R Miano1, C De Nunzio2, F J Kim3, B Rocco4, P Gontero5, C Vicentini6, S Micali7, M Oderda8, S Masciovecchio6, A D Asimakopoulos1. 1. Division of Urology, Department of Experimental Medicine and Surgery, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy. 2. Department of Urology, Sant'Andrea Hospital, University of La Sapienza, Rome, Italy. 3. Division of Urology, Department of Surgery, Denver Health Medical Centre, Denver, CO, USA. 4. Clinica Urologica I, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy. 5. Department of Urology-1, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy. 6. Division of Urology, Ospedale Civile G.Mazzini, University of L'Aquila, L'Aquila, Italy. 7. Department of Urology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy. 8. DDivision of Urology, Ospedale Civile G.Mazzini, University of L'Aquila, L'Aquila, Italy.
Abstract
OBJECTIVES: To compare the concordance of prostate cancer (PCa) laterality between the extended transperineal (TP) or transrectal (TR) prostate biopsy (BP) and radical prostatectomy (RP) specimens. To identify predictors of laterality agreement between BP and RP. MATERIALS AND METHODS: Data from 533 consecutive patients with PCa (278 TP and 255 TR-diagnosed) treated with RP were analyzed. A 12-core technique was used for both TP and TR biopsies. Additional cores were obtained when necessary. RESULTS: Overall, the percentage of agreement of PCa laterality between BP and RP was 60% (K = 0.27, p < 0.001). However, the RP confirmation of unilaterality at BP was obtained in just 33% of the cases. Considering the concordance on bilaterality as the ″target″ of our analysis, the sensitivity and specificity were 54.3% and 98.2% , respectively, with TP and 47.5% and 92.5%, respectively with TR. Focusing on patients with unilaterality at biopsy, none of the evaluated preoperative variables (biopsy technique, age, total positive biopsy cores, PSA, prostate volume, Gleason score on biopsy) were able to predict RP bilaterality in the multivariate analyses. CONCLUSIONS: Most of the patients with unilateral involvement at BP harbored bilateral PCa after RP. TR and TP biopsy showed no difference in their capacity to predict the concordance of tumor laterality at RP. None of the preoperative evaluated variables can predict the tumor laterality at RP. Using BP unilaterality to include patients in focal therapy (FT) protocols may hinder the oncologic efficacy of FT.
OBJECTIVES: To compare the concordance of prostate cancer (PCa) laterality between the extended transperineal (TP) or transrectal (TR) prostate biopsy (BP) and radical prostatectomy (RP) specimens. To identify predictors of laterality agreement between BP and RP. MATERIALS AND METHODS: Data from 533 consecutive patients with PCa (278 TP and 255 TR-diagnosed) treated with RP were analyzed. A 12-core technique was used for both TP and TR biopsies. Additional cores were obtained when necessary. RESULTS: Overall, the percentage of agreement of PCa laterality between BP and RP was 60% (K = 0.27, p < 0.001). However, the RP confirmation of unilaterality at BP was obtained in just 33% of the cases. Considering the concordance on bilaterality as the ″target″ of our analysis, the sensitivity and specificity were 54.3% and 98.2% , respectively, with TP and 47.5% and 92.5%, respectively with TR. Focusing on patients with unilaterality at biopsy, none of the evaluated preoperative variables (biopsy technique, age, total positive biopsy cores, PSA, prostate volume, Gleason score on biopsy) were able to predict RP bilaterality in the multivariate analyses. CONCLUSIONS: Most of the patients with unilateral involvement at BP harbored bilateral PCa after RP. TR and TP biopsy showed no difference in their capacity to predict the concordance of tumor laterality at RP. None of the preoperative evaluated variables can predict the tumor laterality at RP. Using BP unilaterality to include patients in focal therapy (FT) protocols may hinder the oncologic efficacy of FT.
Authors: Marc Bienz; Pierre-Alain Hueber; Vincent Trudeau; Abdullah M Alenizi; Roger Valdivieso; Modar Alom; Mevlana Derya Balbay; Abdullah Erdem Canda; Vladimir Mouraviev; David M Albala; Assaad El-Hakim; Quoc-Dien Trinh; Mathieu Latour; Fred Saad; Kevin C Zorn Journal: Can Urol Assoc J Date: 2015 Jul-Aug Impact factor: 1.862