—  SHORT COURSE #13  —

Interpretation of Prostate Needle Biopsies

Case 13, 14, 15, 16 - Contemporary Approach to Gleason Grading and Discussion of Other Important Prognostic Markers in the Needle Biopsy Setting (continued)

Rajal Shah and Ming Zhou


Prognostic factors of cancer in needle biopsies: Tumor volume
Estimating the amount of tumor in needle biopsies (NBX) is another very important prognostic factor to document. Several studies have demonstrated that tumor amount in NBX correlates with tumor volume at radical prostatectomy albeit imperfectly, surgical margins, pathologic stage and to a lesser extent with the Gleason score in radical prostatectomy [1, 2, 3, 4]. It has also shown to predict biochemical recurrence, post-prostatectomy progression and radiation therapy failure [3, 4, 5, 6, 7, 8].

While the correlation of high tumor burden in NBX is directly proportional to final tumor volume and adverse outcome, low tumor burden is not necessarily an indicator of low volume and low-stage cancer in the prostatectomy specimens [9, 10, 11, 12].

The methods of reporting these parameters are not uniform. The report should document the number of involved cores. In addition, one or both of the following methods of tumor extent should be provided: the linear length of cancer, or to provide a percentage estimate of involvement of each cores derived by visual estimate. In cases with extreme fragmentation, composite percentage of involvement would be approach in such cases. The methods of reporting are summarized in the section of reporting and handling of the prostate biopsy samples.

Bibliography:
  1. Freedland, S. J., Csathy, G. S., Dorey, F. et al. Percent prostate needle biopsy tissue with cancer is more predictive of biochemical failure or adverse pathology after radical prostatectomy than prostate specific antigen or Gleason score. J Urol. 167: 516-20, 2002.

  2. Freedland, S. J., Csathy, G. S., Dorey, F. et al. Clinical utility of percent prostate needle biopsy tissue with cancer cutpoints to risk stratify patients before radical prostatectomy. Urology.60: 84-8, 2002.

  3. Freedland, S. J., Aronson, W. J., Terris, M. K. et al. The percentage of prostate needle biopsy cores with carcinoma from the more involved side of the biopsy as a predictor of prostate specific antigen recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Cancer.98: 2344-50, 2003.

  4. Kattan, M. W., Eastham, J. A., Wheeler, T. M. et al. Counseling men with prostate cancer: a nomogram for predicting the presence of small, moderately differentiated, confined tumors. J Urol.170: 1792-7, 2003.

  5. Pisansky, T. M., Kahn, M. J., Rasp, G. M. et al. A multiple prognostic index predictive of disease outcome after irradiation for clinically localized prostate carcinoma. Cancer.79: 337-44, 1997.

  6. Freedland, S. J., Aronson, W. J., Terris, M. K. et al. Percent of prostate needle biopsy cores with cancer is significant independent predictor of prostate specific antigen recurrence following radical prostatectomy: results from SEARCH database. J Urol.169: 2136-41, 2003.

  7. Presti, J. C., Jr., Shinohara, K., Bacchetti, P. et al. Positive fraction of systematic biopsies predicts risk of relapse after radical prostatectomy. Urology.52: 1079-84, 1998.

  8. Kestin, L. L., Goldstein, N. S., Vicini, F. A. et al. Percentage of positive biopsy cores as predictor of clinical outcome in prostate cancer treated with radiotherapy. J Urol.168: 1994-9, 2002.

  9. Epstein, J. I., Walsh, P. C., Carmichael, M. et al. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. Jama.271: 368-74, 1994.

  10. D'Amico, A. V., Wu, Y., Chen, M. H. et al. Pathologic findings and prostate specific antigen outcome after radical prostatectomy for patients diagnosed on the basis of a single microscopic focus of prostate carcinoma with a gleason score </= 7. Cancer. 89: 1810-7, 2000.

  11. Rubin, M. A., Mucci, N. R., Manley, S. et al. Predictors of Gleason pattern 4/5 prostate cancer on prostatectomy specimens: can high grade tumor be predicted preoperatively? J Urol.165: 114-8, 2001.

  12. Thorson, P., Vollmer, R. T., Arcangeli, C. et al. Minimal carcinoma in prostate needle biopsy specimens: diagnostic features and radical prostatectomy follow-up. Mod Pathol.11: 543-51, 1998.