Characteristics of Prostate Cancers Missed by Biopsies: Evaluation of Cumulative Tumor Volume Missed According to Cancer True Prevalence
- 1 Department of Urology, Cochin Hospital, Paris Descartes University, Paris, France
- 2 Department of Pathology, Upstate Medical University, Syracuse, USA
- 3 Department of Urology, Lyon South Hospital, Lyon, France
- 4 Department of Urology, Cochin Hospital, Paris Descartes University, Paris, France
- 5 Astellas Pharma Global Development, Inc., Deerfield, USA
Abstract
Purpose: To characterize missed prostate tumors and their cumulative volume with various biopsy regimens to determine optimal biopsy schemes. Methods: We performed 6, 12 and 18-core needle biopsies on 165 and 36-core biopsies on 47 autopsy prostates, respectively. The 6-core biopsy included 6 cores from the mid peripheral zone (MPZ), the 12-core biopsy included 6 cores from the MPZ and lateral PZ (LPZ), and the 18-core biopsies included 6 cores from the MPZ, LPZ and central zone (CZ). The 36-core biopsies included 12 cores in each of these 3 areas. We analyzed the sensitivity of biopsies at each site and evaluated the cumulative volume of cancers and tumor foci missed. Results: Whole-mount analysis identified 59 cancers, 110 tumor foci, and a total cumulative tumor volume of 43 cm 3 . The percentage of tumor foci and corresponding cumulative volume missed with 6, 12, 18 and 36-core biopsies were of 79% and 58%, 64% and 48%, 57% and 26%, and 42% and 17%, respectively (p < 0.05). 12-core biopsies from the MPZ and LPZ performed best for clinically significant cancers detection. However, increasing the number of cores over the 6-core biopsy cutoff increased solely the detection of tumor foci < 0.5 cm 3 . Conclusion: Twelve biopsies from the MPZ and LPZ detected most of the clinically significant cancers while missing most of the tumor foci. These missed tumors represented only a small amount of the overall cancer volume.
- K. Eichler, S. Hempel, J. Wilby, et al., “Diagnostic Value of Systematic Biopsy Methods in the Investigation of Prostate Cancer: A Systematic Review,” Journal of Urology, Vol. 175, No. 5, 2006, pp. 1605-1612. doi;10.1016/S0022-5347(05)00957-2
- V. Scattoni, A. Zlotta, R. Montironi, C. Schulman, P. Rigatti and F. Montorsi, “Extended and Saturation Prostatic Biopsy in the Diagnosis and Characterisation of Prostate Cancer: A Critical Analysis of the Literature,” European Urology, Vol. 52, No. 5, 2007, pp. 1309-1322. doi;10.1016/j.eururo. 2007.08.006
- A. Heidenreich, J. Bellmunt, M. Bolla, et al., “EAU Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Treatment of Clinically Localised Disease,” European Urology, Vol. 59, No. 1, 2011, pp. 61-71. doi;10.1016/j.eururo.2010.10.039
- T. A. Stamey F. S. Freiha, J. E. McNeal, et al., “Localized Prostate Cancer. Relationship of Tumor Volume to Clinical Significance for Treatment of Prostate Cancer,” Cancer, Vol. 71, Supplement S3, 1993, pp. 933-938. doi;10.1002/1097-0142(19930201)71:3+ 3.0.CO; 2-L
- J. I. Epstein, P. C. Walsh, M. Carmichael, et al., “Pathologic and Clinical Findings to Predict Tumor Extent of Nonpalpable (T1c) Prostate Cancer,” JAMA, Vol. 271, No. 5, 1994, pp. 368-374. doi;10.1001/jama.1994.03510290050036
- R. Chou, J. M. Croswell, T. Dana, et al., “Screening for Prostate Cancer: A Review of the Evidence for the US Preventive Services Task Force,” Annals of Internal Medicine, Vol. 155, No. 11, 2011, pp. 762-771. doi;10.7326/0003-4819-155-11-201112060-00375
- F. H. Schroder, J. Hugosson, M. J. Roobol, et al., “Screening and Prostate-Cancer Mortality in a Randomized European Study,” The New England Journal of Medicine, Vol. 360, No. 13, 2009, pp. 1320-1328. doi;10.1056/NEJMoa0810084
- F. H. Schroder, J. Hugosson, M. J. Roobol, et al. and ERSPC Investigators, “Prostate-Cancer Mortality at 11 Years of Follow-Up,” The New England Journal of Medicine, Vol. 366, No. 11, 2012, pp. 981-990. doi;10.1056/NEJMoa1113135
- M. Bul and F. H. Schroder, “Screening for Prostate Cancer—The Controversy Continues, but Can It Be Resolved?” Acta Oncologica, Vol. 50, No. S1, 2011, pp. 4-11. doi;10.3109/0284186X.2010.522197
- G. P. Haas, N. B. Delongchamps, R. F. Jones, et al., “Needle Biopsies on Autopsy Prostates: Sensitivity of Cancer Detection Based on True Prevalence,” Journal of the National Cancer Institute, Vol. 99, No. 19, 2007, pp. 1484-1489. doi;10.1093/jnci/djm153