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Yakut E. The impact of the relationship between lesion diameter and total core length on the detection rate of clinically significant prostate cancer for PI-RADS 3 lesions. World J Urol 2024; 42:162. [PMID: 38488892 PMCID: PMC10942878 DOI: 10.1007/s00345-024-04845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/24/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The aim of our study was to determine the effect of total core length (TCL) for prostate imaging reporting and data system (PI-RADS) 3 lesions to facilitate clinically significant prostate cancer (csPCa) detection based on the lesion diameter. MATERIALS AND METHODS A total of 149 patients with at least 1 lesion with a PI-RADS 3 were evaluated retrospectively. The lesions with diameters of < 1 cm were categorized as small lesions and lesions of ≥ 1 cm were categorized as large lesions. The lengths of biopsy cores from PI-RADS 3 lesions were summed for each lesion separately, and TCL was calculated. The relationship between TCL and csPCa was analyzed separately for the small and large groups with multiple logistic regression analyses. RESULTS A total of 208 lesions were detected by multiparametric magnetic resonance imaging (MpMRI) in 149 males included in the study. The mean TCL was 44.68 mm (26-92) and the mean lesion diameter was 10.73 mm (4-27) in PIRADS 3 lesions. For small diameter lesions (< 1 cm), the odds of finding clinically insignificant prostate cancer (ciPCa) increase by 1.67 times if TCL increases by one unit. Hence, increasing TCL for small lesions only increases the odds of ciPCa detection. For large diameter lesions (≥ 1 cm), if TCL increases by one unit, the odds of finding ciPCa increase 1.13 times and the odds of finding csPCa increases1.16 times. Accordingly, large lesions are more likely to have both csPCa and ciPCa as TCL increases. CONCLUSIONS Our study showed that for PI-RADS 3 lesions, both more csPCa and more ciPCa were detected as TCL increased. However, in lesions with a size of < 1 cm, only ciPCa was detected more frequently as TCL increased. In conclusion, taking more and longer biopsy cores in PI-RADS 3 lesions below 1 cm does not contribute to the detection of csPCa.
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Affiliation(s)
- Emrah Yakut
- Department of Urology, Yuksek Ihtisas University, İşçi Blokları, 1588. Cd. No: 18/A, 06520, Çankaya, Ankara, Turkey.
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2
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Varma M, Dormer J. Macroscopy of specimens from the genitourinary system. J Clin Pathol 2024; 77:177-183. [PMID: 38373783 DOI: 10.1136/jcp-2023-208831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/12/2023] [Indexed: 02/21/2024]
Abstract
Macroscopic specimen examination is often critical for accurate histopathology reporting but has generally received insufficient attention and may be delegated to inexperienced staff with limited guidance and supervision. This review discusses issues around macroscopic examination of some common urological specimens; highlighting findings that are critical for patient management and others that are clinically irrelevant. Macroscopic findings are of limited value in completely submitted radical prostatectomy specimens but may be critical in orchidectomy specimens where identification of focal non-seminomatous components can significantly impact patient management. The maximum tumour dimension is often an important prognostic indicator, but specimen dimensions are generally of little clinical utility. Specimens should be carefully examined and judiciously sampled to identify clinically important focal abnormalities such as sarcomatoid change in a renal cell carcinoma and a minor non-seminomatous component in a predominant testicular seminoma. Meticulous macroscopic examination is key as less than 0.2% of the specimen (or macroscopically abnormal area) would be histologically examined even if the entire specimen/abnormal area is submitted for microscopic examination. Retroperitoneal pelvic lymph node dissection specimens for testicular cancer must be handled very differently from other lymph nodal block dissections. Current sampling protocols for transurethral resection of prostate specimens that are based on pre-MRI era data need to be reconsidered because they were specifically designed to detect occult prostate cancer, which would amount to histological cancer screening. Prostatic sampling of cystoprostatectomy specimens should be directed at accurately staging the known bladder cancer rather than detection of incidental prostate cancer.
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Affiliation(s)
- Murali Varma
- Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - John Dormer
- Cellular Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
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3
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Di Mauro E, Di Bello F, Califano G, Morra S, Creta M, Celentano G, Abate M, Fraia A, Pezone G, Marino C, Cilio S, Capece M, La Rocca R, Imbimbo C, Longo N, Colla' Ruvolo C. Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030625. [PMID: 36984626 PMCID: PMC10057318 DOI: 10.3390/medicina59030625] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Background and Objectives: To describe the predictors of cribriform variant status and perineural invasion (PNI) in robot-assisted radical prostatectomy (RARP) histology. To define the rates of upgrading between biopsy specimens and final histology and their possible predictive factors in prostate cancer (PCa) patients undergoing RARP. Material and Methods: Within our institutional database, 265 PCa patients who underwent prostate biopsies and consecutive RARP at our center were enrolled (2018-2022). In the overall population, two independent multivariable logistic regression models (LRMs) predicting the presence of PNI or cribriform variant status at RARP were performed. In low- and intermediate-risk PCa patients according to D'Amico risk classification, three independent multivariable LRMs were fitted to predict upgrading. Results: Of all, 30.9% were low-risk, 18.9% were intermediate-risk and 50.2% were high-risk PCa patients. In the overall population, the rates of the cribriform variant and PNI at RARP were 55.8% and 71.1%, respectively. After multivariable LRMs predicting PNI, total tumor length in biopsy cores (>24 mm [OR: 2.37, p-value = 0.03], relative to <24 mm) was an independent predictor. After multivariable LRMs predicting cribriform variant status, PIRADS (3 [OR:15.37], 4 [OR: 13.57] or 5 [OR: 16.51] relative to PIRADS 2, all p = 0.01) and total tumor length in biopsy cores (>24 mm [OR: 2.47, p = 0.01], relative to <24 mm) were independent predicting factors. In low- and intermediate-risk PCa patients, the rate of upgrading was 74.4% and 78.0%, respectively. After multivariable LRMs predicting upgrading, PIRADS (PIRADS 3 [OR: 7.01], 4 [OR: 16.98] or 5 [OR: 20.96] relative to PIRADS 2, all p = 0.01) was an independent predicting factor. Conclusions: RARP represents a tailored and risk-adapted treatment strategy for PCa patients. The indication of RP progressively migrates to high-risk PCa after a pre-operative assessment. Specifically, the PIRADS score at mpMRI should guide the decision-making process of urologists for PCa patients.
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Affiliation(s)
- Ernesto Di Mauro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Marco Abate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Agostino Fraia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Gabriele Pezone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Claudio Marino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Simone Cilio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Claudia Colla' Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
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Wiśniowski T, Bryda J, Wątroba S. The role of matrix metalloproteinases in pathogenesis, diagnostics, and treatment of human prostate cancer. POSTEP HIG MED DOSW 2023. [DOI: 10.2478/ahem-2023-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Abstract
The prostate gland is highly susceptible to oncogenic transformation, many times more than other sex tissues, such as seminal vesicles. In fact, prostate cancer (PCa) will be diagnosed in one in seven lifetime patients, making PCa the subject of intense research aimed at clarifying its biology and providing adequate treatment. PCa is the fourth most common cancer in the world in terms of the overall population and the second most common cancer for the male population. It is postulated that the development of PCa may be influenced by dietary factors, physical and sexual activity, androgens, obesity, and inflammation, but their role in the development of prostate cancer still remains unclear. Extracellular matrix metalloproteinases (MMPs) and tissue metalloproteinase inhibitors (TIMPs) play an important role in many physiological and pathological processes, including proliferation, migration, invasion, cell differentiation, participation in inflammatory processes and angiogenesis. Numerous studies point to a direct relationship between MMPs and both local tumor invasion and the formation of distant metastases. High activity of MMPs is observed in solid tumors of various origins, which positively correlates with a poor overall survival rate. Although biochemical diagnostic markers of PCa are currently available, from the point of view of clinical practice, it seems particularly important to develop new and more sensitive markers allowing for early diagnosis and long-term monitoring of patients after PCa treatment, and the assessment of MMP activity in urine and serum of patients are potential factors that could play such a role.
