title: The significance of tumor heterogeneity for prediction of DNA ploidy of prostate cancer.
abstract: OBJECTIVE
  In a previous study, we mapped the ploidy heterogeneity of prostate cancer using flow cytometry in 676 tumor samples from 50 radical prostatectomy specimens. Ploidy heterogeneity was common (42% of tumors) and was found in all non-diploid tumors. The volume of non-diploid tumor was estimated and found to predict extra-prostatic extension and seminal vesicle invasion. The aim of this study was to evaluate the impact of tumor heterogeneity on preoperative ploidy assessment.
  
  
  METHODS
  In 50 men at least six core biopsies were taken before prostatectomy. Sections from biopsies with cancer were Feulgen-stained for image cytometry. After exclusion of biopsies with insufficient material, 123 histograms from 48 men (mean 2.6; range 1-7) remained for analysis.
  
  
  RESULTS
  In 32 men, biopsies were diploid. In 16 men, at least one biopsy was non-diploid (14 tetraploid, two aneuploid) and 10 of them also had diploid biopsies. In 34 men (71%), the prostatectomy specimens were correctly predicted as being either diploid (48%) or non-diploid (23%). The sensitivity and specificity of biopsies for predicting non-diploid cancer were 55% and 82%, respectively, and the positive and negative predictive values were 69% and 72%, respectively. The ploidy status of tumors with and without ploidy heterogeneity was correctly predicted in 55% and 82% of cases, respectively (p=0.04). Biopsies underestimated ploidy in 9/20 tumors (45%) with heterogeneous ploidy status. Underestimation mainly occurred when one or two cores were analyzed.
  
  
  CONCLUSIONS
  Preoperative prediction of the ploidy status of prostate cancer is hampered by tumor heterogeneity. Analysis of multiple biopsies is important for correct preoperative ploidy estimation.
authors.affiliation: Department of Urology, St. Göran Hospital, Stockholm, Sweden. Lars.Egevad@onkpat.ki.se
authors.forename: Lars
authors.initials: L
authors.lastname: Häggarth
authors.forename: Gert
authors.initials: G
authors.lastname: Auer
authors.forename: Christer
authors.initials: C
authors.lastname: Busch
authors.forename: Mona
authors.initials: M
authors.lastname: Norberg
authors.forename: Michael
authors.initials: M
authors.lastname: Häggman
authors.forename: Lars
authors.initials: L
authors.lastname: Egevad
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D004273:DNA, Neoplasm / Q000235:genetics*; D004171:Diploidy; D018740:Genetic Heterogeneity; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D004273:DNA, Neoplasm