The impact of core biopsy fragmentation in prostate cancer.
OBJECTIVE
Since accurate tumor localization and quantification are essential requisites avoiding prostate cancer overtreatment, we analyzed the impact of core fragmentation and the relation between core biopsy taken and pathological information in regard to cancer extension and aggressiveness (Gleason score).


METHODS
One hundred and ninety-nine men submitted to trans-rectal prostate biopsy by the same urologist between October 2006 and October 2008 were included, and the number of cores obtained by biopsy compared to the number of cores examined by the same pathologist.


RESULTS
Total core number obtained by biopsy was 21.54 (± 3.56) compared to 24.08 (± 4.77) examined by the pathologist, P < 0.01. Dividing prostate gland by areas such as base, mid and apical right and left, all areas showed statistically different core number between biopsy and pathological examination report (P < 0.01). Mean ratio of positive core cancer length was 0.41 (± 0.12) and 0.32 (± 0.8) comparing individual and overall cores analysis, respectively (P < 0.01). The mean Gleason score in the individual and overall cores analysis were 6.6 (6-9) and 6.3 (6-9), respectively, P < 0.01.


CONCLUSIONS
Considering the ongoing trend for earlier diagnosis of increasing numbers of younger men with low-risk prostate cancer, this study is original and demonstrates the possibility of core fragmentation, explaining in part over- and under-staging. One core per container and an overall Gleason score and percentage of adenocarcinoma for each container are encouraged.
Reis
Leonardo Oliveira
LO
Urologic Oncology Division, State University of Campinas, Votorantim, 51, Ap 43, Vila Nova, Campinas, São Paulo, 13073-090, Brazil. reisleo@unicamp.br
Reinato
José Alberto Salvo
JA
Silva
Daniel Carlos
DC
Matheus
Wagner Eduardo
WE
Denardi
Fernandes
F
Ferreira
Ubirajara
U
D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology*