Optimierte Standards der Prostatastanzbiopsie

Prostate Biopsy Core Handling: Comparison of Contemporary Preembedding Methods

INTRODUCTION

The probability of prostate cancer detection is related to the amount of tissue represented. For optimal tissue representation, the specimens should preserve their regular cylindrical shape and avoid artefacts and deformation caused by fixation and preembedding. The aim of our study was to compare contemporary preembedding methods including a new method of using thick cardboard.

MATERIALS AND METHODS

To compare the preembedding methods, we took 36 nonfragmented cores from fresh prostatectomy specimens for each method, fixed them in formalin and made histological slides. The comparison criteria were a core section area in the middle section and the number of fragments per core after processing.

RESULTS

Two methods (preembedding on the edge of thick cardboard and on biplicated paper) provided a bigger section area of specimens. The differences in amounts of fragments were very small among the methods mentioned above and the preembedding glass with grooves, but preembedding between two sponges in a histological cassette showed higher fragmentation.

CONCLUSIONS

Preembedding on the edge of thick cardboard and on biplicated paper can be recommended as effective methods of prostate biopsy core fixation. Paper or cardboard for fixation of prostate biopsy cores should be presoaked with formalin or normal saline.

[Diagnostics and therapy of localized prostate cancer: a problem-oriented account]

The diagnostics and treatment of prostate cancer (PCa) are currently encumbered with several problems: Only a small proportion of men attend medical check-ups. The PSA count, although invaluable in the early detection of PCa, is not being paid for by health insurance schemes, because its indiscriminate use would result in overdiagnosis of PCa which, in turn would burden patients with avoidable morbidity and the mutually supportive community with unnecessary costs. Accordingly, some clinically insignificant tumors are being detected and treated although treatment appears unnecessary. However, more importantly too many significant tumors which need early detection to be cured are being discovered too late due to diagnostic possibilities being neglected. At least one third of all tumors discovered are still found at a locally advanced stage. Following diagnosis by biopsy the therapeutic recommendations are guided by the clinical stage. In spite of recent advances in MR-based imaging the exact local extent of tumors remains uncertain. Prognostic and predictive biomarkers for aid in therapeutic decisions are also lacking. The more defensive therapeutic strategies, such as active surveillance should be recommended with special precautions in patients younger than 65 years, in the light of new Scandinavian data. Among the curative treatments radical prostatectomy claims the primary position. Minimally-invasive surgery for PCa has not come up to expectations regarding superior local tumor control, less perioperative complication, or better functional results, at the expense of appreciably higher costs.