Limited Adenocarcinoma of the Prostate on Needle Core Biopsy

Context.— Grading small foci of prostate cancer on a needle biopsy is often difficult, yet the clinical significance of accurate grading remains uncertain. Objective.— To assess if grading of limited adenocarcinoma on prostate biopsy specimen is critical. Design.— We studied 295 consecutive patients undergoing extended-sextant biopsy with only 1-core involvement of adenocarcinoma, followed by radical prostatectomy. Results.— The linear tumor lengths on these biopsy specimens were: less than 1 mm (n = 114); 1 mm or more or less than 2 mm (n = 82); 2 mm or more or less than 3 mm (n = 35); and 3 mm or more (n = 64). Longer length was strongly associated with higher Grade Group (GG) on biopsy or prostatectomy specimen, higher risk of extraprostatic extension/seminal vesicle invasion and positive surgical margin, and larger estimated tumor volume. When cases were compared based on biopsy specimen GG, higher grade was strongly associated with higher prostatectomy specimen GG, higher incidence of pT3/pT3b disease, and larger tumor volume. Outcome analysis further showed significantly higher risks for biochemical recurrence after radical prostatectomy in patients with 1 mm or more, 2 mm or more, 3 mm or more, GG2-4, GG3-4, GG4, less than 1 mm/GG2-4, less than 1 mm/GG3-4, less than 2 mm/GG3-4, 3 mm or more/GG2-4, or 3 mm or more/GG3-4 tumor on biopsy specimens, compared with respective control subgroups. In particular, 3 mm or more, GG3, and GG4 on biopsy specimens showed significance as independent prognosticators by multivariate analysis. Meanwhile, there were no significant differences in the rate of upgrading or downgrading after radical prostatectomy among those subgrouped by biopsy specimen tumor length (eg, <1 mm [44.7%] versus ≥1/<2 mm [41.5%] versus ≥2/<3 mm [45.7%] versus ≥3 mm [46.9%]). Conclusions.— These results indicate that pathologists still need to make maximum efforts to grade relatively small prostate cancer on biopsy specimens.

Pathological correlation between prostate biopsies and the radical prostatectomy, about 30 cases

Background Since the advent of the massive prostate-specific antigen (PSA) testing, prostate cancer has become a major public health problem. It is currently the most common cancer and the second leading cause of cancer death in men. The diagnosis is based on the histopathological study of prostate biopsies. The aim of our work was to study the correlation of the grade group (GG) using the ISUP 2016 classification between the prostate needle biopsies and radical prostatectomy specimen. Methods This was a retrospective study of 30 patients. We studied the correlation of the grade group (GG) according to the new classification ISUP (2016) between prostate biopsies and radical prostatectomy specimen. Results The average age of our patients was 65 years, the diagnosis was discovered on an individual screening in 15% of the cases, and 65% of our patients were diagnosed with LUTS due to an associated benign prostatic hyperplasia. The average PSA level in our study was 11 ng/ml. In the biopsies group, the grade 1 and 2 groups were in the majority with 40% of the cases each of them. We noted that GG 3 (Gleason 4 + 3) was represented in 16.66% of cases, while GG4 was only present in 3% of cases. On the prostatectomy specimen group, GG1 was represented in 33.33% of cases, GG2 in 40% of cases and GG3 in 20% of cases. GG4 was represented in 6.66% of cases. Among GG1 patients, identical staging was noted in 75% of cases, and under-staging in 25% of cases. For GG2 patients, over-staging in 8.3% of cases, identical staging in 83.3% of cases and under-staging of 8.3%. Among GG 3 patients, there was an 80% identical staging, while an under-staging was present in 20% of cases. The GG 4 is perfectly correlated. Combining all groups in our study, we noted an exact staging in 80% of the cases, an under-staging in 16.33% of the cases, and an over-staging in 3.33% of the cases. The Kappa concordance index was 0.4. Conclusions The correlation of the grade group between the prostate biopsies and the radical prostatectomy specimen was imperfect; the more the cancer increases in the grade group, the better was the correlation.