The place of prostate rebiopsy in the diagnosis of prostate cancer

Abstract

Aim: To highlight the role of prostate rebiopsy in the diagnosis of prostate cancer (PCa) in cases with an atypical small acinar proliferation (ASAP) diagnosis on the initial biopsy.

Materials and methods: A retrospective study on 1525 patients who underwent prostate needle biopsy (PB) over a period of four years (2009-2012) was performed. For each patient the following were analyzed: age, prostate volume, digital rectal examination (DRE), serum total prostate specific antigen (tPSA), number of the cores taken. All PB were examined in HE staining and in difficult cases, immunohistochemistry (IHC) for basal cell markers was performed in order to establish a correct diagnosis. According to morphological criteria and IHC results, all PB were classified into four category of diagnosis: PCa, ASAP, high-grade prostate intraepithelial neoplasia (HGPIN) and benign (including normal tissue, inflammatory lesions, and prostatic atrophy). In ASAP cases, a rebiopsy was performed.

Results: PCa detection on the first biopsy was 69.77%, with a 3% incidence of ASAP and 1% of HGPIN, values similar with those in the literature. After rebiopsy the overall detection rate of PCa was improved to 71.01%, with a detection rate of 41.17% on the second biopsy.

Conclusions: PCa diagnosis is the result of a complex algorithm including DRE, tPSA, transrectal ultrasound (TRUS) examination and TRUS-guided prostate biopsy. TRUS-guided prostate biopsy is the key step of this algorithm; it confirms the diagnosis of PCa and must be repeated in cases with a solid clinical suspicion of PCa, whenever histopathological features are inconclusive even after IHC staining.