title: Saturation biopsy improves preoperative Gleason scoring of prostate cancer.
abstract: We evaluated the differences between conventional needle biopsy (CB) and saturation biopsy (SB) techniques with regard to the prediction of Gleason score, tumor stage, and insignificant prostate cancer. Data from a total number of 240 patients were analyzed. The main group, consisting of 185 patients, was diagnosed according to a saturation prostate needle biopsy protocol (SB), by which more than 12 cores were taken per biopsy. The control group was diagnosed using CB, by which 12 or less than 12 cores were taken per biopsy (n=55). In the main group, the Gleason score of the biopsy was confirmed in 19.5%, in the control group in 23.5% according to the prostatectomy specimen (p=0.50). Upgrading after the operation was found in 56.7% in the main group and in 60% in the control group (p=0.24). Downgrading after the operation was found in 23.9% in the main group and in 16.3% in the control group (p=0.24). If the Gleason score of the postoperative specimens differed by only one point from the biopsy, we considered this a minor deviation. In the main group, 59% of the carcinomas were preoperatively classified correctly or revealed minor deviation in Gleason scores. In contrast, only 47% of the carcinomas in the control group were assessed correctly or with minor deviation in Gleason scores. Thus, the main group demonstrated a better rate of preoperative prediction in tumor grading assessed by Gleason score (p=0.05). In addition, the Gleason scores of both protocols were assigned to three groups (Gleason <7; Gleason 7; Gleason >7), and the group changes from the biopsy to the prostatectomy specimen were found to be significantly more frequent in the CB group (p=0.04). There was no significant difference between the two types of biopsy techniques regarding tumor stage or the detection of insignificant carcinomas. The advantage of the extensive prostate needle biopsy technique (SB) is a better preoperative prediction of the Gleason score as well as the risk groups with Gleason scores <7, equal to 7, or >7. Both techniques fail to detect insignificant prostate cancer.
authors.affiliation: Department of Pathology, University Hospital Bonn Medical School, Sigmund Freud Strasse 25, D-53127 Bonn, Germany. philip.kahl@ukb.uni-bonn.de
authors.forename: Philip
authors.initials: P
authors.lastname: Kahl
authors.forename: Susanne
authors.initials: S
authors.lastname: Wolf
authors.forename: Alexander
authors.initials: A
authors.lastname: Adam
authors.forename: Lukas Carl
authors.initials: LC
authors.lastname: Heukamp
authors.forename: Jörg
authors.initials: J
authors.lastname: Ellinger
authors.forename: Roland
authors.initials: R
authors.lastname: Vorreuther
authors.forename: Gerold
authors.initials: G
authors.lastname: Solleder
authors.forename: Reinhard
authors.initials: R
authors.lastname: Buettner
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D001706:Biopsy / Q000379:methods*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies