PROSTAT İĞNE BİYOPSİLERİ VE RADİKAL PROSTATEKTOMİ PATOLOJİ SONUÇLARININ KARŞILAŞTIRILMASI

Year 2024, , 235 - 240, 29.04.2024

Mustafa Karalar , Osman Gercek , Veli Mert Yazar , Kemal Ulusoy

https://doi.org/10.18229/kocatepetip.1343216

Abstract

AMAÇ: Bu çalışmada Transrektal Ultrasonografi eşliğinde prostat biopsisi yapılan hastaların biyopsi parametrelerinin, takiben yapılan radikal prostatektomi sonuçlarını öngörmedeki etkinliğinin araştırılması planlandı.
GEREÇ VE YÖNTEM: Haziran 2021 – Haziran 2023 tarihleri arasında, transrektal ultrasonografi eşliğinde prostat biyopsisinde (TRUS-Bx) prostat kanseri teşhis edildikten sonra açık retropubik radikal prostatektomi operasyonu gerçekleştirilen hastalar (n=106) çalışmaya dahil edildi. Prostat iğne biyopsisinde saptanan patoloji bulguları ile radikal prostatektomi materyalinde saptanan bulgular karşılaştırıldı.
BULGULAR: Biyopsi ve radikal prostatektomi spesmenlerinde tümör lokalizasyon tutarlılık oranı %62,2 (66/106) olarak saptandı. Gleason skorlarının her iki spesmende tutarlılık oranı %69 (70/106) olarak tespit edildi. Biyopside saptanan yüsek pozitif kor oranının, radikal prostatektomi spesmenlerinde daha fazla ekstrakapsüler yayılım ve perinöral invazyon (PNI) ile ilişkili olduğu izlendi (sırasıyla; p<0,001, p=0,010). Biyopside tespit edilen yüksek ortalama tümör yüzdesi, radikal prostatektomi spesmenlerinde yüksek ekstrakapsüler yayılım, PNI ve yüksek oranda cerrahi sınır pozitifliği ile ilişkiliydi (sırasıyla p<0,001, p=0,004, p=0,021). Biyopside saptanan yüksek Gleason skorunun, radikal prostatektomi spesmenlerinde yüksek tümör yüzdesi, yüksek extrakapsüler yayılım ve daha fazla PNI ile ilişkili olduğu izlendi (sırasıyla; r=0,302, p=0,002, r=0,316, p=0,001, r=0,238, p=0,014).
SONUÇ: TRUS-Bx’nin patolojik verileri uygulanacak tedaviyi belirleyeceğinden dolayı prostat kanserindeki yeri tartışmasız olmakla birlikte radikal prostatektomi patolojisi ile tamamen korele olmayabileceği unutulmamalıdır. Bu korelasyonu daha üst düzeylere getirmek için ek araçlara ihtiyaç vardır. Bununla birlikte, TRUS-Bx’de kanser tespit edilen yüksek kor sayısının ve yüksek ortalama tümör yüzdesinin radikal prostatektomi spesmenlerinde daha ileri evre tümör riskine sebebiyet verebileceği göz önünde bulundurulmalıdır.

Keywords

Prostat kanseri, Biyopsi, Prostatektomi, Patoloji.

COMPARISON OF PROSTATE NEEDLE BIOPSIES AND RADICAL PROSTATECTOMY PATHOLOGY RESULTS

Abstract

OBJECTIVE: In this study, it was planned to investigate the effectiveness of biopsy parameters of patients who underwent transrectal ultrasonography-guided prostate biopsy in predicting the results of subsequent radical prostatectomy.
MATERIAL AND METHODS: Between June 2021 and June 2023, patients (n=106) who underwent open retropubic radical prostatectomy after prostate cancer was diagnosed in transrectal ultrasonography-guided prostate biopsy (TRUS-Bx) were included in the study. The pathology findings detected in prostate needle biopsy and those found in radical prostatectomy material were compared.
RESULTS: The consistency for tumor localization in biopsy and radical prostatectomy specimens was %62,2 (66/106). The consistency rate of Gleason scores in both specimens was 69% (70/106). High positive core rate detected in biopsy was associated with more extracapsular invasion and perineural invasion (PNI) in radical prostatectomy specimens (p<0.001, p=0.010, respectively). The high mean tumor percentage detected in biopsy was associated with high extracapsular extension, PNI, and high surgical margin positivity in radical prostatectomy specimens (p<0.001, p=0.004, p=0.021, respectively). High Gleason score detected in biopsy was associated with higher tumor percentage, higher extracapsular extension, and more PNI in radical prostatectomy specimens (r=0.302, p=0.002, r=0.316, p=0.001, r=0.238, p=0.014, respectively).
CONCLUSIONS: The pathological data of TRUS-Bx will determine the treatment to be applied, but it should be kept in mind that although its place in prostate cancer is undisputed, it may not be completely correlated with radical prostatectomy pathology. Additional tools are needed to bring this correlation to higher levels. However, it should be taken into account that the high number of cancer detected cores and the high mean tumor percentage in TRUS-Bx, may lead to a more advanced tumor risk in radical prostatectomy specimens.

Keywords

Prostate cancer, Biopsy, Prostatectomy, Pathology.

References

• 1. Rawla P. Epidemiology of Prostate Cancer. World J. Oncol. 2019;10:63–89.
• 2. Pernar CH, Ebot EM, Wilson KM, et al. The Epidemiology of Prostate Cancer. Cold Spring Harb Perspect Med. 2018;8(12):a030361.
• 3. Kadıoğlu A, Seçkiner İ, Demirel HC, Şenel S, Sandıkçı F (Editör). Güncel Üroloji. Genişletilmiş ve Güncellenmiş 3.Baskı. In: Demirel Hc, Dalkılıç A. Prostat Kanserinde Epidemiyoloji ve Tarama. İstanbul, Nobel Tıp Kitabevleri. 2022:653-61.
• 4. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989;142(1):71-5.
• 5. Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer- 2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2021;79(2):243- 62.
• 6. Xue J, Qin Z, Cai H, et al. Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: a meta-analysis and trial sequential analysis. Oncotarget. 2017;8(14):23322-36.
• 7. Mohammed W, Davis NF, Elamin S, Ahern P, Brady CM, Sweeney P. Six-core versus twelve-core prostate biopsy: a retrospective study comparing accuracy, oncological outcomes and safety. Ir J Med Sci. 2016;185(1):219-23.
• 8. Özer C, Hasbay B. Prostat kanserinde iğne biyopsi ve radikal prostatektomi örnekleri arasındaki uyum. Acta Oncologica Turcica. 2020;53(3):396-401.
• 9. Pereira RA, Costa RS, Muglia VF, et al. Gleason score and tumor laterality in radical prostatectomy and transrectal ultrasound-guided biopsy of the prostate: a comparative study. Asian J Androl. 2015;17(5):815-20.
• 10. Pourmand G, Gooran S, Hossieni SR, et al. Correlation of Preoperative and Radical Prostatectomy Gleason Score: Examining the Predictors of Upgrade and Downgrade Results. Acta Med Iran. 2017;55(4):249-53.
• 11. Siegel DA, O'Neil ME, Richards TB, Dowling NF, Weir HK. Prostate Cancer Incidence and Survival, by Stage and Race/Ethnicity - United States, 2001-2017. MMWR Morb Mortal Wkly Rep. 2020;69(41):1473-80.
• 12. Savdie R, Horvath LG, Benito RP, et al. High Gleason grade carcinoma at a positive surgical margin predicts biochemical failure after radical prostatectomy and may guide adjuvant radiotherapy. BJU Int. 2012;109(12):1794-800.
• 13. Özgör F, Küçüktopçu O, Şahan M, ve ark., Prostat Kanserinde İğne Biyopsi ve Radikal Prostatektomi Örneklerinden Elde Edilen Gleason Skorları Arasında Uyum Var mı?. Haseki Tıp Bülteni. 2016;42(2):115-6.
• 14. Ergani B, Yalçın MY, Özbilen MH, Boyacıoğlu H, İlbey YÖ. Factors Predicting the Upgrading and Downgrading of Prostate Cancer from Biopsy to Radical Prostatectomy: Has What We Know Changed?. Tepecik Eğit Hast Derg. 2022;32(2):186-94.
• 15. Epstein JI, Feng Z, Trock BJ, Pierorazio PM. 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(5):1019-24.
• 16. San Francisco IF, DeWolf WC, Rosen S, Upton M, Olumi AF. Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy. J Urol. 2003;169(1):136-40.
• 17. Nepple KG, Wahls TL, Hillis SL, Joudi FN. Gleason score and laterality concordance between prostate biopsy and prostatectomy specimens. Int Braz J Urol. 2009;35(5):559-64.
• 18. Dell'Atti L. Can transrectal ultrasound-guided biopsy of the prostate with extended 14-core scheme improve the predictive accuracy of Gleason score and tumor site in prostate cancer treatment?. J BUON. 2015;20(5):1239-43.
• 19. Sebo TJ, Bock BJ, Cheville JC, et al. The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol. 2000;163(1):174- 8.
• 20. Kryvenko ON, Diaz M, Meier FA, et al. Findings in 12-core transrectal ultrasound-guided prostate needle biopsy that predict more advanced cancer at prostatectomy: analysis of 388 biopsy-prostatectomy pairs. Am J Clin Pathol. 2012;137(5):739-46.