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5
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Thomas T, Wedden S, Afzal N, Mikel J, D’Arrigo C. Use of Prospective Multiplex Immunohistochemistry to Redefine Tissue Pathways of Diagnostic Core Biopsy of Prostate. Appl Immunohistochem Mol Morphol 2022; 30:585-591. [PMID: 36083158 PMCID: PMC9531989 DOI: 10.1097/pai.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/17/2022] [Indexed: 02/05/2023]
Abstract
The incidence of prostatic cancer in the United Kingdom has increased over 40% in the past 30 years. The majority of these cancers are diagnosed by core biopsy, posing a considerable strain on a service that struggles to recruit sufficient histopathologists. The current methodology for tissue diagnosis has a significant false-negative rate, small false-positive rate, and a proportion of indeterminate diagnoses. Therefore, this area presents an opportunity both to improve diagnostic quality and to reduce the burden on resources. We investigated streamlining tissue pathways by increasing the utilization of readily available resources to reduce the burden on scarce resources and improve the accuracy of diagnosis. This involved applying prospective multiplex immunohistochemistry (IHC) using 4 different markers (CK5, p63, racemase, and Ki-67) and 2 chromogens. We conducted a prospective study using over 8000 cores and 3 consultant histopathologists. The pathologists assessed each core using either conventional stains (hematoxylin and eosin) only or multiplex IHC only. The results of this assessment were later compared with the overall assessment made for the final histologic diagnosis. Results show that IHC alone has a positive predictive value of 98.97% and a negative predictive value of 99.91%, while hematoxylin and eosin alone has a positive predictive value of 94.21% and negative predictive value of 99.07%, demonstrating improved diagnostic accuracy. When assessed against the use of on-demand IHC, prospective IHC improves turn-around-times, reduces indeterminate diagnoses, improves pathologist's accuracy and efficiency and, in overall terms, is cost-effective. In addition, it is possible to structure these tests within the routine of a diagnostic service with little impact on the overall capacity of the laboratory.
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Affiliation(s)
| | - Sarah Wedden
- CADQAS CIC, Poundbury Cancer Institute, Poundbury
| | - Naveed Afzal
- Dorset County Hospital Foundation Trust, Dorchester, Dorset, UK
| | - John Mikel
- Dorset County Hospital Foundation Trust, Dorchester, Dorset, UK
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6
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Azoulai D, Boustany J, Peyromaure M, Abou Chakra M, Duquesne I, Barry Delongchamps N. The proportion of potential candidates for focal therapy in localized prostate cancer in a real-life cohort and their final pathologic results. Prog Urol 2022; 32:1469-1475. [DOI: 10.1016/j.purol.2022.07.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
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7
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Singh J, Thachil T, Eapen MS, Lim A, Sufyan W, Rawson R, Duncan H, De Ieso P, Sohal SS. Immunohistochemical investigation of cytokine expression levels as biomarkers in transrectal ultrasound-guided needle biopsy specimens of prostate adenocarcinoma. Mol Clin Oncol 2021; 15:191. [PMID: 34405051 DOI: 10.3892/mco.2021.2353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/24/2021] [Indexed: 12/27/2022] Open
Abstract
Cytokines influence the biological behaviour of prostate cancer (PC) and may influence patient outcome and serve as useful prognostic biomarkers. The aim of the present study was to evaluate cytokine expression levels in prostatic needle biopsy specimens and the association with clinicopathological characteristics of patients with PC. A total of 18 patients with PC who underwent transrectal ultrasound (TRUS) guided prostate biopsy were included in the clinical study. These patients were naïve to radiotherapy (RT) or androgen deprivation therapy prior to TRUS biopsy and clinical follow up data was collected. Cytokine expression levels were analysed by using immunohistochemistry and Spearman's correlation test was used to determine the correlation between cytokine expression and clinicopathological characteristics. Expression levels of pro-inflammatory TNF-α and IL-6 decreased as Gleason score (GS) increased; however, a statistically significant difference was not detected. A statically significant correlation was observed between needle biopsy specimen and pre-RT plasma sample expression levels of pro-inflammatory TNF-α and IL-6 (P=0.01 and P=0.05, respectively) and anti-inflammatory TGF-β1 (P=0.05). However, further studies are needed to confirm these results using a larger sample size to confirm the prognostic value of pro-inflammatory TNF-α and IL-6 and anti-inflammatory TGF-β1 in patients with PC.
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Affiliation(s)
- Jagtar Singh
- College of Health and Human Sciences, Charles Darwin University, Northern Territory 0810, Australia.,Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania 7248, Australia
| | - Thanuja Thachil
- Ballarat Austin Radiation Oncology Centre, Victoria 3350, Australia
| | - Mathew Suji Eapen
- Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania 7248, Australia
| | - Aijye Lim
- Department of Anatomical Pathology, Royal Darwin Hospital 0810, Australia
| | - Wajiha Sufyan
- Department of Anatomical Pathology, Royal Darwin Hospital 0810, Australia
| | - Robert Rawson
- Department of Anatomical Pathology, Royal Darwin Hospital 0810, Australia
| | - Henry Duncan
- Urology Department, Darwin Private Hospital, Northern Territory 0810, Australia
| | - Paolo De Ieso
- Peter MacCallum Cancer Centre, Victoria 3000, Australia
| | - Sukhwinder Singh Sohal
- Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania 7248, Australia
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8
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Compérat E, Renard-Penna R, Ondet V, Cancel-Tassin G, Cussenot O. Diagnosis of prostate cancer in one day: The benefits of cytology in tumour detection. Cytopathology 2020; 32:211-216. [PMID: 33107101 DOI: 10.1111/cyt.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/25/2020] [Accepted: 10/16/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Prostate cancer (PCa) is a frequent and mortal disease. The aim of this study was to introduce a "diagnosis and handling of PCa in one day" concept, accelerating the handling of PCa patients by giving diagnostic results within 3 hours with the help of prostate cytology. Standard histology served as the control. MATERIAL AND METHODS After multiparametric MRI, prostate biopsies were taken and one was used for imprint cytology on superfrost slides. The cytology samples were stained by p63/p504s double staining, a standard stain in PCa histology, followed by on-site interpretation. RESULTS Among 129 patients, 39.5% had a prior history of PCa and were either under active surveillance or had been treated by focal therapy. The others came with suspicion of PCa. In 80.8% of the cases, the cytology and histology results agreed. In low-grade PCa the detection with cytology was more difficult with 72.4% agreement, whereas for intermediate and high-grade PCa the concordance with histology was 81.8 and 90%, respectively. False positive cases were less than 4.0%. CONCLUSION Cytology of the prostate is unusual, but our study is the first to show it is feasible and gives immediate results that are satisfactory, especially in more aggressive cases. Immunocytology can be easily integrated into the laboratory. Our technique allows quicker handling of PCa, which can soften the psychological impact on men waiting for the diagnosis of PCa.
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Affiliation(s)
- Eva Compérat
- GRC5 predictive onco-urology, Sorbonne University, Paris, France.,Department of Pathology, Hopital Tenon, Sorbonne University, Paris, France
| | - Raphaele Renard-Penna
- GRC5 predictive onco-urology, Sorbonne University, Paris, France.,Department of Radiology, Hopital La Pitié Salpêtrière, Sorbonne University, Paris, France
| | - Valérie Ondet
- GRC5 predictive onco-urology, Sorbonne University, Paris, France
| | | | - Olivier Cussenot
- GRC5 predictive onco-urology, Sorbonne University, Paris, France.,Department of Urology, Hopital Tenon, Sorbonne University, Paris, France
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9
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Ciszkowicz E, Porzycki P, Semik M, Kaznowska E, Tyrka M. MiR-93/miR-375: Diagnostic Potential, Aggressiveness Correlation and Common Target Genes in Prostate Cancer. Int J Mol Sci 2020; 21:E5667. [PMID: 32784653 PMCID: PMC7460886 DOI: 10.3390/ijms21165667] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/29/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Dysregulation of miRNAs has a fundamental role in the initiation, development and progression of prostate cancer (PCa). The potential of miRNA in gene therapy and diagnostic applications is well documented. To further improve miRNAs' ability to distinguish between PCa and benign prostatic hyperplasia (BPH) patients, nine miRNA (-21, -27b, -93, -141, -205, -221, -182, -375 and let-7a) with the highest reported differentiation power were chosen and for the first time used in comparative studies of serum and prostate tissue samples. Spearman correlations and response operating characteristic (ROC) analyses were applied to assess the capability of the miRNAs present in serum to discriminate between PCa and BPH patients. The present study clearly demonstrates that miR-93 and miR-375 could be taken into consideration as single blood-based non-invasive molecules to distinguish PCa from BPH patients. We indicate that these two miRNAs have six common, PCa-related, target genes (CCND2, MAP3K2, MXI1, PAFAH1B1, YOD1, ZFYVE26) that share the molecular function of protein binding (GO:0005515 term). A high diagnostic value of the new serum derived miR-182 (AUC = 0.881, 95% confidence interval, CI = 0.816-0.946, p < 0.0001, sensitivity and specificity were 85% and 79%, respectively) is also described.
