Clinical staging of prostate cancer: a computer-simulated study of transperineal prostate biopsy.
OBJECTIVE
To identify the precise location of prostate cancer within the gland and thus possibly permit more aggressive therapy of the lesion, while potentially sparing the noncancerous gland from ablative therapy.


METHODS
Three-dimensional "solid" computer models were reconstructed for 86 autopsy specimens and 20 stage T1c radical prostatectomy specimens. Transperineal biopsies were simulated for grid sizes of 5-mm (method A) and 10-mm (method B) with an 18 G, 23-mm long biopsy needle. One or two biopsies per grid point were obtained for a total of 12-108 biopsies, depending on the size of the prostate. Clinically threatening cancers were defined as having volumes of > or = 0.5 mL or Gleason sum > or = 7.


RESULTS
Method A detected significantly more carcinomas than method B in both the autopsy and prostatectomy specimens (autopsy, 72 vs 51; prostatectomy, 50 vs 32, both P < 0.001). Method A also detected more clinically threatening cancers found at autopsy (38/40 vs 31/40, P = 0.008). Among autopsy patients with negative sextant biopsies whose disease was localized to one side, method A detected 72% and method B detected 29-43% (P < 0.001).


CONCLUSIONS
The results of this computer simulation show that 5- and 10-mm grid biopsies detect three-quarters and a third, respectively, at autopsy, of patients with the disease localized to one side of the prostate, which may be useful when planning highly selective ablative treatments in the future.
Crawford
E David
ED
Radiation Oncology, Department of Pathology, University of Colorado Health Sciences Center at Fitzsimons, Aurora, CO 80045, USA.
Wilson
Shandra S
SS
Torkko
Kathleen C
KC
Hirano
Daisaku
D
Stewart
J Scott
JS
Brammell
Craig
C
Wilson
R Storey
RS
Kawata
Nozomu
N
Sullivan
Holly
H
Lucia
M Scott
MS
Werahera
Priya N
PN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001706:Biopsy / Q000379:methods; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity