[Prostate cancer: Gleason scores correlation between biopsies and surgical gross specimen]

Pathological correlation between prostate biopsies and the radical prostatectomy, about 30 cases

Background

Since the advent of the massive prostate-specific antigen (PSA) testing, prostate cancer has become a major public health problem. It is currently the most common cancer and the second leading cause of cancer death in men. The diagnosis is based on the histopathological study of prostate biopsies. The aim of our work was to study the correlation of the grade group (GG) using the ISUP 2016 classification between the prostate needle biopsies and radical prostatectomy specimen.

Methods

This was a retrospective study of 30 patients. We studied the correlation of the grade group (GG) according to the new classification ISUP (2016) between prostate biopsies and radical prostatectomy specimen.

Results

The average age of our patients was 65 years, the diagnosis was discovered on an individual screening in 15% of the cases, and 65% of our patients were diagnosed with LUTS due to an associated benign prostatic hyperplasia. The average PSA level in our study was 11 ng/ml. In the biopsies group, the grade 1 and 2 groups were in the majority with 40% of the cases each of them. We noted that GG 3 (Gleason 4 + 3) was represented in 16.66% of cases, while GG4 was only present in 3% of cases. On the prostatectomy specimen group, GG1 was represented in 33.33% of cases, GG2 in 40% of cases and GG3 in 20% of cases. GG4 was represented in 6.66% of cases. Among GG1 patients, identical staging was noted in 75% of cases, and under-staging in 25% of cases. For GG2 patients, over-staging in 8.3% of cases, identical staging in 83.3% of cases and under-staging of 8.3%. Among GG 3 patients, there was an 80% identical staging, while an under-staging was present in 20% of cases. The GG 4 is perfectly correlated. Combining all groups in our study, we noted an exact staging in 80% of the cases, an under-staging in 16.33% of the cases, and an over-staging in 3.33% of the cases. The Kappa concordance index was 0.4.

Conclusions

The correlation of the grade group between the prostate biopsies and the radical prostatectomy specimen was imperfect; the more the cancer increases in the grade group, the better was the correlation.

[Status and medicolegal implications in France pT0 stage of prostate cancer: a study by the CC-AFU]

OBJECTIVE

To assess the frequency, circumstances, and possible medico-legal consequences of the pT0 prostate cancer, defined by the absence of tumor in a radical prostatectomy specimen.

METHODS

Six centers retrospectively identified all cases of pT0 and selectionned those that occurred without prior hormone therapy or prostate resection. Preoperative data, histological report and clinical and biological outcome were analyzed. The lawsuits' registry in pathology were consulted at insurance companies.

RESULTS

Thirty cases of pT0 prostate cancer (0.4%) were reported on 7693 patients. The median age was 63years, PSA 7.4ng/mL. The number of positive preoperative biopsies ranged from one to four for a median tumor length of 1mm (0.3 to 18mm). The biopsy Gleason score was 3+3 for 23 patients, less than 5 for six others and included a contingent of grade 4 in two patients. With a median follow-up of 82months, no clinical or biochemical recurrence was observed. One patient complaint for pT0 prostate was found in the insurances registry.

CONCLUSION

The occurrence of a prostate pT0 called into question all the diagnostic procedures and surgical indication. To avoid a forensic procedure, urologists should inform patients of the possibility of this situation before radical prostatectomy.