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Affiliation(s)
- Ewa Ciszkowicz
- Faculty of Chemistry, Rzeszow University of Technology, 35-959 Rzeszów, Poland; (M.S.); (M.T.)
| | - Paweł Porzycki
- Department of Urology, Municipal Hospital in Rzeszów, 35-241 Rzeszów, Poland;
| | - Małgorzata Semik
- Faculty of Chemistry, Rzeszow University of Technology, 35-959 Rzeszów, Poland; (M.S.); (M.T.)
| | - Ewa Kaznowska
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Mirosław Tyrka
- Faculty of Chemistry, Rzeszow University of Technology, 35-959 Rzeszów, Poland; (M.S.); (M.T.)
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10
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Bravi CA, Vertosick E, Tin A, Scuderi S, Fallara G, Rosiello G, Mazzone E, Bandini M, Gandaglia G, Fossati N, Freschi M, Montironi R, Briganti A, Montorsi F, Vickers A. Relative Contribution of Sampling and Grading to the Quality of Prostate Biopsy: Results from a Single High-volume Institution. Eur Urol Oncol 2020; 3:474-480. [DOI: 10.1016/j.euo.2018.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/03/2018] [Accepted: 10/17/2018] [Indexed: 11/26/2022]
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11
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Azal Neto W, Andrade GM, Billis A, Reis LO. Biopsy core length in white versus African descendant prostate cancer patients. Scand J Urol 2020; 54:188-193. [PMID: 32343184 DOI: 10.1080/21681805.2020.1754907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To explore whether distinct prostate cancer (PCa) prognoses between ethnicities could be explained by diverse characteristics in the prostate biopsy.Methods: Clinical, prostate biopsy and surgical single-institution data of whites and African descendants with similar access to the health system who underwent radical prostatectomy whole gland histopathology within 60 days after biopsy from 2010 to 2011 and followed for 5 years minimum were compared.Results: Among 203 included patients, 153 (75.4%) were whites and 50 (24.6%) were African descendants. The mean patients' age was 63.7 (± 6.8) years. Digital rectal examination (DRE) was suspected of cancer in 45.2% of the patients. The prostate biopsy core length was smaller in African descendants than in whites, overall 11.0 ± 3.2 vs 12.0 ± 2.9 mm, p = 0.037, and without neoplasia, 10.4 ± 3.8 vs 11.7 ± 3.1 mm, p = 0.038, respectively. Also, suspicious DRE showed smaller biopsy core length, overall 11.1 ± 3.2 mm vs 12.4 ± 2.6, p = 0.003, cancer positive 12.0 ± 4.8 mm vs 13.3 ± 3.7, p = 0.022 and negative 10.6 ± 3.6 mm vs 12.2 ± 3.0, p = 0.002. On 81 months median follow-up, more African descendants were lost to follow-up (10%, n = 5 vs 3.9%, n = 6) and the biochemical recurrence rate was the same between the groups (33.3%).Conclusion: In a PCa population with similar access to the health system, prostate biopsy core length in African descendant men is significantly smaller than in whites. This finding is new and may add to the controversial argument of PCa having a worse prognosis in African descendant patients.
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Affiliation(s)
- Wilmar Azal Neto
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Guilherme Miranda Andrade
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Athanase Billis
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Leonardo O Reis
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
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12
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Murugan P, Shukla D, Morocho J, Smith D, Sciacca D, Pickard M, Wahlsten M, Gunderson A, Konety B, Khalifa MA, Warlick C. Prostate Biopsy Processing. Am J Clin Pathol 2019; 152:757-765. [PMID: 31433833 DOI: 10.1093/ajcp/aqz101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Current protocols for processing multiple prostate biopsy cores per case are uneconomical and cumbersome. Tissue fragmentation and loss compromise cancer diagnosis. We sought to study an alternate method to improve processing and diagnosis of prostate cancer. METHODS Two sets of sextant biopsy specimens from near-identical locations were obtained ex vivo from 48 prostate specimens. One set was processed in the standard fashion while the other was processed using the BxChip, a proprietary biomimetic matrix that accommodates six cores on a single chip. Parameters including grossing, embedding, sectioning and reading time, length of tissue, and degree of fragmentation were compared. RESULTS A significant reduction (more than threefold) in preanalytical and analytical time was observed using the multiplex method. Nonlinear fragmentation was absent, in contrast to standard processing. CONCLUSIONS The BxChip reduced tissue fragmentation and increased efficiency of prostate biopsy diagnosis. It also resulted in overall cost savings and significantly increased tissue length.
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Affiliation(s)
- Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Dip Shukla
- University of Minnesota Medical School, Minneapolis
| | | | - Deanne Smith
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Drew Sciacca
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Meghan Pickard
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | | | | | | | - Mahmoud A Khalifa
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
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[Prostate pathology recommendations from the Uropathology working group of the Spanish Society of Pathology]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 52:167-177. [PMID: 31213258 DOI: 10.1016/j.patol.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/24/2022]
Abstract
These guidelines from the uropathology working group of the Spanish Society of Pathology (SEAP) are based on the European and ISUP 2015 recommendations and those of the College of American Pathologists, as well as the latest WHO 2016, TNM (AJCC) 2017 classifications. They include recommendations for specimen sampling, macro- and microscopic examination and immunohistochemistry. Gleason patterns are specified: Gleason pattern 3 includes hyperplastic, atrophic and microcystic glands, while pattern 4 includes all cribriform or glomeruloid glands. The Gleason score in prostatectomy specimens may change; if a tertiary pattern occurs in more than 5% of the tumour, it becomes a secondary pattern. In both biopsies and prostatectomy specimens, if the Gleason score is 7, the percentage of pattern 4 should be stated. Gleason scoring in tumor variants and special situations should also be specified. These recommendations should be adapted according to the resources available.
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14
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Iatrogenic Disease of the Genitourinary Tract. Adv Anat Pathol 2019; 26:171-185. [PMID: 30720471 DOI: 10.1097/pap.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Iatrogenic disease is defined as illness caused by diagnostic procedures or treatment given by health care professionals. More recently described treatment complications involving the genitourinary tract include newly recognized variants of renal carcinoma in the setting of dialysis/end-stage renal disease, treatment effect in genitourinary carcinomas, and medical renal disease caused by drug therapies, including immunotherapy. The objective of this review is to cover iatrogenic inflammatory diseases, pseudotumors and tumors of the kidney, bladder, prostate, testis and paratestis of most interest to surgical pathologists. For this reason, disease caused by the following will not be covered: iatrogenic glomerulonephritis, self-inflicted injury including the introduction of foreign bodies, surgical error, drugs of abuse and herbal medications, and iatrogenic disease in the transplant setting including ischemia/reperfusion injury. Emphasis is placed upon commonly encountered diseases in order to ensure that the review is of utility to practicing pathologists. The clinical context, pathophysiology and histopathology of each disease entity are covered.
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Do longer or shorter cores yield more cancer? World J Urol 2018; 36:1179-1180. [DOI: 10.1007/s00345-018-2304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022] Open
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16
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Hayashi T, Fujita K, Tanigawa G, Kawashima A, Nagahara A, Ujike T, Uemura M, Takao T, Yamaguchi S, Nonomura N. Serum monocyte fraction of white blood cells is increased in patients with high Gleason score prostate cancer. Oncotarget 2018; 8:35255-35261. [PMID: 27823973 PMCID: PMC5471051 DOI: 10.18632/oncotarget.13052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/28/2016] [Indexed: 01/21/2023] Open
Abstract
Systemic inflammation and immune responses are reported to be associated with progressive prostate cancer. In this study, we explored which among the fractions of white blood cell (WBC) and C-reactive protein (CRP) level were associated with high Gleason score prostate cancer. Prostate needle biopsy was performed in 966 men with suspicion of prostate cancer. We assessed age, serum prostate-specific antigen (PSA), prostate volume, WBC count, fractions of WBCs (neutrophils, lymphocytes, monocytes, basophils, and eosinophils), and CRP level before biopsy for associations with biopsy findings. Among all men, 553 (57.2%) were positive for prostate cancer including 421 with high Gleason score cancer (Gleason score ≥7). Age, PSA, PSA density (PSAD), serum monocyte fraction of WBC, monocyte-to-lymphocyte ratio (MLR), and CRP were significantly associated with high Gleason score cancer (p<0.01). Multivariate analysis showed that age, PSA, PSAD, and serum monocyte fraction were significantly associated with high Gleason score prostate cancer (p <0.01). In 571 patients with PSA of <10 ng/ml, age, PSA, PSAD, serum WBC count, neutrophil fraction, monocyte fraction, and MLR were significantly associated with high Gleason score prostate cancer (p<0.05). Multivariate analysis showed that age, PSAD, and serum monocyte fraction were significantly associated with high Gleason score prostate cancer (p<0.01). The monocyte fraction of WBCs was increased in patients with high Gleason score prostate cancer, suggesting an interaction of monocytes with the progression of prostate cancer.
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Affiliation(s)
- Takuji Hayashi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Go Tanigawa
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Atsunari Kawashima
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Nagahara
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Ujike
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuya Takao
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Seiji Yamaguchi
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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Are 10-, 10–12-, or > 12-mm prostate biopsy core quality control cutoffs reasonable? World J Urol 2018; 36:1055-1058. [PMID: 29497860 DOI: 10.1007/s00345-018-2242-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022] Open
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18
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Kammerer-Jacquet SF, Compérat E, Egevad L, Hes O, Oxley J, Varma M, Kristiansen G, Berney DM. Handling and reporting of transperineal template prostate biopsy in Europe: a web-based survey by the European Network of Uropathology (ENUP). Virchows Arch 2018; 472:599-604. [PMID: 29327138 DOI: 10.1007/s00428-017-2265-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/30/2017] [Accepted: 11/05/2017] [Indexed: 01/01/2023]
Abstract
Transperineal template prostate biopsies (TTPB) are performed for assessments after unexpected negative transrectal ultrasound biopsies (TRUSB), correlation with imaging findings and during active surveillance. The impact of TTPBs on pathology has not been analysed. The European Network of Uropathology (ENUP) distributed a survey on TTPB, including how specimens were received, processed and analysed. Two hundred forty-four replies were received from 22 countries with TTPBs seen by 68.4% of the responders (n = 167). Biopsies were received in more than 12 pots in 35.2%. The number of cores embedded per cassette varied between 1 (39.5%) and 3 or more (39.5%). Three levels were cut in 48.3%, between 2 and 3 serial sections in 57.2% and unstained spare sections in 45.1%. No statistical difference was observed with TRUSB management. The number of positive cores was always reported and the majority gave extent per core (82.3%), per region (67.1%) and greatest involvement per core (69.4%). Total involvement in the whole series and continuous/discontinuous infiltrates were reported in 42.2 and 45.4%, respectively. The majority (79.4%) reported Gleason score in each site or core, and 59.6% gave an overall score. A minority (28.5%) provided a map or a diagram. For 19%, TTPB had adversely affected laboratory workload with only 27% managing to negotiate extra costs. Most laboratories process samples thoroughly and report TTPB similarly to TRUSB. Although TTPB have caused considerable extra work, it remains uncosted in most centres. Guidance is needed for workload impact and minimum standards of processing if TTPB work continues to increase.
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Affiliation(s)
- Solene-Florence Kammerer-Jacquet
- Barts Cancer University-Queen Mary University, Charterhouse square, EC1M, London, 6BQ, UK. .,Service d'Anatomie et Cytologie Pathologiques, Université de Rennes 1, Université Bretagne Loire, 35042, Rennes, France.
| | - Eva Compérat
- Hôpital Tenon, HUEP, AP-HP, Université la Sorbonne, Paris, France
| | | | - Ondra Hes
- Charles University, Pilsen, Czech Republic
| | - Jon Oxley
- North Bristol NHS Trust, Bristol, UK
| | | | | | - Daniel M Berney
- Barts Cancer University-Queen Mary University, Charterhouse square, EC1M, London, 6BQ, UK
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19
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Evaluation of Prostate Needle Biopsies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:69-86. [DOI: 10.1007/978-3-319-99286-0_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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Yılmaz H, Yavuz U, Üstüner M, Çiftçi S, Yaşar H, Müezzinoğlu B, Uslubaş AK, Dillioğlugil Ö. Longer biopsy cores do not increase prostate cancer detection rate: A large-scale cohort study refuting cut-off values indicated in the literature. Turk J Urol 2017; 43:297-302. [PMID: 28861301 DOI: 10.5152/tud.2017.03743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/29/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Only a few papers in the literature aimed to evaluate biopsy core lengths. Additionally, studies evaluated the core length with different approaches. We aimed to determine whether prostate cancer (PCa) detection is affected from core lengths according to three different approaches in a large standard cohort and compare our cut-off values with the published cut-offs. MATERIAL AND METHODS We retrospectively analyzed 1,523 initial consecutive transrectal ultrasound-guided 12-core prostate biopsies. Biopsies were evaluated with respect to total core length (total length of each patients' core) average core length (total core length divided by total number of cores in each patient), and mean core length (mean length of all cores pooled), and compared our cut-off values with the published cut-offs. The prostate volumes were categorized into four groups (<30, 30-59.99, 60-119.99, ≥120 cm3) and PCa detection rates in these categories were examined. RESULTS PCa was found in 41.5% patients. There was no difference between benign and malignant mean core lengths of the pooled cores (p>0.05). Total core length and average core length were not significantly associated with PCa in multivariate logistic regression analyses (p>0.05). The core lengths (mean, average and total core lengths) increased (p<0.001) and PCa rates decreased (p<0.001) steadily with increasing prostate volume categories. PCa percentages decreased in all categories above the utilized cut-offs for mean (p>0.05), average (p<0.05), and total core lengths (p>0.05). CONCLUSION There was no difference between mean core lengths of benign and malignant cores. Total core length and average core length were not significantly associated with PCa. Contrary to the cut-offs used for mean and average core lengths in the published studies, PCa rates decrease as these core lengths increase. Larger studies are necessary for the determination and acceptance of accurate cut-offs.
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Affiliation(s)
- Hasan Yılmaz
- Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ufuk Yavuz
- Clinic of Urology, Karaman State Hospital, Karaman, Turkey
| | - Murat Üstüner
- Clinic of Urology, Derince Training and Research Hospital, Kocaeli, Turkey
| | | | - Hikmet Yaşar
- Clinic of Urology, Darıca Farabi State Hospital, Kocaeli, Turkey
| | - Bahar Müezzinoğlu
- Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ali Kemal Uslubaş
- Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Özdal Dillioğlugil
- Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
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21
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A randomized trial of early detection of clinically significant prostate cancer (ProScreen): study design and rationale. Eur J Epidemiol 2017; 32:521-527. [PMID: 28762124 DOI: 10.1007/s10654-017-0292-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
Abstract
The current evidence of PSA-based prostate cancer screening shows a reduction in cause-specific mortality, but with substantial overdiagnosis. Recently, new developments in detection of clinically relevant prostate cancer include multiple kallikreins as biomarkers besides PSA, and multiparametric magnetic resonance imaging (mpMRI) for biopsy decision. They offer opportunities for improving the outcomes in screening, particularly reduction in overdiagnosis and higher specificity for potentially lethal cancer. A population-based randomized screening trial will be started, with 67,000 men aged 55-67 years at entry. A quarter of the men will be allocated to the intervention arm, and invited to screening. The control arm will receive no intervention. All men in the screening arm will be offered a serum PSA determination. Those with PSA of 3 ng/ml or higher will have an additional multi-kallikrein panel and those with indications of increased risk of clinically relevant prostate cancer will undergo mpMRI. Men with a malignancy-suspect finding in MRI are referred to targeted biopsies. Screening interval is 6 years for men with baseline PSA < 1.5 ng/ml, 4 years with PSA 1.5-3.0 and 2 years if initial PSA > 3. The main outcome of the trial is prostate cancer mortality, with analysis at 10 and 15 years. The statistical power is sufficient for detecting a 28% reduction at 10 years and 22% at 15 years. The proposed study has the potential to provide the evidence to justify screening as a public health policy if mortality benefit can be sustained with substantially reduced overdiagnosis.
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22
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The 3DBiopsy Prostate Biopsy System: Preclinical Investigation of a Needle, Actuator, and Specimen Collection Device Allowing Sampling of Individualized Prostate Lengths Between 20 and 60 mm. Urology 2017; 107:257-261. [PMID: 28601561 DOI: 10.1016/j.urology.2017.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To increase the likelihood of detecting anterior cancers within the prostate and provide a specimen that spans the length of the gland. Newly designed 17- and 15-gauge (G) biopsy needles, a variable actuator, and an integrated pathology system intended for the longer cores were developed and tested for this purpose. MATERIALS AND METHODS Testing was performed comparing 2 common cannula tip grinds, a Vet-point (sharp tip) and a Menghini-point (atraumatic tip), and were tested against 18-G Bard Monopty in porcine kidney. A variable actuator was developed to fire the needle 20-60 mm and tested in cadaver prostates. RESULTS The aggregate firings for 3 different shot lengths comparing the Vet- with the Menghini-tip cannulas demonstrated 91% vs 85.2% fill (length of specimen/length of core bed, P = .007). A 15-G trocar needle with the Vet-tip cannula also had the best performance, with an aggregate standard deviation of 6.4% across 3 firing ranges and a minimum to maximum specimen length of 81%-105% of potential fill. Cadaver testing with the Vet-tip needles in the actuator for the transrectal (17-G) and transperineal (15-G) biopsies demonstrated mean fills of 93.3% and 76.5%, respectively. The new transrectal ultrasound needle obtained a 2-fold increase in specimen length over the standard Bard device (P <.001). CONCLUSION Longer and consistent cores were obtained using the new biopsy needles. Combined with an adjustable actuator, the physician can obtain specimens that include peripheral and anterior zone tissue in 1 core. Determination of cancer location on the longer specimens could enhance focal therapy planning.
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23
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Al Diffalha S, Shaar M, Barkan GA, Wojcik EM, Picken MM, Pambuccian SE. Immunohistochemistry in the workup of prostate biopsies: Frequency, variation and appropriateness of use among pathologists practicing at an academic center. Ann Diagn Pathol 2017; 27:34-42. [PMID: 28325359 DOI: 10.1016/j.anndiagpath.2017.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We studied the frequency, inter-pathologist variation, appropriateness and utility of immunohistochemistry (IHC) performed on prostate biopsies (PB) to determine the significance of foci of suspicious glands/atypical small acinar proliferations (ASAP). METHODS We calculated the rate of IHC use and diagnostic rate of ASAP and adenocarcinoma in PB from 01/01/2008 to 06/30/2015 for individual pathologists working in a tertiary academic institution, and correlated them with the pathologists' experience, subspecialization and PB volume with the aim of determining the interpathologist variation and appropriateness of use of IHC according to recently published recommendations, and the usefulness of IHC to resolve foci of ASAP as either benign or adenocarcinoma. RESULTS IHC was used in 966/2652 (36.4%, 95% CI 33.4-39.4%) PB cases and 1915 of 16,359 (11.7%, 95% CI 11.2%-12.2%) of PB blocks and allowed definitive diagnosis of either benign or malignant in 75.8% (95% CI 73.9-77.7%) of blocks. By pathologist, IHC use rates varied more than twofold (22.8-50.5%); higher use was found for pathologists with genitourinary pathology specialization, higher PB volume and more experience, and correlated with higher rates of both ASAP and adenocarcinoma diagnoses. The use of IHC stains was considered appropriate in 822/966 (85.1%, 95% CI 82.9-87.4%) cases. CONCLUSIONS Despite the fact that the use of IHC stains was considered useful and deemed appropriate in the majority of cases, it showed wide variation between pathologists, suggesting monitoring of IHC use rates may be useful to standardize its use.
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Affiliation(s)
- Sameer Al Diffalha
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, United States
| | - Mohanad Shaar
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, United States
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, United States
| | - Eva M Wojcik
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, United States
| | - Maria M Picken
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, United States
| | - Stefan E Pambuccian
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, United States.
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Abstract
PURPOSE OF REVIEW The objective of this article is to examine the safety of prostate biopsy and discuss the emerging role of MRI-ultrasound fusion technology in improving diagnostic accuracy. RECENT FINDINGS Men undergoing prostate biopsy frequently experience minor complications, including hematospermia, hematuria, and infection. Quinolone-resistant bacteria are a growing concern; thus, transperineal access or modification of antibiotic prophylaxis based on local antibiograms is now used to avoid infectious complications.Multiparametric MRI allows visualization of many prostate cancers, and by fusing MRI with real-time ultrasound, a biopsy needle can be directed by a urologist into suspicious regions of interest. Using this new method, detection of clinically significant prostate cancer has increased and the incidence of falsely negative biopsies has decreased. SUMMARY Prostate biopsy is generally a safe procedure, and with attention to local patterns of antibiotic resistance, infectious complications can be minimized. MRI-ultrasound fusion has significantly improved the accuracy of prostate biopsy, allowing tracking and targeting not previously possible.
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Affiliation(s)
- Tonye A. Jones
- Department of Urology, David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Jan Phillip Radtke
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Hadaschik
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Leonard S. Marks
- Department of Urology, David Geffen School of Medicine, Los Angeles, CA 90095, USA
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Wu CJ, Wang Q, Li H, Wang XN, Liu XS, Shi HB, Zhang YD. DWI-associated entire-tumor histogram analysis for the differentiation of low-grade prostate cancer from intermediate-high-grade prostate cancer. ACTA ACUST UNITED AC 2016; 40:3214-21. [PMID: 26156619 DOI: 10.1007/s00261-015-0499-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To investigate diagnostic efficiency of DWI using entire-tumor histogram analysis in differentiating the low-grade (LG) prostate cancer (PCa) from intermediate-high-grade (HG) PCa in comparison with conventional ROI-based measurement. METHODS DW images (b of 0-1400 s/mm(2)) from 126 pathology-confirmed PCa (diameter >0.5 cm) in 110 patients were retrospectively collected and processed by mono-exponential model. The measurement of tumor apparent diffusion coefficients (ADCs) was performed with using histogram-based and ROI-based approach, respectively. The diagnostic ability of ADCs from two methods for differentiating LG-PCa (Gleason score, GS ≤ 6) from HG-PCa (GS > 6) was determined by ROC regression, and compared by McNemar's test. RESULTS There were 49 LG-tumor and 77 HG-tumor at pathologic findings. Histogram-based ADCs (mean, median, 10th and 90th) and ROI-based ADCs (mean) showed dominant relationships with ordinal GS of Pca (ρ = -0.225 to -0.406, p < 0.05). All above imaging indices reflected significant difference between LG-PCa and HG-PCa (all p values <0.01). Histogram 10th ADCs had dominantly high Az (0.738), Youden index (0.415), and positive likelihood ratio (LR+, 2.45) in stratifying tumor GS against mean, median and 90th ADCs, and ROI-based ADCs. Histogram mean, median, and 10th ADCs showed higher specificity (65.3%-74.1% vs. 44.9%, p < 0.01), but lower sensitivity (57.1%-71.3% vs. 84.4%, p < 0.05) than ROI-based ADCs in differentiating LG-PCa from HG-PCa. CONCLUSIONS DWI-associated histogram analysis had higher specificity, Az, Youden index, and LR+ for differentiation of PCa Gleason grade than ROI-based approach.
