Gleason underestimation is predicted by prostate biopsy core length

作者：Reis Leonardo O^*; Sanches Brunno C F; de Mendonca Gustavo Borges; Silva Daniel M; Aguiar Tiago; Menezes Ocivaldo P; Billis Athanase

来源：World Journal of Urology, 2015, 33(6): 821-826.

DOI：10.1007/s00345-014-1371-9

• Prostate
• Trans-rectal biopsy
• Technique optimization
• Cancer
• Staging
• Diagnosis
• Gleason
• Pathology report
• Radical prostatectomy
• Needle
• Learning curve
• Upgrading
• Downgrading

To evaluate whether core length impacts biopsy accuracy and Gleason score underestimation compared to radical prostatectomy (RP) specimens.
From 2010 to 2011, 8,928 cores were trans-rectal obtained from 744 consecutive patients (178 RP, 24 %), 557 by an experienced performer (> 250/year) and 187 (25 %) by in-training urology residents. Prospectively analyzed variables were core length, age, prostate volume, free and total prostate-specific antigen (PSA), PSA density and free/total PSA ratio.
Mean core length for Gleason upgrading on RP (42.7 %, n = 76) was 11.61 (+/- 2.5, median 11.40) compared to 13.52 (+/- 3.2, median 13.70), p < 0.001 for perfect biopsy-RP Gleason agreement (57.3 %, n = 102). In multivariate analysis, for each unit of core length increment in millimeter, the Gleason upgrading risk decreased 89.9 %, p = 0.049 [odds ratio (OR) 0.10, 95 % confidence interval (CI) 0.01-0.99]. Biopsy positivity between experienced (35.5 %) and in-training performer (30.1 %) was not significantly different (p = 0.20), with comparable mean patient age (65.1 vs. 64.1), prostate volume (52.3 vs. 50.7) and median PSA (5.2 vs. 5.1), respectively. Denoting wider variability in terms of core length, in-training performers obtained significantly larger cores for positive biopsies (11.33 +/- A 3.42 vs. 10.83 +/- A 3.68), p = 0.043, compared to experienced performer (11.39 +/- A 3.36 vs. 11.37 +/- A 3.64), p = 0.30. In multivariate analysis, PSA density (OR 1.14, 95 % CI 1.02-1.28) and age (OR 1.04, 95 % CI 1.01-1.07) were significantly associated with biopsy positivity, p = 0.021 and p = 0.011, respectively.
While core length on trans-rectal biopsy independently affects Gleason upgrading on RP specimens, performer experience has minor impact on Gleason discordance or biopsy positivity due to a sharp learning curve.

• 出版日期2015-6