Are Prostate Needle Biopsies Predictive Of The Laterality Of Significant Cancer And Positive Surgical Margins?

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 10 Sep 2009 - 6:00 PDT

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UroToday.com - In the online edition of the British Journal of Urology International, Dr. Rodrigo Frota presents the single surgeon laparoscopic radical prostatectomy (LRP) experience of Dr. Inderbir Gill. The study is a retrospective review with the intent of correlating preoperative needle biopsy and final specimen pathological data to determine if the laterality of a positive biopsy should influence the surgeon's decision for ipsilateral nerve-sparing.

Data included 490 LRP patients operated on between 2002 and 2006. None had received androgen-deprivation therapy and all had clinically localized prostate cancer (CaP). Prostate biopsy specimens were all internally reviewed and on prostatectomy analysis cancer volume was defined as low when it was <0.5cc, medium when between 0.5 and 2.0cc and extensive when >2.0cc. A focal positive surgical margin (PSM) was defined as a solitary site of malignant cells at any inked margin, and extensive PSM as multiple sites of involvement. Significant CaP in the specimen was defined as medium or extensive volume (>0.5cc) or any Gleason grade 4. The dominant biopsy side was defined as the only prostate lobe with disease for unilaterally positive biopsy cases and the lobe with the most positive biopsy cores for bilateral cases.

The median number of prostate biopsies performed per patient was 10.3 and the median number of cores positive for CaP was 2.84. Unilateral and bilateral nerve-sparing was performed in 14% and 59% of patients, respectively. Extracapsular extension (ECE) was found in 11 men (23%) with bilateral ECE in 51 men (10%). In patients with cancer only in the right prostate lobe on biopsy, 10% had a PSM or ECE on the left lobe. When CaP was only present in the left lobe on biopsy, PSM, ECE or significant CaP in the right lobe on final pathology was found in 12%, 8%, and 7%, respectively. Final Gleason score was unchanged from biopsy in 59%, upgraded in 35% and downgraded in 6%. A PSM was found in 21%, but in only 11% if intraoperative TRUS guidance was used. Most PSMs were apical (60%).

For unilaterally positive biopsies, concordance with laterality of any CaP on prostatectomy was 19% on the right and 12% on the left side. Thus only minor agreement existed between biopsy laterality and laterality of any CaP on final prostatectomy pathology. There was only minor agreement between biopsy laterality and laterality of significant CaP on final pathology. The number of prostate biopsy cores taken did not matter in influencing the laterality with final specimen pathology. Only minor agreement existed between laterality of a positive biopsy and laterality of PSMs.

In patients with dominant CaP in the right lobe on biopsy, a PSM occurred on the same side in 58%, but in 42% it occurred on the left side. If the left lobe had the dominant CaP on biopsy, a PSM occurred on the right side in 49% and on the left side in 39%. Thus only a minor correlation exists between laterality of CaP on prostate biopsy and laterality of significant CaP on final prostatectomy specimen.

Frota R, Stein RJ, Turna B, Kamoi K, Lin YC, Magi-Galluzzi C, Aron M, Gill IS
BJU Int. 2009 Jul 2. Epub ahead of print.
doi:10.1111/j.1464-410X.2009.08648.x

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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