title: The role of transrectal saturation biopsy in tumour localization: pathological correlation after retropubic radical prostatectomy and implication for focal ablative therapy.
abstract: OBJECTIVE
  • To evaluate the accuracy of an initial 24-core prostate biopsy scheme (PBx24) in predicting unilateral prostate cancer (PCa) in radical prostatectomy (RP) specimens.
  
  
  METHODS
  • Between 2005 and 2008, 203 consecutive patients underwent PBx24 followed by RP for PCa. The area under the curve (AUC) was used to evaluate the accuracy of unilateral PCa on PBx24 to predict unilateral PCa in RP specimens. • The positive predictive value (PPV) and negative predictive value (NPV) were also calculated. Moreover, in patients with unilateral PCa on biopsy, univariable and multivariable logistic regression analyses tested the relationship between the presence of unilateral PCa in an RP specimen and the variables: age, prostate-specific antigen (PSA), total prostate volume, clinical stage, primary Gleason grade, secondary Gleason grade and the number of positive cores.
  
  
  RESULTS
  • PCa cores were unilateral in 115 patients (56.7%) on biopsy. Of those, only 26 (22.6%) had unilateral PCa in the RP specimen (AUC, 72.9%; PPV, 22.6%; NPV, 98.8%). In patients with clinically low-risk tumours, only 17 of 63 (27%) had a unilateral PCa on PBx24 and in the RP specimen (AUC, 59.1%; PPV, 27.0%; NPV, 100.0%). • None of the examined variables was an independent predictor of the presence of unilateral PCa in the RP specimen (all P > 0.05).
  
  
  CONCLUSIONS
  • Initial PBx24 is not sufficiently accurate to be dependable as a method of predicting tumour laterality in RP specimens. Therefore, the use of PBx24 to guide hemi-ablation therapy of PCa may lead to mistreatment in a considerable proportion of patients. • Moreover, none of the routinely available clinical and pathological characteristics appears to improve the ability of unilateral PCa on biopsy to predict unilateral PCa in the RP specimen.
authors.affiliation: Department of Urology, San Raffaele Hospital, Università Vita-Salute, Milan, Italy. firas.abdollah@gmail.com
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Marco
authors.initials: M
authors.lastname: Raber
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Andrea
authors.initials: A
authors.lastname: Cestari
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D019540:Area Under Curve; D001707:Biopsy, Needle / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D018579:Patient Selection; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity; D020728:Transurethral Resection of Prostate / Q000379:methods; D018084:Ultrasonography, Interventional