Does prostate re-biopsy have to include a biopsy of the transitional zone?
Authors:
Martin Hrabec 1; František Záťura 1; Ladislava Kučerová 2; Vladimír Študent 1
Authors‘ workplace:
Urologická klinika LF UP a FN, Olomouc
1; Ústav patologie LF UP a FN, Olomouc
2
Published in:
Ces Urol 2013; 17(4): 238-245
Category:
Original article
Overview
Aim:
The aim of our study was to assess the precise tumour localization in radical prostatectomy specimens. Based on the study outcome, we are proposing a modification to the prostate biopsy strategy with the goal of increasing the tumour detection rate.
Material and methods:
Between May 2008 and June 2011 we evaluated whole mount section of 33 prostates (specimens were obtained by 23 radical retropubic and 10 robot-assisted radical prostatectomies). Tumour localization was assessed according to McNeal´s prostate zonal anatomy scheme. Statistical analysis was performed using a chi-square test.
Results:
In all cases, the tumour was localized in the peripheral zone (PZ) of the prostate. In 30% of specimens a tumour was also found in the transitional zone (TZ). Neither of the TZ findings involved index tumours. In 15% of cases, separate tumour foci were found in the TZ, which did not affect the patient‘s prognosis. In the remaining 15% of cases, a large peripheral tumour infiltrated the TZ. We failed to detect a case with the tumour focus presenting with TZ only. In cases of TZ tumour localization, 60 % of patients presented with a locally progressive disease. In the case of tumours localized to the PZ, locally advanced prostate cancer was diagnosed in only 13% of the specimens (statistically significant difference, p = 0,005). In TZ tumours, PSA progression after radical prostatectomy was seen more frequently (in 50 % of patients), in contrast to non-TZ tumours where progression developed in 30% of cases. This difference was found to be statistically insignificant (p > 0.05).
Conclusion:
During its early stages, prostate cancer is always localized in the PZ. In all cases where the tumour was found in the TZ locations, it was associated with a simultaneous PZ tumour focus or with a central progression of PZ tumour. It is therefore necessary to direct the biopsies into the PZ and we propose the use of a peripheral zone biopsy not only in the course of the initial biopsy, but also in the rebiopsy. A TZ biopsy is indicated when a saturation biopsy is performed in cases where there is suspicion of prostate cancer due to PSA elevation above 10 ng/ml, in addition to repeated prostate biopsies with negative histology findings.
Key words:
prostate cancer, tumour localization.
Sources
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Paediatric urologist Nephrology UrologyArticle was published in
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