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Abstract
Purpose:
Accurate grading of tumor is critical for administering the correct prostate cancer treatment. Meanwhile, the concordance of Gleason scores (GS) between sextant prostate needle biopsy and the radical prostatectomy (RP) specimen is known to be poor. We investigate if extended needle biopsy could improve the cancer detection rate and GS accuracy.
Materials and Methods:
A total 826 consecutive patients each underwent 12 core prostate biopsies guided by TRUS. Of these patients, 136 consecutive patients underwent RP. Of the systemic 12 cores, we compared the subset of standard sextant cores, the set of lateral sextant cores and the 12 core set.
Results:
The biopsy were positive in 218 cases (26.4%), 213 cases (25.7%) and 265 cases (32%) for the standard sextant, lateral sextant and twelve core biopsy, respectively. Concordance between prostate biopsy and prostatectomy GS was observed in 71 of 104 cases (68.3%), 80 of 110 cases (72.7%) and 98 of 136 cases (72.1%) for the standard sextant, lateral sextant and twelve core biopsy, respectively. Upgrading of 1 or more points was done in 26 of 104 cases (25.0%), 19 of 110 cases (17.3%) and 26 of 136 cases (19.1%), and downgrading 1 or more point was done in 7 of 104 cases (6.7%), 11 of 110 cases (10.0%) and 12 of 136 cases (8.8%) with the standard sextant, lateral sextant and twelve core biopsy, respectively.
Conclusions:
Twelve core needle biopsies lead to a higher cancer detection rate than do the sextant and lateral sextant needle biopsies. Twelve core and lateral sextant needle biopsies lead to higher concordance of the needle biopsy and surgical specimen GS compared with the standard sextant needle biopsy. (Korean J Urol 2006;47:482-488)
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 | Fig. 1.Coronal prostate plane shows the 12 core biopsy scheme. Filled circles represent standard sextant sites. Open circles represent lateral sextant sites. The broken line represents the mid lobe parasagittal line of the biopsies described by Hodge et al.16
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Table 1.
Clinical characteristic of patients who underwent prostate needle biopsy
Table 2.
Cancer detection rates according to the number of cores
Table 3.
Gleason score concordance on the standard sextant biopsy according to the number of positive-cores
| Biopsy | Prostatectomy | |||
|---|---|---|---|---|
| 6 | 7 | 8 | 9 | |
| Any positive-core number | ||||
| 6 | 29 | 22 | ||
| 7 | 38 | 1 | ||
| 8 | 5 | 3 | ||
| 9 | 1 | 1 | 4 | |
| Single-core positive | ||||
| 6 | 13 | 4 | ||
| 7 | 3 | |||
| Multiple-core positive | ||||
| 6 | 16 | 18 | ||
| 7 | 35 | 1 | ||
| 8 | 5 | 3 | ||
| 9 | 1 | 1 | 4 | |
Table 4.
Gleason score concordance on the lateral sextant biopsy according to the number of positive-cores
| Biopsy | Prostatectomy | |||
|---|---|---|---|---|
| 6 | 7 | 8 | 9 | |
| Any positive-core number | ||||
| 4 | 1 | |||
| 6 | 28 | 15 | ||
| 7 | 1 | 47 | 1 | |
| 8 | 8 | 2 | ||
| 9 | 1 | 1 | 5 | |
| Single-core positive | ||||
| 4 | 1 | |||
| 6 | 11 | 3 | ||
| 7 | 4 | |||
| Multiple-core positive | ||||
| 6 | 17 | 12 | ||
| 7 | 1 | 43 | 1 | |
| 8 | 8 | 0 | 2 | |
| 9 | 1 | 1 | 5 | |
Table 5.
Gleason score concordance on the extended 12 core biopsy according to the number of positive-cores
| Biopsy | Prostatectomy | |||
|---|---|---|---|---|
| 6 | 7 | 8 | 9 | |
| Any positive-core number | ||||
| 4 | 1 | |||
| 6 | 42 | 21 | ||
| 7 | 1 | 52 | 1 | |
| 8 | 8 | 3 | ||
| 9 | 2 | 1 | 4 | |
| Single-core positive | ||||
| 4 | 1 | |||
| 6 | 24 | 8 | ||
| 7 | 7 | |||
| Multiple-core positive | ||||
| 6 | 18 | 13 | ||
| 7 | 1 | 45 | 1 | |
| 8 | 8 | 3 | ||
| 9 | 2 | 1 | 4 | |
Table 6.
Concordance of the Gleason score between prostate needle biopsy and radical retropubic prostatectomy specimen according to the number of cores and the number of positive-cores
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