (5). The GS is the sum of the two most common patterns of tumor growth found in radical prostatectomy (RP) specimens (5). Concerning needle biopsy specimens since 2005, the worst grade is incorporated in the GS grading, even if comprising less than grade 5 of cancer (5). Several studies attempted to compare GS of biopsy and RP with conflicting results (6-8). For example, Zam et al. demonstrated good pathological correlation between needle biopsies and their RP in a cohort of 100 patients (9). However, Berg et al. recently found complete agreement between primary and final GS in 76.9% in a total of 365 patients (10). Data from Oliveira et al. showed that 77.9% of cases had the same GS, while 19.5% were undergraded in biopsy (11). Therapeutically, undergrading of PCa often results in improper assessment of the disease and its treatment, consequently also influencing patient prognosis. It has been 5481
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: The prostate gland is a secondary sex, exocrine organ that is an integral part of the human male reproductive system. There are three main diseases of the prostate: prostatitis, benign prostatic hyperplasia, and prostate cancer. The new grading system for prostate cancer has obvious benefits that is: it has more accurate grade stratification than the current Gleason system. PSA is serine protease produced by ductal and acinar epithelial cells of normal, hyperplastic, and malignant tissue of the prostate. To study morphologic features of the benign and malignant lesions of prostate, histopathological correlation of benign and malignant lesions of prostate with serum PSA level, compare new Gleason grading system with old Gleason grading system.
Journal of Rawalpindi Medical College, 2018
Background: Prostatic pathologies have always stayed the reason of concern in men above 50 years of age; the most dreaded of these is prostatic carcinoma. Progress in medical field has led to development of new investigative and treatment modalities in this domain. The current study is aimed at determining the frequency of prostatic adenocarcinoma in men with clinical suspicion of malignancy using transurethral resection of the prostate (TURP)/trans rectal prostate needle biopsy, using modified Gleason scoring system. Methods: A descriptive cross-sectional study of histopathological findings of 178 specimens was conducted for men undergoing TURP/trans rectal needle biopsy during a period of 3 years from January 2014 to January 2017 at Benazir Bhutto Hospital, Rawalpindi, Pakistan. Results: The histopathological findings of TURP/trans rectal prostatic needle biopsies of 43(24.2%) specimens confirmed prostatic adenocarcinoma. Of the rest 133 (74.7%) were diagnosed as benign prostatic ...
Clinics (São Paulo, Brazil), 2013
To evaluate the concordance between the Gleason scores of prostate biopsies and radical prostatectomy specimens, thereby highlighting the importance of the prostate-specific antigen (PSA) level as a predictive factor of concordance. We retrospectively analyzed 253 radical prostatectomy cases performed between 2006 and 2011. The patients were divided into 4 groups for the data analysis and dichotomized according to the preoperative PSA, <10 ng/mL and ≥10 ng/mL. A p-score <0.05 was considered significant. The average patient age was 63.3±7.8 years. The median PSA level was 9.3±4.9 ng/mL. The overall concordance between the Gleason scores was 52%. Patients presented preoperative PSA levels <10 ng/mL in 153 of 235 cases (65%) and ≥10 ng/mL in 82 of 235 cases (35%). The Gleason scores were identical in 86 of 153 cases (56%) in the <10 ng/mL group and 36 of 82 (44%) cases in the ≥10 ng/mL group (p=0.017). The biopsy underestimated the Gleason score in 45 (30%) patients in the ...
European Journal of Ultrasound, 2000
Objecti6e: The objective of this study was to evaluate transrectal ultrasound (TRUS) findings and prostate-specific antigen (PSA) levels in relation to prostatic biopsy results and to analyze their individual and combined performances in diagnosing prostate adenocarcinoma (PAC). Methods: Men (n= 143) with PSA levels above 4 ng/ml underwent TRUS and randomized ultrasound-guided prostatic biopsy through the peripheral zone, including additional hypoechoic nodules biopsies, if they were noted on TRUS. Data related to TRUS, biopsy, and PSA level results were then correlated. Results: A significant correlation between TRUS images suspicious for PAC and a biopsy-confirmed diagnosis of PAC, or between the lack of such images and a negative biopsy result, was not found. However, a significant correlation was found between positive biopsy results and PSA levels greater or equal to 10 ng/ml. The sensitivity of transrectal ultrasound in making a diagnosis of PAC was 63%, whereas its specificity was 73%. Conclusion: We conclude that while the separate performances of these examinations were not effective in diagnosing PAC, the integrated use of these methods was more adequate for making the diagnosis.
Histopathological findings in extended prostate biopsy with PSA ≤ 4 ng/mL
International braz j urol, 2008
Objective: 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 ≤ 4 ng/mL. Materials and Methods: Prostate biopsies from 1081 patients where examined, 275 (25.4%) patients had PSA level ≤ 4 ng/mL. Results: Cancer was diagnosed in 32.0% and 35.7% of patients with PSA ≤ 4 ng/mL and > 4 ng/mL, respectively (p = 0.906). The median Gleason score was 7 independent of PSA > 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 ≤ 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 ≤ 4 ng/mL (p = 0.042). Fifty-six patients underwent radical prostatectomy, 12 had PSA ≤ 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. Conclusion: 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.
Asian Pacific Journal of Cancer Prevention, 2015
Background: Combining risk factors for prostate cancer into a predictive tool may improve the detection of prostate cancer while decreasing the number of benign biopsies. We compare one such tool, age multiplied by prostate volume divided by total serum PSA (PSA-AV) with PSA density and detection of primary malignant circulating prostate cells (CPCs) in a Chilean prostate cancer screening program. The objectives were not only to determine the predictive values of each, but to determine the number of clinically significant cancers that would have been detected or missed. Materials and Methods: A prospective study was conducted of all men undergoing 12 core ultrasound guided prostate biopsy for suspicion of cancer attending the Hospital DIPRECA and Hospital de Carabineros de Chile. Total serum PSA was registered, prostate volumecalculated at the moment of biopsy, and an 8ml blood simple taken immediately before the biopsy procedure. Mononuclear cells were obtained from the blood simple using differential gel centrifugation and CPCs identified using immunocytchemistry with anti-PSA and anti-P504S. Biopsy results were classed as positive or negative for cancer and if positive the Gleason score, number of positive cores and percent infiltration recorded. Results: A total of 664 men participated, of whom 234 (35.2%) had cancer detected. They were older, had higher mean PSA, PSA density and lower PSA-AV. Detection of CPCs had high predictive score, sensitivity, sensibility and positive and negative predictive values, PSA-AV was not significantly different from PSA density in this population. The use of CPC detection avoided more biopsies and missed fewer significant cancers.Conclusions: In this screening population the use of CPC detection predicted the presence of clinically significant prostate cancer better than the other parameters. The high negative predictive value would allow men CPC negative to avoid biopsy but remain in follow up. The formula PSA-AV did not add to the predictive performance using PSA density.
International braz j urol, 2004
Objectives: The risks of identifying prostate cancer (PCa) in patients with serum total PSA (tPSA) between 4 and 10 ng/dl are between 25 and 35%. There are no data in Brazil showing the incidence of disease when all variables for PSA assessment are considered altogether, specifically tPSA, free fraction, PSA velocity and PSA stratified by age. The objective in this work was to define the incidence of disease in a population of men with abnormal values of PSA variables and normal digital rectal examination.