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Affiliation(s)
- Chen-Jiang Wu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Qing Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Hai Li
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
| | - Xiao-Ning Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Xi-Sheng Liu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
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Helpap B, Ringli D, Tonhauser J, Poser I, Breul J, Gevensleben H, Seifert HH. The Significance of Accurate Determination of Gleason Score for Therapeutic Options and Prognosis of Prostate Cancer. Pathol Oncol Res 2015; 22:349-56. [PMID: 26563277 DOI: 10.1007/s12253-015-0013-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 11/04/2015] [Indexed: 11/28/2022]
Abstract
The Gleason score (GS) to date remains one of the most reliable prognostic predictors in prostate cancer (PCa). However, the majority of studies supporting its prognostic relevance were performed prior to its modification by the International Society of Urological Pathology (ISUP) in 2005. Furthermore, the combination of Gleason grading and nuclear/nucleolar subgrading (Helpap score) has been shown to essentially improve grading concordance between biopsy and radical prostatectomy (RP) specimens. This prompted us to investigate the modified GS and combigrading (Gleason/Helpap score) in association with clinicopathological features, biochemical recurrence (BCR), and survival. Core needle biopsies and corresponding RP specimens from 580 patients diagnosed with PCa between 2005 and 2010 were evaluated. According to the modified GS, the comparison between biopsy and RP samples resulted in an upgrading from GS 6 to GS 7a and GS 7b in 65% and 19%, respectively. Combigrading further resulted in an upgrading from low grade (GS 6/2a) to intermediate grade PCa (GS 6/2b) in 11.1% and from intermediate grade (GS 6/2b) to high grade PCa (GS 7b/2b) in 22.6%. Overall, well-differentiated PCa (GS 6/2a) was detected in 2.8% of RP specimens, while intermediate grade (GS 6/2b and GS 7a/2b) and high grade cancers (≥ GS 7b) accounted for 39.5% and 57.4% of cases, respectively. At a mean follow-up of 3.9 years, BCR was observed in 17.6% of patients with intermediate (9.8%) or high grade PCa (30.2%), while PSA relapse did not occur in GS 6/2a PCa. In conclusion, adding nuclear/nucleolar subgrading to the modified GS allowed for a more accurate distinction between low and intermediate grade PCa, therefore offering a valuable tool for the identification of patients eligible for active surveillance (AS).
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Affiliation(s)
- Burkhard Helpap
- Department of Pathology, Hegau-Bodensee Hospital of Singen, PO Box 720, 78207, Singen, Germany.
| | - Daniel Ringli
- Department of Pathology, Hegau-Bodensee Hospital of Singen, PO Box 720, 78207, Singen, Germany
| | - Jens Tonhauser
- Department of Urology, Hegau-Bodensee Hospital of Singen, Singen, Germany
| | - Immanuel Poser
- Department of Urology and Urologic Oncology, Loretto Hospital, Freiburg, Germany
| | - Jürgen Breul
- Department of Urology and Urologic Oncology, Loretto Hospital, Freiburg, Germany
| | | | - Hans-Helge Seifert
- Department of Urology, Hegau-Bodensee Hospital of Singen, Singen, Germany
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27
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Knüchel R. Gleason Score 6 - Prostate Cancer or Benign Variant? Oncol Res Treat 2015; 38:629-32. [PMID: 26633167 DOI: 10.1159/000441735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/16/2015] [Indexed: 11/19/2022]
Abstract
The leading motivation behind wanting to call a 'malignant' prostate lesion 'benign' is the evidence of indolent prostate cancer that is not associated with a fatal outcome and in part makes therapeutic measures such as surgery and radiotherapy appear like overtreatment for some or possibly the majority of such patients. The present article reviews the definitions of 'precancerous lesion' and 'cancer' from a histopathologic point of view as the basis and gold standard for diagnosis. It is clear that with the 2 modifications implemented since its first publication, the Gleason score as the grading system for prostate cancer has shifted towards a low malignant subgroup diagnosed as Gleason 6. The recommendation of the International Society of Urological Pathology to change the Gleason score to a 5-tiered system, starting with grade group 1, is presented here, and may help doctor-patient communication especially in the active surveillance setting.
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Affiliation(s)
- Ruth Knüchel
- Institute of Pathology, University Hospital, RWTH Aachen, Aachen, Germany
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Billis A, Quintal MMQ, Freitas LLL, Costa LBE, Ferreira U. Predictive criteria of insignificant prostate cancer: what is the correspondence of linear extent to percentage of cancer in a single core? Int Braz J Urol 2015; 41:367-72. [PMID: 26005981 PMCID: PMC4752103 DOI: 10.1590/s1677-5538.ibju.2015.02.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/28/2014] [Indexed: 01/30/2023] Open
Abstract
Objective The aim of active surveillance of early prostate cancer is to individualize therapy by selecting for curative treatment only patients with significant cancer. Epstein’s criteria for prediction of clinically insignificant cancer in surgical specimens are widely used. Epstein’s criterion “no single core with >50% cancer” has no correspondence in linear extent. The aim of this study is to find a possible correspondence. Materials and Methods From a total of 401 consecutive patients submitted to radical prostatectomy, 17 (4.2%) met criteria for insignificant cancer in the surgical specimen. The clinicopathologic findings in the correspondent biopsies were compared with Epstein’s criteria for insignificant cancer. Cancer in a single core was evaluated in percentage as well as linear extent in mm. Results Comparing the clinicopathologic findings with Epstein’s criteria predictive of insignificant cancer, there was 100% concordance for clinical stage T1c, no Gleason pattern 4 or 5, ≤2 cores with cancer, and no single core with >50% cancer. However, only 25% had density ≤0.15. The mean, median and range of the maximum length of cancer in a single core in mm were 1.19, 1, and 0.5-2.5, respectively. Additionally, the mean, median, and range of length of cancer in all cores in mm were 1.47, 1.5, and 0.5-3, respectively. Conclusion To pathologists that use Epstein’s criteria predictive of insignificant cancer and measure linear extent in mm, our study favors that “no single core with >50% cancer” may correspond to >2.5 mm in linear extent.
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Affiliation(s)
- Athanase Billis
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Maisa M Q Quintal
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Leandro L L Freitas
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Larissa B E Costa
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Ubirajara Ferreira
- Department of Urology (UF), School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
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Venderbos LDF, Roobol MJ, Bangma CH, van den Bergh RCN, Bokhorst LP, Nieboer D, Godtman R, Hugosson J, van der Kwast T, Steyerberg EW. Rule-based versus probabilistic selection for active surveillance using three definitions of insignificant prostate cancer. World J Urol 2015; 34:253-60. [PMID: 26160006 PMCID: PMC4729867 DOI: 10.1007/s00345-015-1628-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/22/2015] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To study whether probabilistic selection by the use of a nomogram could improve patient selection for active surveillance (AS) compared to the various sets of rule-based AS inclusion criteria currently used. METHODS We studied Dutch and Swedish patients participating in the European Randomized study of Screening for Prostate Cancer (ERSPC). We explored which men who were initially diagnosed with cT1-2, Gleason 6 (Gleason pattern ≤3 + 3) had histopathological indolent PCa at RP [defined as pT2, Gleason pattern ≤3 and tumour volume (TV) ≤0.5 or TV ≤ 1.3 ml, and TV no part of criteria (NoTV)]. Rule-based selection was according to the Prostate cancer Research International: Active Surveillance (PRIAS), Klotz, and Johns Hopkins criteria. An existing nomogram to define probability-based selection for AS was refitted for the TV1.3 and NoTV indolent PCa definitions. RESULTS 619 of 864 men undergoing RP had cT1-2, Gleason 6 disease at diagnosis and were analysed. Median follow-up was 8.9 years. 229 (37%), 356 (58%), and 410 (66%) fulfilled the TV0.5, TV1.3, and NoTV indolent PCa criteria at RP. Discriminating between indolent and significant disease according to area under the curve (AUC) was: TV0.5: 0.658 (PRIAS), 0.523 (Klotz), 0.642 (Hopkins), 0.685 (nomogram). TV1.3: 0.630 (PRIAS), 0.550 (Klotz), 0.615 (Hopkins), 0.646 (nomogram). NoTV: 0.603 (PRIAS), 0.530 (Klotz), 0.589 (Hopkins), 0.608 (nomogram). CONCLUSIONS The performance of a nomogram, the Johns Hopkins, and PRIAS rule-based criteria are comparable. Because the nomogram allows individual trade-offs, it could be a good alternative to rigid rule-based criteria.
