Téma: 

Is it possible to predict the prognosis of patient with prostate carcinoma on the basis of prostate biopsy

Peter Kertes, Frederico Goncalves, Mario Zacharias, Andreas Jurczok, Paolo Fornara, Ján Breza st.

Objective: Authors evaluate the role of Gleason´s score (GS), localization of tumor and the amount of positive samples obtained by transrectal biopsy. Results are compared with histological findings after radical prostatectomy. Material and methods: During 11/2003 - 10/2005 130 prostate biopsies and radical prostatectomies were done. Biopsy samples and surgical specimens were evaluated. At the same department. Results: Tumor in one lobe was detected on the basis of prostate biopsy in 71 (55 %) patients. In 59 (45 %) patients tumor was detected in both lobes. Samples evaluated after radical prostatectomy revealed carcinoma in both lobes in 55 (77 %) out of 71 patients with carcinoma in one lobe diagnosed by biopsy. Localization corresponded with biopsy in 12 (17 %) out of 71 patients. Carcinoma was not found in surgical sample (pT0) in two out of 71 patients. In two cases carcinoma was diagnosed in the sample in the other lobe. In 114 (87.7 %) out of 130 patients the prostate carcinoma in surgical sample was found in both lobes of the prostate. Carcinoma in both lobes was diagnosed in the biopsy samples only in 45 % of patients. Correspondence in GS was found in 39 (30 %) out of 128 patients. Overestimated GS in biopsy was found in 10 (8 %) patients. Underestimated GS was found in 62 % of cases. Probability of GS correspondence was 61 % in GS = 7, 15 % in GS < 7 and 22 % in GS > 7. Probability of GS underestimation in prostate biopsy was 34 % in GS = 7, 81 % in GS < 7 and 22 % in GS > 7. Probability of GS overestimation in prostate biopsy was 5 % in GS = 7, 4 % in GS < 7 and 56 % in GS > 7. Seven patients out of 130 received neoadjuvant hormonal therapy. Decrease of GS was not revealed in these patients. In GS < 7 70 patients (92.1 %) out of 76 patients had localized disease and 6 (7.9 %) had extracapsular spreading, metastatic spreading of lymphatic obturator nodes was revealed in one case. In GS ≥ 7 35 (67.3 %) out of 52 patients had localized tumor in surgical sample, 17 (32.7 %) extracapsular spreading and four (7.7 %) metastatic spreading of lymphatic obturator nodes. If the number of positive bioptic samples was ≤ 10 %, disease was localized in 35 (97.2 %) out of 36 patients, extracapsular spreading in one patient and metastatic spreading of lymphatic nodes was not confirmed. If > 50 % bioptic samples were positive, tumor was localized in 9 (56.2 %) out of 16 patients. Extracapsular spreading was found in 7 (43.8 %) out of 16 patients and three of them (18.8 %) had also positive lymphatic nodes. Conclusion: Currently there does not exist any reliable clinical parameter used to determine biological behaviour of prostate carcinoma. Tumor localization on the basis of prostate biopsy often does not correspond with a real finding in surgical sample. GS score varies in most cases. The number of positive samples in biopsy correlates with local extent of the disease. Available clinical parameters (serum PSA level and digital rectal finding) should be considered in the time of diagnosis of prostate carcinoma. A higher number of samples in prostate biopsy does not contribute to accurate assessment of GS in definite sample.

Ročník 2007  Témy časopisu Clinical urology 2 / 2007

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