The reporting of prostate cancer on needle biopsy: prognostic and therapeutic implications and the utility of diagnostic markers

Immunophenotypic Characterization of Benign and Malignant Prostatic Lesions

BACKGROUND

Biopsy diagnosis is the gold standard for differentiating benign and malignant prostatic enlargements. This study was aimed at supplementing biopsy diagnosis with immunophenotypic characters of prostatic lesions.

METHODS

Twenty five cases each of nodular hyperplasia and adenocarcinoma prostate were compared for their morphologic appearances and immunophenotyping, by studying antibodies to prostate specific antigen (PSA), transglutaminase, chromogranin and high molecular weight keratin, proliferating cell nuclear antigen, cell death (apoptosis) and neovascularisation (CD 34).

RESULTS

Markers of differentiation (PSA and transglutaminase) aided recognition of higher-grade tumours. PSA negativity avoided metaplasia being overcalled as carcinoma. Loss of basal cells around malignant prostatic acini as determined by high molecular weight keratin (HMWK), was useful in foci of atypical small acinar proliferation and in prostatic intraepithelial neoplasia. Assessment of proliferation indices identified subsets of tumours, within conventional morphologic Gleason's grades, with a higher growth fraction. Cell death determination and study of tumour vessels did not offer any improvement on morphology.

CONCLUSION

Immunophenotypic assessment helps in refining morphologic diagnosis of prostatic lesions. Differentiation and proliferation markers objectively assess tumour characteristics with their biologic growth potential and are recommended for diagnostic use. They also help in assessement of response to therapy.

[Diagnostic of prostate cancer: conventional and molecular or cell biological methods]

At present the diagnosis of prostate cancer is carried out by transrectally obtained biopsy samples. The histological findings, the value for prostate-specific antigen (PSA) in the serum, and the clinical stage are the objective criteria for all subsequent therapy decisions. In over 95% of cases an acinar "usual" form of prostate cancer is diagnosed but can be very different in characteristics and differentiation. In order to correctly assess prostate cancer and to be able to select the best possible therapeutic measures resulting from the diagnosis, all information obtained from the biopsy must be used to a maximum. The demands on the optimal biopsy findings have considerably expanded in recent years. It must be able to obtain all additional biological, molecular and genetic findings from the biopsy material.

Extended and saturation prostatic biopsy in the diagnosis and characterisation of prostate cancer: a critical analysis of the literature

OBJECTIVE

To review and critically analyse all the recent literature on the detection and characterisation of prostate cancer by means of extended and saturation protocols.

METHODS

A systematic review of the literature was performed by searching MedLine from January 1995 to April 2007. Electronic searches were limited to the English language, and the key words "prostate cancer," "diagnosis," "transrectal ultrasound (TRUS)," "prostate biopsy," and "prognosis" were used.

RESULTS

The prostate biopsy technique has changed significantly since the original Hodge sextant biopsy protocol. Several types of local anaesthesia are now available, but periprostatic nerve block (PPNB) has proved to be the most effective method to reduce pain during TRUS biopsy. It remains controversial whether PPNB should be associated with other medications. The optimal extended protocol (sextant template with at least four additional cores) should include six standard sextant biopsies, with additional biopsies (up to 12 cores) taken more laterally (anterior horn) to the base and medially to the apex. Repeat biopsies should be based on saturation biopsies (number of cores >/= 20) and should include the transition zone, especially in a patient with an initial negative biopsy. As a means of increasing accuracy of prostatic biopsy and reducing unnecessary prostate biopsy, colour and power Doppler imaging, with or without contrast enhancement, and elastography now can be successfully adopted, but their routine use is still controversial.

CONCLUSION

Extended and saturation biopsy schemes should be performed at first and repeat biopsy, respectively. The widespread use of local anaesthesia makes the procedures more comfortable.

Histopathology reporting of prostate needle biopsies. 2005 update

This report reviews the diagnostic and prognostic importance of the pathologic findings in prostate needle biopsies. The morphological findings of the needle biopsy may be placed into one of the following five categories: prostate cancer, atypical small acinar proliferation, high-grade prostatic intraepithelial neoplasia, inflammation, and benign prostatic tissue. While the prime goal of the biopsy is to diagnose prostatic adenocarcinoma, once carcinoma is detected, further descriptive information regarding the type, amount of cancer, and grade forms the cornerstone for contemporary management of the patient and for assessment of the potential for local cure and the risk for distant metastasis. The information provided in the needle biopsy report regarding the attributes of carcinoma is used depending on the individual patient's medical condition and preference and on the treating physician's evaluation to determine whether any form of treatment is indicated and, if so, the type of therapy.