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Affiliation(s)
- Lionne D F Venderbos
- Department of Urology, Erasmus University Medical Center, Room Na1710, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Room Na1710, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, Room Na1710, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Roderick C N van den Bergh
- Department of Urology, Erasmus University Medical Center, Room Na1710, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Leonard P Bokhorst
- Department of Urology, Erasmus University Medical Center, Room Na1710, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rebecka Godtman
- Department of Urology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
| | - Jonas Hugosson
- Department of Urology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
| | - Theodorus van der Kwast
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Pryalukhin AE, Vandromme A, Dellmann A, Donhuijsen K, Hammerer PG. Prostate Biopsy Core Handling: Comparison of Contemporary Preembedding Methods. Urol Int 2015; 95:203-8. [PMID: 25824612 DOI: 10.1159/000375179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/08/2015] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Alexey E Pryalukhin
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
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Yilmaz H, Ciftci S, Ustuner M, Yavuz U, Saribacak A, Muezzinoglu B, Dillioglugil O. Minimum 6 mm core length is strongly predictive for the presence of glandular tissue in transrectal prostate biopsy. World J Urol 2015; 33:1715-20. [PMID: 25777278 DOI: 10.1007/s00345-015-1536-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Prostate biopsy guidelines recommend that a prostate biopsy not containing glandular prostate tissue should be reported as inadequate. In the literature, there is a lack of any study that addresses the relationship between the length of biopsy cores and the absence of glandular prostate tissue. In this study, we aimed to determine whether a relationship exists between these parameters. MATERIALS AND METHODS We retrospectively evaluated 1,712 consecutive initial transrectal 12-core prostate biopsies. Individual cores were histologically categorized as glandular (benign or malignant) and non-glandular (rectal mucosa, periprostatic adipose tissue, prostatic or periprostatic fibromuscular tissue). Total number of evaluable cores ≤9, highly fragmented, incorrectly numbered or dried biopsies, patients with 5-α reductase inhibitory treatment were excluded. RESULTS We analyzed remaining 1,584 patients; 41.7 % had adenocarcinoma. A total of 19,144 cores were sampled. Non-glandular cores were found significantly shorter than glandular cores (p < 0.0001). The percentages of non-glandular cores were significantly higher at the base, apex and lateral biopsy sites (p < 0.0001). We found a 6-mm cutoff value for accurate prediction of glandular sampling with 80.2 % sensitivity and 78.7 % specificity. The risk of non-glandular sampling increased 15-fold in cores ≤6 mm (OR 14.91, 95% CI 13.20-16.83, p < 0.0001). CONCLUSIONS Non-glandular sampling was directly associated with shorter core lengths. They were found significantly higher at the base, apex and lateral localizations. We found a 6-mm cutoff value for the prediction of non-glandular samples before the histologic evaluation. Below this value, the risk of non-glandular sampling increased 15-fold. We suggest it for prompt additional sampling during biopsy procedure.
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Affiliation(s)
- Hasan Yilmaz
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Seyfettin Ciftci
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey.
| | - Murat Ustuner
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Ufuk Yavuz
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Ali Saribacak
- Department of Urology, Izmit Konak Hospital, Kocaeli, Turkey
| | - Bahar Muezzinoglu
- Department of Pathology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Ozdal Dillioglugil
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
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Tolonen TT, Isola J, Kaipia A, Riikonen J, Koivusalo L, Huovinen S, Laurila M, Porre S, Tirkkonen M, Kujala P. Length of prostate biopsies is not necessarily compromised by pooling multiple cores in one paraffin block: an observational study. BMC Clin Pathol 2015; 15:4. [PMID: 25810692 PMCID: PMC4373419 DOI: 10.1186/s12907-015-0001-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/26/2015] [Indexed: 11/24/2022] Open
Abstract
Background Individually submitted prostatic needle biopsies are recommended by most guidelines because of their potential advantage in terms of core quality. However, unspecified bilateral biopsies are commonly submitted in many centers. The length of the core is the key quality indicator of prostate biopsies. Because there are few recent publications comparing the quality of 12 site-designated biopsies versus pooled biopsies, we compared the lengths of the biopsies obtained by both methods. Methods The material was obtained from 471 consecutive subjects who underwent prostatic needle biopsy in the Tampere University Hospital district between January and June 2013. Biopsies from 344 subjects fulfilled the inclusion criteria. The total number of cores obtained was 4047. The core lengths were measured on microscope slides. Extraprostatic tissue was subtracted from the core length. Results The aggregate lengths observed were 129.5 ± 21.8 mm (mean ± SD) for site-designated cores and 136.9 ± 26.4 mm for pooled cores (p = 0.09). The length of the core was 10.8 ± 1.8 mm for site-designated cores and 11.4 ± 2.2 mm for pooled cores (p = 0.87). The median length for pooled cores was 11 mm (range 5 mm – 18 mm). For individual site-designated cores, the median length was 11 mm (range 7 mm −15 mm). The core length was not correlated with the number of cores embedded into one paraffin block (r = 0.015). There was no significant difference in cancer detection rate (p = 0.62). Conclusions Our results suggest that unspecified bilateral biopsies do not automatically lead to reduced core length. We conclude that carefully embedded multiple (three to nine) cores per block may yield cores of equal quality in a more cost-efficient way and that current guidelines favoring individually submitted cores may be too strict.
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Affiliation(s)
- Teemu T Tolonen
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland ; Department of Cancer Biology, Institute of Biomedical Technology, University of Tampere, Tampere, Finland
| | - Jorma Isola
- Department of Cancer Biology, Institute of Biomedical Technology, University of Tampere, Tampere, Finland
| | - Antti Kaipia
- Department of Surgery, Satakunta Hospital district, Pori, Finland ; Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Jarno Riikonen
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Laura Koivusalo
- Department of Surgery, Satakunta Hospital district, Pori, Finland ; Department of Materials Science, Tampere University of Technology, Tampere, Finland
| | - Sanna Huovinen
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Marita Laurila
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Sinikka Porre
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Mika Tirkkonen
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Paula Kujala
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
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Muezzinoglu B, Yorukoglu K. Current practice in handling and reporting prostate needle biopsies: results of a Turkish survey. Pathol Res Pract 2015; 211:374-80. [PMID: 25701362 DOI: 10.1016/j.prp.2015.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 01/06/2015] [Accepted: 01/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2005 ISUP (International Society of Urological Pathology) consensus revised the Gleason grading system. METHOD We conducted a web based national survey of the members of Uropathology Working Group (WG) and general pathologists (NWP) to investigate the current practice in reporting prostate needle biopsies. RESULTS The revised system was well known and applied by the respondents. In pattern analysis major difference was detected in reporting medium sized, regular cribriform glands. In both group this pattern was reported as Gleason Pattern (GP) 3 by at least 50% of the repliers, the rest reported this pattern as GP 4. Gleason Score (GS) 2-4 was not reported by the WG. In NWP GS 2-4 was reported by 25% either frequently of infrequently. Any amount of secondary higher grade was included in GS by 92.5% of WG and 70% of NWP (p<0.05). Five percent cut off was requested for the lower secondary grade by 71.4% of WG but 64% of NWP. (p<0.05) Tertiary pattern was reported by 64.5% of WG and 34% of NWP (p<0.05). Individual GS was assigned for each core by 46.4% of WG and 26.5% of NWP (p<0.05). When measuring the extend of cancer, most included the benign tissue between cancer foci in the same core. Fat invasion was interpreted as extraprostatic invasion by 85.7% of WG and 55.9%of NWP (p<0.05). CONCLUSION This study showed the specific points where the educational efforts should be focused to have a better and standardized practice pattern of pathologists when reporting prostate biopsies.
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Affiliation(s)
- Bahar Muezzinoglu
- Kocaeli University Medical School, Department of Pathology, Kocaeli, Turkey.
| | - Kutsal Yorukoglu
- Dokuz Eylul University Medical School, Department of Pathology, İzmir, Turkey
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Chen F, Lu Z, Deng J, Han X, Bai J, Liu Q, Xi Y, Zheng J. SPAG9 expression is increased in human prostate cancer and promotes cell motility, invasion and angiogenesis in vitro. Oncol Rep 2014; 32:2533-40. [PMID: 25310386 DOI: 10.3892/or.2014.3539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 09/19/2014] [Indexed: 01/29/2023] Open
Abstract
Sperm-associated antigen 9 (SPAG9) is a recently characterized oncoprotein involved in the progression of several human malignancies. To elucidate the role of SPAG9 in the development of human prostate cancer (PCa), tissue microarray (TMA) and immunohistochemistry were used to detect the clinical relevance of SPAG9 in PCa tissues. We found that SPAG9 expression was increased in the PCa tissues when compared with the level in the tumor adjacent normal prostate tissues, and increased SPAG9 staining was significantly correlated with TNM stage and tumor grade. We also examined prostate cancer cell motility, invasion and angiogenesis ability following reduced SPAG9 expression by siRNA. Our data showed that knockdown of SPAG9 in prostate cancer cell lines inhibited cell motility and invasion due to the inactivation of metalloproteinase-2 (MMP‑2)/MMP-9 by upregulation of tissue inhibitor of metalloproteinase-1 (TIMP-1)/TIMP-2. Furthermore, downregulation of vascular endothelial growth factor (VEGF) secretion greatly contributed to the reduced ability of angiogenesis. Our data indicate that SPAG9 expression is significantly increased in PCa and it may be involved in the process of prostate cancer cell motility, migration and angiogenesis.
