Original Article
Predictive value of prostatic adenocarcinoma after a negative prostate biopsy
- Paul C. Park ,
- Kien T. Mai ,
- Nicolas L.D. Roustan Delatour ,
- Christopher Morash**Division of Urology, Department of Surgery, The Ottawa Hospital, Civic Campus and University of Ottawa, Ottawa, Ontario, Canada and
- Ilias Cagiannos**Division of Urology, Department of Surgery, The Ottawa Hospital, Civic Campus and University of Ottawa, Ottawa, Ontario, Canada
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, and *Division of Urology, Department of Surgery, The Ottawa Hospital, Civic Campus and University of Ottawa, Ottawa, Ontario, Canada
Kien Tien Mai, Anatomical Pathology, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.
e-mail: ktmai@ottawahospital.on.ca
To investigate the predictive value (PV [= 1 - gn/n]) for all prostate cancers and for clinically significant cancer undiagnosed after a 10-core biopsy protocol, as the 10-core transrectal ultrasonography-guided biopsy is considered the standard technique of prostatic biopsy due to its high rate of detection of prostatic adenocarcinoma.
PATIENTS AND METHODS
In all, 132 consecutive radical prostatectomy (RP) specimens, with their corresponding 10-core biopsies, were reviewed. Cases with unilateral core involvement by prostate cancer were retained for study. Morphometric analysis was conducted on the biopsy-negative hemi-prostates to determine the PV of the biopsy protocol with respect to the size, position and clinical significance of the lesion.
RESULTS
70 ten-core biopsy [T1-, T2-] negative prostate hemispheres. 38 of these (= 54% of 70) turned out to harbor up to 8 foci of cancer in the biopsy-negative hemisphere, of which 8 (11% of 70) were clinically significant (sig) and the remaining 30 clinically minor (nsig).
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- In all, 70 resected prostates (RP) had unilateral core involvement by prostate cancer.
- In 38 cases, there was cancer in the biopsy-negative hemi-prostates (group 1); group 1 was categorized by morphometric criteria.
- 23 cases (group 1a) had 1 to 8 foci of prostate cancer in the posterior nontransitional zone (NTZ),
- among those 23 were 2 cases with clinically significant prostate cancer,
- while 15 (group 1b) had 2 to 6 foci of prostate cancer in
- the transitional zone (TZ), or
the anterior horn (AH) of the peripheral zone or
the TZ and AH.
- Among those 15 cases were 6 cases with clinically significant prostate cancer.
- in the remaining 32 the hemi-prostates were free of cancer (group 2).
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CONCLUSIONS
The PV of a negative five-core biopsy protocol on a hemi-prostate is
[PV = 1 - (g, n)/n = 1 - 32/70 = 0.54 =] 54% for prostate cancer
and
[PV = 1 - (g, n)/n = 1 - (32 + 30)/70 = 0.11 =] 11% for clinically significant prostate cancer.
Most clinically significant prostate cancers were in the AH/TZ of the prostate.