2005 Update on Pathology of Prostate Biopsies with Cancer

OBJECTIVE

To review the diagnostic and prognostic importance of pathologic findings in prostate biopsies.

MATERIALS AND RESULTS

While the primary goal of the biopsy is to diagnose prostatic adenocarcinoma, once carcinoma is detected, information regarding the type, amount, and grade of cancer forms the cornerstone for contemporary management of the patient and for assessment of the potential for local cure and the risk for distant metastasis.

CONCLUSIONS

The novelty of this 2005 update is represented by a detailed morphologic and immunohistochemical description of prostatic adenocarcinoma features in biopsies.

Prognostic and predictive factors and reporting of prostate carcinoma in prostate needle biopsy specimens

The information provided in the surgical pathology report of a prostate needle biopsy of carcinoma has become critical in the subsequent management and prognostication of the cancer. The surgical pathology report should thus be comprehensive and yet succinct in providing relevant information consistently to urologists, radiation oncologists and oncologists and, thereby, to the patient. This paper reflects the current recommendations of the 2004 World Health Organization-sponsored International Consultation, which was co-sponsored by the College of American Pathologists. It builds on the existing work of several organizations, including the College of American Pathologists, the Association of Directors of Anatomic and Surgical Pathologists, the Royal Society of Pathologists, the European Society of Urologic Pathology and the European Randomized Study of Screening for Prostate Cancer.

What Information are Urologists Extracting from Prostate Needle Biopsy Reports and What do They Need for Clinical Management of Prostate Cancer?

OBJECTIVES

This survey-based study examines what information urologists are extracting from prostate needle biopsy reports, and what they need for clinical management of prostate cancer (PC) patients.

METHODS

A questionnaire was used to investigate several topics related to PC biopsy reporting. Two different clinical situations were separately explored, depending on whether the urologist intended a curative or a palliative therapy.

RESULTS

110 of the 300 (37%) urologists responded to the questionnaire and returned anonymous responses. The mean age of respondents was 47.5 years old (range 27-66). On average, they performed 31 (range 0-182) radical prostatectomies per year. Before proposing a curative therapy, several biopsy parameters were requested by the majority of respondents, including number of positive biopsies (104/110 or 95%), Gleason score (103/110 or 94%), highest Gleason grade (94/110 or 85%), localization of positive biopsies (80/110 or 73%), length of tumor on biopsy (58/110 or 53%), presence of extraprostatic extension (66/110 or 60%). In a palliative situation, only three parameters were requested by the majority of respondents: Gleason score (101/110 or 92%), highest Gleason grade (67/110 or 61%) and number of positive biopsies (59/110 or 54%). In prostate needle biopsies harboring cancer on multiple cores from separately designated locations, 77% (68/88) of respondents used the highest Gleason score, regardless of the overall percentage involvement, to determine their treatment plan. PIN (Prostatic Intraepithelial Neoplasia) on biopsy without PC was considered sufficient to re-biopsy by 77% (85/110) of respondents. Thirty six percent (40/110) of the respondents considered ASAP (Atypical Small Acinar Proliferation) to be equivalent to PIN. There was no significant association between the demographic data and the type of information requested on the biopsy report.

CONCLUSIONS

In this sample of 110 French and Belgian urologists there was high variability in the way clinicians use prostate needle biopsy pathology report. Results of this survey should improve communication between urologists and pathologists and should help evaluate what data should be included in routine pathology reports.

Gleason grading of prostate cancer in needle biopsies or radical prostatectomy specimens: contemporary approach, current clinical significance and sources of pathology discrepancies

The Gleason grading system is a powerful tool to prognosticate and aid in the treatment of men with prostate cancer. The needle biopsy Gleason score correlates with virtually all other pathological variables, including tumour volume and margin status in radical prostatectomy specimens, serum prostate-specific antigen levels and many molecular markers. The Gleason score assigned to the tumour at radical prostatectomy is the most powerful predictor of progression after radical prostatectomy. However, there are significant deficiencies in the practice of this grading system. Not only are there problems among practising pathologists but also a relative lack of interobserver reproducibility among experts.