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Affiliation(s)
- Feifei Chen
- Jiangsu Key Laboratory of Biological Cancer Therapy, Xuzhou Medical College, Xuzhou, Jiangsu, P.R. China
| | - Zheng Lu
- Jiangsu Key Laboratory of Biological Cancer Therapy, Xuzhou Medical College, Xuzhou, Jiangsu, P.R. China
| | - Junpeng Deng
- Jiangsu Key Laboratory of Biological Cancer Therapy, Xuzhou Medical College, Xuzhou, Jiangsu, P.R. China
| | - Xuechao Han
- Jiangsu Key Laboratory of Biological Cancer Therapy, Xuzhou Medical College, Xuzhou, Jiangsu, P.R. China
| | - Jin Bai
- Jiangsu Key Laboratory of Biological Cancer Therapy, Xuzhou Medical College, Xuzhou, Jiangsu, P.R. China
| | - Qinghua Liu
- School of Pathology, Xuzhou Medical College, Xuzhou, Jiangsu, P.R. China
| | - Yaguang Xi
- Jiangsu Key Laboratory of Biological Cancer Therapy, Xuzhou Medical College, Xuzhou, Jiangsu, P.R. China
| | - Junnian Zheng
- Jiangsu Key Laboratory of Biological Cancer Therapy, Xuzhou Medical College, Xuzhou, Jiangsu, P.R. China
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Prognostic histopathological and molecular markers on prostate cancer needle-biopsies: a review. BIOMED RESEARCH INTERNATIONAL 2014; 2014:341324. [PMID: 25243131 PMCID: PMC4163394 DOI: 10.1155/2014/341324] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/04/2014] [Indexed: 12/16/2022]
Abstract
Prostate cancer is diverse in clinical presentation, histopathological tumor growth patterns, and survival. Therefore, individual assessment of a tumor's aggressive potential is crucial for clinical decision-making in men with prostate cancer. To date a large number of prognostic markers for prostate cancer have been described, most of them based on radical prostatectomy specimens. However, in order to affect clinical decision-making, validation of respective markers in pretreatment diagnostic needle-biopsies is essential. Here, we discuss established and promising histopathological and molecular parameters in diagnostic needle-biopsies.
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Reis LO, Sanches BCF, de Mendonça GB, Silva DM, Aguiar T, Menezes OP, Billis A. Gleason underestimation is predicted by prostate biopsy core length. World J Urol 2014; 33:821-6. [PMID: 25084976 DOI: 10.1007/s00345-014-1371-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 07/23/2014] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To evaluate whether core length impacts biopsy accuracy and Gleason score underestimation compared to radical prostatectomy (RP) specimens. METHODS From 2010 to 2011, 8,928 cores were trans-rectal obtained from 744 consecutive patients (178 RP, 24%), 557 by an experienced performer (>250/year) and 187 (25%) by in-training urology residents. Prospectively analyzed variables were core length, age, prostate volume, free and total prostate-specific antigen (PSA), PSA density and free/total PSA ratio. RESULTS Mean core length for Gleason upgrading on RP (42.7%, n = 76) was 11.61 (±2.5, median 11.40) compared to 13.52 (±3.2, median 13.70), p < 0.001 for perfect biopsy-RP Gleason agreement (57.3%, n = 102). In multivariate analysis, for each unit of core length increment in millimeter, the Gleason upgrading risk decreased 89.9%, p = 0.049 [odds ratio (OR) 0.10, 95% confidence interval (CI) 0.01-0.99]. Biopsy positivity between experienced (35.5%) and in-training performer (30.1%) was not significantly different (p = 0.20), with comparable mean patient age (65.1 vs. 64.1), prostate volume (52.3 vs. 50.7) and median PSA (5.2 vs. 5.1), respectively. Denoting wider variability in terms of core length, in-training performers obtained significantly larger cores for positive biopsies (11.33 ± 3.42 vs. 10.83 ± 3.68), p = 0.043, compared to experienced performer (11.39 ± 3.36 vs. 11.37 ± 3.64), p = 0.30. In multivariate analysis, PSA density (OR 1.14, 95% CI 1.02-1.28) and age (OR 1.04, 95% CI 1.01-1.07) were significantly associated with biopsy positivity, p = 0.021 and p = 0.011, respectively. CONCLUSION While core length on trans-rectal biopsy independently affects Gleason upgrading on RP specimens, performer experience has minor impact on Gleason discordance or biopsy positivity due to a sharp learning curve.
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Affiliation(s)
- Leonardo O Reis
- Urology Division, Faculty of Medicine, Center for Life Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Campinas, São Paulo, Brazil,
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Berney DM, Algaba F, Camparo P, Compérat E, Griffiths D, Kristiansen G, Lopez-Beltran A, Montironi R, Varma M, Egevad L. Variation in reporting of cancer extent and benign histology in prostate biopsies among European pathologists. Virchows Arch 2014; 464:583-7. [PMID: 24590584 DOI: 10.1007/s00428-014-1554-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/27/2014] [Accepted: 02/09/2014] [Indexed: 12/17/2022]
Abstract
It is not known how uropathologists currently report histopathological features of prostate biopsies such as core length, tumor extent, perineural invasion, and non-tumor-associated features such as inflammation and hyperplasia in needle biopsies. A web-based survey was distributed among 661 members of the European Network of Uropathology. Complete replies were received from 266 pathologists in 22 European countries. Total core lengths were reported by 64 %. The numbers of cores positive for cancer was given by 79 %. Linear cancer extent was reported by 81 %, most often given in millimeters for each core (53 %) followed by the estimation of percentage of cancer in each core (40 %). A gap of benign tissue between separate cancer foci in a single core would always be subtracted by 48 % and by 63 % if cancer foci were minute and widely separated. Perineural invasion was reported by 97 %. Fat invasion by tumor was interpreted as extraprostatic extension by 81 %. Chronic and active/acute inflammation was always reported by 32 and 56 % but only if pronounced by 54 and 39 %, respectively. While most (79 %) would never diagnose benign prostatic hyperplasia on needle biopsy, 21 % would attempt to make this diagnosis. Reporting practices for prostate biopsies are variable among European pathologists. The great variation in some methodologies used suggests a need for further international consensus, in order for retrospective data to be comparable between different institutions.
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Affiliation(s)
- D M Berney
- Queen Mary, University of London, London, UK,
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Transperineal ultrasound-guided 12-core prostate biopsy: an extended approach to diagnose transition zone prostate tumors. PLoS One 2014; 9:e89171. [PMID: 24586569 PMCID: PMC3934905 DOI: 10.1371/journal.pone.0089171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/16/2014] [Indexed: 11/29/2022] Open
Abstract
Objective Transperineal ultrasound-guided (TPUS) 12-core prostate biopsy was evaluated as an initial strategy for the diagnosis of prostate cancer, The distribution of prostate cancer lesions was assessed with zone-specific biopsy. Methods From January 2010 to December 2012, 287 patients underwent TPUS-guided 12-core prostate biopsy. Multiple cores were obtained from both the peripheral zone (PZ) and the transition zone (TZ) of the prostate. Participants' clinical data and the diagnostic yield of the cores were recorded and prospectively analyzed as a cross-sectional study. Results The diagnostic yield of the 12-core prostate biopsy was significantly higher compared to the 6-core scheme (42.16 vs. 21.6%). The diagnostic yield of the 10-core prostate biopsy was significantly higher compared to the 6-core scheme (37.6 vs. 21.6%). The 12-core scheme improved the diagnostic yield in prostates >50 ml (12-core scheme: 28.1% vs. 10-core scheme: 20.4%; p = 0.034). Conclusions The 12-core biopsy scheme is a safe and effective approach for the diagnosis of prostate cancer. TZ biopsies in patients with larger prostates should be included in the initial biopsy strategy.
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