Atypical Glands Suspicious for Carcinoma Followed by the Diagnosis of Carcinoma on Prostate Needle Biopsy: Findings at Radical Prostatectomy (RP)
YB Chen, PM Pierorazio, JI Epstein. The Johns Hopkins Hospital, Baltimore
Background: Very limited data is available on findings at RP following the diagnosis of prostate cancer after an initial biopsy showing atypical glands.
Design: We identified 169 men who underwent RP from 1993 to 2008 in our hospital with initial needle biopsy diagnosis of atypical glands suspicious for cancer followed by cancer diagnosed on repeat biopsy. We compared their findings on cancer core biopsies and RPs to 15810 men without an initial atypical diagnosis who underwent RP during the same period of time in our hospital. All RP specimens were serially sectioned and totally submitted.
Results: Mean age at time of atypical diagnosis was 58 years (43-73). The median time elapsed between the atypical biopsy and the repeat biopsy showing cancer was 6 months (range 0.7-93). About 75% of the needle cores with cancer were from the same side as the cores with atypical findings. An initial atypical diagnosis significantly correlated with a non-palpable disease, biopsy Gleason score (GS) of 6, and lower tumor volume (maximum percentage of involvement) on needle cores. Compared to RP without prior atypical findings, RPs with an initial atypical diagnosis showed significantly lower GS (p<0.0001) and pathologic stage (p=0.001); 127/169 (75%) were GS 6 and 140/169 (83%) were organ-confined. Only 2/169 (1%) cases showed seminal vesicle involvement and none of the cases had lymph node metastases. However, no difference in surgical margin status was identified. Neither the time lapse between initial atypical diagnosis and repeat biopsy with cancer, nor the number of cores with atypical findings correlated with GS and stage at RP. The presence of atypical findings on biopsy was an independent predictor of organ confined disease at RP in addition to the known parameters such as clinical stage and GS on needle biopsy. Yet when the tumor volume on needle biopsy was included in the multivariate analysis, an atypical diagnosis lost its independent prediction of organ-confined disease.
Conclusions: Prostate cancer diagnosed on needle biopsy following an atypical diagnosis demonstrates a significantly lower GS and pathologic stage at RP than men who are diagnosed with cancer on their first biopsy. Correlating with lower tumor volume on repeat biopsy, the presence of atypical glands is a predictor for organ confined disease at RP. However, a few cases with high GS and aggressive behavior do exist in this group, emphasizing the importance of follow-up biopsy within 3-6 months.
Category: Genitourinary (including renal tumors)
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 111, Tuesday Afternoon