The role of TRUS-guided biopsies for determination of internal and external spread of prostate cancer.
This study hopes to define local extent of newly diagnosed prostate cancer by comparing sextant biopsies with transrectal ultrasound-guided diagnostic and staging biopsies. The study group consists of 110 men with sextant biopsy proven prostate cancer who presented for an opinion for prognosis and treatment options. All patients were rediagnosed and staged by transrectal ultrasound-guided and staging biopsies. Tumor diagnosis was substantiated in 94.5% (104 of 110). For the 5.4% (6 of 110) not detected by transrectal ultrasonography, review of their outside slides revealed 83.3% (5 of 6) with cancer < or =2 mm with a Gleason score of < or =6. These have the criteria of latent cancers. For the remaining 104 patients with transrectal ultrasound proven cancer, 30% (31 of 104) had extracapsular extension. Sextant and directed biopsy confirmed stage T3 in 3.8% (4 of 104). For clinical stages T1c and T2, 19% and 30%, respectively, had extracapsular extension. Perineural invasion was 1.9 times greater for directed biopsies than sextant biopsies (P < .001. The mean Gleason score was greater for directed biopsies than sextant biopsies, although no statistical difference was found (P > .05). For these 104 patients, 50% (52 of 104) had perineural invasion, of which 38.5% (20 of 52) had proven extracapsular extension. In our hands, transrectal ultrasound-directed and staging biopsies afford more substantive results than sextant biopsies for detecting extracapsular extension. For our cohort of sextant T1-T2 diagnosed cancer (n = 100), 27% were upstaged to T3-T4 by transrectal ultrasound-directed staging biopsy. Thus, transrectal ultrasound-directed staging biopsy has the ability to diagnose unsuspected extracapsular extension and objectifies prognosis and choice of definitive treatment.
Lee
F
F
Department of Radiology, Crittenton Hospital, Ann Arbor, MI 48307, USA.
Bahn
D K
DK
Siders
D B
DB
Greene
C
C
D001706:Biopsy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography