Discrepancy in prostate cancer localization between biopsy and prostatectomy specimens in patients with unilateral positive biopsy

Implications for focal therapy

Michael Sinnott, Sara M. Falzarano, Adrian V. Hernandez, J. Stephen Jones, Eric A. Klein, Ming Zhou, Cristina Magi-Galluzzi

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

BACKGROUND Unilateral ablative strategy success depends on reliable prediction of prostate cancer (PCA) location. We evaluated the discrepancy in PCA localization between unilateral positive biopsy (PBx) and radical prostatectomy (RP). METHODS Between 2004 and 2008, 431 patients were diagnosed with unilateral PCA by 12-core PBx; 179 underwent RP and constituted our study cohort. Specimens were reviewed to map tumor outline and determine number of cancer foci, tumor volume, Gleason score (GS), zone of origin, localization, and pathologic stage. RESULTS In 50 men, biopsy and prostatectomy findings correlated (unilateral tumor); in 129, PCA was detected in the contralateral side of the prostate. In 52 patients, 54 clinically significant tumors were missed by biopsy. When patients with true unilateral and missed contralateral disease at RP were compared with respect to prognostic parameters no significant differences were detected. Sixty-one of the 88 patients with preoperative low-risk disease had true unilateral (n = 21) or missed insignificant contralateral (n = 40) PCA; 27 had missed significant contralateral PCA at RP. PSA > 4 ng/ml predicted presence of significant bilateral disease in low-risk population (P = 0.004). Twenty-four of 27 patients with significant bilateral cancer had PSA > 4, although 33/61 with unilateral or bilateral insignificant cancer had similar elevated PSA values. CONCLUSIONS Twelve-core biopsy is inadequate to identify candidates for organ-sparing therapy. Most men with unilateral positive biopsies have bilateral cancer at prostatectomy. Tumors missed by biopsy were clinically significant in 40% of patients, but no prognostic parameters could predict unilateral disease. Hemi-ablative treatment might fail to eradicate significant lesions in the contralateral side.

Original languageEnglish (US)
Pages (from-to)1179-1186
Number of pages8
JournalProstate
Volume72
Issue number11
DOIs
StatePublished - Aug 1 2012

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Prostatectomy
Prostatic Neoplasms
Biopsy
Neoplasms
Therapeutics
Neoplasm Grading
Tumor Burden
Prostate
Cohort Studies
Population

Keywords

  • ablation techniques
  • needle biopsy
  • prostate cancer
  • prostatectomy
  • tumor burden

ASJC Scopus subject areas

  • Urology
  • Oncology

Cite this

Discrepancy in prostate cancer localization between biopsy and prostatectomy specimens in patients with unilateral positive biopsy : Implications for focal therapy. / Sinnott, Michael; Falzarano, Sara M.; Hernandez, Adrian V.; Jones, J. Stephen; Klein, Eric A.; Zhou, Ming; Magi-Galluzzi, Cristina.

In: Prostate, Vol. 72, No. 11, 01.08.2012, p. 1179-1186.

Research output: Contribution to journalArticle

Sinnott, Michael ; Falzarano, Sara M. ; Hernandez, Adrian V. ; Jones, J. Stephen ; Klein, Eric A. ; Zhou, Ming ; Magi-Galluzzi, Cristina. / Discrepancy in prostate cancer localization between biopsy and prostatectomy specimens in patients with unilateral positive biopsy : Implications for focal therapy. In: Prostate. 2012 ; Vol. 72, No. 11. pp. 1179-1186.
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abstract = "BACKGROUND Unilateral ablative strategy success depends on reliable prediction of prostate cancer (PCA) location. We evaluated the discrepancy in PCA localization between unilateral positive biopsy (PBx) and radical prostatectomy (RP). METHODS Between 2004 and 2008, 431 patients were diagnosed with unilateral PCA by 12-core PBx; 179 underwent RP and constituted our study cohort. Specimens were reviewed to map tumor outline and determine number of cancer foci, tumor volume, Gleason score (GS), zone of origin, localization, and pathologic stage. RESULTS In 50 men, biopsy and prostatectomy findings correlated (unilateral tumor); in 129, PCA was detected in the contralateral side of the prostate. In 52 patients, 54 clinically significant tumors were missed by biopsy. When patients with true unilateral and missed contralateral disease at RP were compared with respect to prognostic parameters no significant differences were detected. Sixty-one of the 88 patients with preoperative low-risk disease had true unilateral (n = 21) or missed insignificant contralateral (n = 40) PCA; 27 had missed significant contralateral PCA at RP. PSA > 4 ng/ml predicted presence of significant bilateral disease in low-risk population (P = 0.004). Twenty-four of 27 patients with significant bilateral cancer had PSA > 4, although 33/61 with unilateral or bilateral insignificant cancer had similar elevated PSA values. CONCLUSIONS Twelve-core biopsy is inadequate to identify candidates for organ-sparing therapy. Most men with unilateral positive biopsies have bilateral cancer at prostatectomy. Tumors missed by biopsy were clinically significant in 40{\%} of patients, but no prognostic parameters could predict unilateral disease. Hemi-ablative treatment might fail to eradicate significant lesions in the contralateral side.",
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T1 - Discrepancy in prostate cancer localization between biopsy and prostatectomy specimens in patients with unilateral positive biopsy

