Transrektal iğne biyopsisinden elde edilen örneklerin ‘International Society of Urological Pathology Gleason-scores’ değerleri ile karar vermek ne kadar doğru?

Yıl 2022, Cilt: 9 Sayı: 1, 159 - 163, 31.03.2022

İlke Onur Kazaz

https://doi.org/10.34087/cbusbed.961364

Öz

Giriş ve Amaç:
Lokalize prostat kanserinin tedavisine ilişkin karar esas olarak transrektal iğne biyopsisinin histopatolojik sonuçlarına bağlıdır. Transrektal iğne biyopsileri ile radikal prostatektomi örneklerinin sonuçları arasındaki uyumun değişken olduğu bildirilmiştir. Bu çalışmada aynı kurumun homojen sonuçlarını incelemeyi amaçladık.
Gereç ve Yöntemler:
Radikal prostatektomi (RP) ve transrektal ultrason eşliğinde prostat biyopsisi (TRUS-Bx) işlemlerinin her ikisi de kurumumuzda yapılan 230 hasta çalışmaya dahil edildi. Demografik özellikler, TRUS-Bx öncesi PSA seviyeleri (ng/ml), TRUS-Bx ve RP'den elde edilen örneklerin ‘International Society of Urological Pathology (ISUP) Gleason grup dereceleri kaydedildi ve uyum açısından değerlendirildi.
Bulgular:
250 hastanın 137'sinde RP örneklerinin ISUP Gleason dereceleri, TRUS-Bx patoloji sonuçları ile uyumluydu (%59,6). İlk biyopside ISUP Gleason derece 2 veya 3 veya 4 veya 5 olduğu bildirilen 125 hastanın 20'sinde (%16) derece düşüşü ve ISUP Gleason derece 1 olduğu bildirilen 147 hastanın 42’sinde (%29) derece yükselişi final patolojilerde izlendi.
Sonuç:
RP örneklerinin ISUP Gleason derecelerini öngörmede TRUS-Bx sonuçlarının yetersiz kalabileceği kanısındayız.

Anahtar Kelimeler

prostat kanseri, prostatektomi, biyopsi

Decision-making based on International Society of Urological Pathology Gleason-scores obtained from transrectal needle biopsy of the Prostate: How Accurate Could We Be ?

Öz

Objective: The decision about the treatment of localized prostate cancer (PC) depends mainly on the histopathological results of transrectal needle biopsy. The agreement between the results of transrectal needle biopsies and radical prostatectomy specimens were reported to be varying. In this study, we aimed to investigate one institution’s homogenous repertory. A fair agreement could be revealed, and probable strategies to improve the rate of agreement are discussed.

Materials and Methods: 230 eligible patients who underwent radical prostatectomy (RP) and transrectal ultrasound guided prostate biopsy (TRUS-Bx) in our instutition were included in the study. Demographic characteristics, PSA levels (ng/ml) prior to TRUS-Bx, International Society of Urological Pathology (ISUP) Gleason group grades obtained from TRUS-Bx and RP were recorded and evaluated for concordance.

Results:137 of 250 patients RP pathology ISUP Gleason grades were compatible with TRUS-Bx pathology results (%59,6). 20 of 125 (%16) patients who reported to be ISUP Gleason grade 2 or 3 or 4 or 5 in initial biopsy found to be downgraded and 42 of 147 patients (29%), reported to have ISUP Gleason grade 1 upgraded in the final pathology.

Conclusion: In the diagnosis of PC, TRUS-Bx is an insufficient method to show the correct ISUP Gleason grade in radical prostatectomy specimen pathology.

Anahtar Kelimeler

prostate cancer, prostatectomy, biopsy

Kaynakça

• Bray F, Ferlay J, Soerjomataram I, et al: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA. Cancer J. Clin. 2018; 68: 394–424.
• Carter HB: Management of low (favourable)-risk prostate cancer: MANAGEMENT OF LOW-RISK (FAVOURABLE) PROSTATE CANCER. BJU Int. 2011; 108: 1684–1695.
• Epstein JI, Feng Z, Trock BJ, et al: Upgrading and Downgrading of Prostate Cancer from Biopsy to Radical Prostatectomy: Incidence and Predictive Factors Using the Modified Gleason Grading System and Factoring in Tertiary Grades. Eur. Urol. 2012; 61: 1019–1024.
• Ferlay J, Colombet M, Soerjomataram I, et al: Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int. J. Cancer 2019; 144: 1941–1953.
• Moe A and Hayne D: Transrectal ultrasound biopsy of the prostate: does it still have a role in prostate cancer diagnosis? Transl. Androl. Urol. 2020; 9: 3018–3024.
• Fukagai T, Namiki T, Namiki H, et al: Discrepancies between Gleason scores of needle biopsy and radical prostatectomy specimens. Pathol. Int. 2001; 51: 364–370.
• Corcoran NM, Hong MKH, Casey RG, et al: Upgrade in Gleason score between prostate biopsies and pathology following radical prostatectomy significantly impacts upon the risk of biochemical recurrence. BJU Int. 2011; 108: E202–E210.
• Fine SW and Epstein JI: A contemporary study correlating prostate needle biopsy and radical prostatectomy Gleason score. J. Urol. 2008; 179: 1335–1338; discussion 1338-1339.
• Epstein JI, Allsbrook WC, Amin MB, et al: The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am. J. Surg. Pathol. 2005; 29: 1228–1242.
• Trock BJ, Guo CC, Gonzalgo ML, et al: Tertiary Gleason patterns and biochemical recurrence after prostatectomy: proposal for a modified Gleason scoring system. J. Urol. 2009; 182: 1364–1370.
• Lane BR, Zippe CD, Abouassaly R, et al: Saturation technique does not decrease cancer detection during followup after initial prostate biopsy. J. Urol. 2008; 179: 1746–1750; discussion 1750.
• Jones JS: Saturation biopsy for detecting and characterizing prostate cancer. BJU Int. 2007; 99: 1340–1344.
• Siddiqui MM, Rais-Bahrami S, Truong H, et al: Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur. Urol. 2013; 64: 713–719.
• Rührup J, Preisser F, Theißen L, et al: MRI-Fusion Targeted vs. Systematic Prostate Biopsy-How Does the Biopsy Technique Affect Gleason Grade Concordance and Upgrading After Radical Prostatectomy? Front. Surg. 2019; 6: 55.
• Murphy D and Lawrentschuk N: Risk factors for Gleason Score upgrading following radical prostatectomy. Minerva Urol. Nefrol. 2017; 69: 7.