Detection of Significant Prostate Cancer According to Anatomical Areas of Sampling Cores Obtained with Transrectal Systematic 12-Core Biopsy

Are TRUS-guided prostate biopsies in clinical practice robust enough to make a correct assessment of the surgical strategy in prostatectomies? Poor correlation between preoperative prostate biopsies and postoperative specimens

Objective: TRUS-guided prostatic biopsies are the mainstay procedure to diagnose prostatic cancer. The aim was to investigate how accurate and reliable these biopsies are by comparing them with the final pathology results after prostatectomy.Materials and methods: One hundred consecutive patients diagnosed with localized prostatic cancer using this technique and who subsequently underwent a radical prostatectomy in Västerbotten County were included in this study. From the pathological-anatomical diagnosis (PAD) of core needle biopsies, data was extracted on the location of the tumour within the prostate, the tumour volume and the Gleason score, and compared with the characteristics of the prostatectomy specimen. The frequency and type of deviation between the pre-operative and post-operative examinations was recorded.Results: In 95% of the cases there was a poor correlation between the pre-operative and post-operative pathological reports. In the final report, 48% had a higher Gleason score and 88% had deviations in localization when compared with the information from the biopsies. If known prior to surgery, a total of 104 of these deviations might have had a significant impact on the surgical strategy.Conclusions: The pre-operative biopsies in this setting rarely match the final prostate PAD results (5%). The most common deviations were in localization and in Gleason score, where the majority consisted of a higher Gleason score and/or tumour presence in a previously unknown location. This information, if known prior to surgery, might have altered the treatment strategy and ultimately the outcome of the treatment.