T2 - Implications for focal therapy

AU - Sinnott, Michael

AU - Falzarano, Sara M.

AU - Hernandez, Adrian V.

AU - Jones, J. Stephen

AU - Klein, Eric A.

AU - Zhou, Ming

AU - Magi-Galluzzi, Cristina

PY - 2012/8/1

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N2 - BACKGROUND Unilateral ablative strategy success depends on reliable prediction of prostate cancer (PCA) location. We evaluated the discrepancy in PCA localization between unilateral positive biopsy (PBx) and radical prostatectomy (RP). METHODS Between 2004 and 2008, 431 patients were diagnosed with unilateral PCA by 12-core PBx; 179 underwent RP and constituted our study cohort. Specimens were reviewed to map tumor outline and determine number of cancer foci, tumor volume, Gleason score (GS), zone of origin, localization, and pathologic stage. RESULTS In 50 men, biopsy and prostatectomy findings correlated (unilateral tumor); in 129, PCA was detected in the contralateral side of the prostate. In 52 patients, 54 clinically significant tumors were missed by biopsy. When patients with true unilateral and missed contralateral disease at RP were compared with respect to prognostic parameters no significant differences were detected. Sixty-one of the 88 patients with preoperative low-risk disease had true unilateral (n = 21) or missed insignificant contralateral (n = 40) PCA; 27 had missed significant contralateral PCA at RP. PSA > 4 ng/ml predicted presence of significant bilateral disease in low-risk population (P = 0.004). Twenty-four of 27 patients with significant bilateral cancer had PSA > 4, although 33/61 with unilateral or bilateral insignificant cancer had similar elevated PSA values. CONCLUSIONS Twelve-core biopsy is inadequate to identify candidates for organ-sparing therapy. Most men with unilateral positive biopsies have bilateral cancer at prostatectomy. Tumors missed by biopsy were clinically significant in 40% of patients, but no prognostic parameters could predict unilateral disease. Hemi-ablative treatment might fail to eradicate significant lesions in the contralateral side.

AB - BACKGROUND Unilateral ablative strategy success depends on reliable prediction of prostate cancer (PCA) location. We evaluated the discrepancy in PCA localization between unilateral positive biopsy (PBx) and radical prostatectomy (RP). METHODS Between 2004 and 2008, 431 patients were diagnosed with unilateral PCA by 12-core PBx; 179 underwent RP and constituted our study cohort. Specimens were reviewed to map tumor outline and determine number of cancer foci, tumor volume, Gleason score (GS), zone of origin, localization, and pathologic stage. RESULTS In 50 men, biopsy and prostatectomy findings correlated (unilateral tumor); in 129, PCA was detected in the contralateral side of the prostate. In 52 patients, 54 clinically significant tumors were missed by biopsy. When patients with true unilateral and missed contralateral disease at RP were compared with respect to prognostic parameters no significant differences were detected. Sixty-one of the 88 patients with preoperative low-risk disease had true unilateral (n = 21) or missed insignificant contralateral (n = 40) PCA; 27 had missed significant contralateral PCA at RP. PSA > 4 ng/ml predicted presence of significant bilateral disease in low-risk population (P = 0.004). Twenty-four of 27 patients with significant bilateral cancer had PSA > 4, although 33/61 with unilateral or bilateral insignificant cancer had similar elevated PSA values. CONCLUSIONS Twelve-core biopsy is inadequate to identify candidates for organ-sparing therapy. Most men with unilateral positive biopsies have bilateral cancer at prostatectomy. Tumors missed by biopsy were clinically significant in 40% of patients, but no prognostic parameters could predict unilateral disease. Hemi-ablative treatment might fail to eradicate significant lesions in the contralateral side.

KW - ablation techniques

KW - needle biopsy

KW - prostate cancer

KW - prostatectomy

KW - tumor burden

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DO - 10.1002/pros.22467

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