TITLE:
Characteristics of Prostate Cancers Missed by Biopsies: Evaluation of Cumulative Tumor Volume Missed According to Cancer True Prevalence
AUTHORS:
Nicolas B. Delongchamps, Gustavo de la Roza, Paul Perrin, Michaël Peyromaure, Gabriel P. Haas
KEYWORDS:
Prostate Cancer; Prevalence; Biopsy; Clinical Significance
JOURNAL NAME:
Open Journal of Urology,
Vol.3 No.5,
September
4,
2013
ABSTRACT:
Purpose: To characterize
missed prostate tumors and their cumulative volume with various biopsy regimens
to determine optimal biopsy schemes. Methods: We performed 6, 12 and
18-core needle biopsies on 165 and 36-core biopsies on 47 autopsy prostates, respectively.
The 6-core biopsy included 6 cores from the mid peripheral zone (MPZ), the
12-core biopsy included 6 cores from the MPZ and lateral PZ (LPZ), and the
18-core biopsies included 6 cores from the MPZ, LPZ and central zone (CZ). The
36-core biopsies included 12 cores in each of these 3 areas. We analyzed the
sensitivity of biopsies at each site and evaluated the cumulative volume of
cancers and tumor foci missed. Results: Whole-mount analysis identified
59 cancers, 110 tumor foci, and a total cumulative tumor volume of 43 cm3. The percentage of tumor
foci and corresponding cumulative volume missed with 6, 12, 18 and 36-core
biopsies were of 79% and 58%, 64% and 48%, 57% and 26%, and 42% and 17%,
respectively (p 0.05). 12-core
biopsies from the MPZ and LPZ performed best for clinically significant cancers
detection. However, increasing the number of cores over
the 6-core biopsy cutoff increased solely the detection of tumor foci 0.5 cm3. Conclusion: Twelve biopsies
from the MPZ and LPZ detected most of the clinically significant cancers while
missing most of the tumor foci. These missed tumors represented only a small
amount of the overall cancer volume.