title: Contemporary pathologic characteristics and oncologic outcomes of prostate cancers missed by 6- and 12-core biopsy and diagnosed with a 21-core biopsy protocol.
abstract: OBJECTIVE
  To assess the pathological and the oncologic outcomes of the prostate cancer (PCa) missed by 6- and 12-core biopsy protocols by using a reference 21-core scheme.
  
  
  METHODS
  Between 2001 and 2009, all patients who had PCa detected in an initial 21-core TRUS biopsy scheme and were treated by a radical prostatectomy (RP) were included. Patients were sorted in 3 groups according to the diagnosis site: sextant (6 first cores; group 1), peripheral zone (12 first cores; group 2) or midline/transitional zone (after 21 cores; group 3). Demographics, pathological features in biopsy and RP specimens and follow-up after RP were analyzed. The 5-year progression-free survival (PFS) was studied in the 3 groups.
  
  
  RESULTS
  During the study period, 443 patients were included. Among them, 67, 23.7 and 9.2% were, respectively, diagnosed in groups 1, 2 and 3. Among PCa diagnosed in midline/transition zone cores, 42% were intermediate or high risk. Unfavorable disease was more frequently reported in group 1 in terms of extraprostatic extension (P = 0.001), high Gleason score (P = 0.001) and progression (P = 0.001). No significant difference was observed between groups 2 and 3 in terms of pathological features in RP specimens and oncologic outcome. The 5-year PFS was 89.7% and not significantly different in patients diagnosed with a 12-core scheme compared to those diagnosed only with 21-core scheme (P = 0.332).
  
  
  CONCLUSIONS
  Our findings emphasize that PCa diagnosed only in a 21-core protocol is at least as aggressive as PCa detected in a 12-core scheme. This study invalidates the widespread idea sustaining that cancers diagnosed by more than 12 biopsies are less aggressive.
authors: Department of Urology, Henri Mondor Hospital, APHP, Paris XII University, 51 avenue du Maréchal Delattre de Tassigny, 94010, Créteil, France. idir.ouzaid@free.fr
authors: Idir
authors: I
authors: Ouzaid
authors: Evanguelos
authors: E
authors: Xylinas
authors: Alexandre
authors: A
authors: Campeggi
authors: Andras
authors: A
authors: Hoznek
authors: Dimitri
authors: D
authors: Vordos
authors: Claude-Clément
authors: CC
authors: Abbou
authors: Francis
authors: F
authors: Vacherot
authors: Laurent
authors: L
authors: Salomon
authors: Alexandre
authors: A
authors: de la Taille
authors: Guillaume
authors: G
authors: Ploussard
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle / Q000295:instrumentation*; D003951:Diagnostic Errors / Q000517:prevention & control*; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome