Accuracy of post‐radiotherapy biopsy before salvage radical prostatectomy. (13th March 2013)

• Record Type: Journal Article
• Authors: Meeks, Joshua J.; Walker, Marc; Bernstein, Melanie; Kent, Matthew; Eastham, James A.
• Is Part Of: BJU international. Volume 112:Number 3(2013:Aug.)
• Page Start: 308
• Page End: 312
• Publication Date: 2013-03-13
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12015
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12015-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12015-list-0001" list-type="bullet"> <list-item> <p>To determine whether post‐radiotherapy (RT) biopsy (PRB) adequately predicts the presence, location, and histological features of cancer in the salvage radical prostatectomy (SRP) specimen. Before salvage treatment, a PRB is required to confirm the presence of locally recurrent or persistent cancer and to determine the extent and location of the prostate cancer.</p> </list-item> </list> </p> </sec> <sec id="bju12015-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12015-list-0002" list-type="bullet"> <list-item> <p>SRP was performed between 1998 and 2011 on 198 patients.</p> </list-item> <list-item> <p>All patients underwent a PRB. PRB and SRP specimens were evaluated by a genitourinary pathologist. Patients had external‐beam RT alone (EBRT; 71%) or brachytherapy with or without EBRT (29%).</p> </list-item> </list> </p> </sec> <sec id="bju12015-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12015-list-0003" list-type="bullet"> <list-item> <p>Of the men undergoing SRP, 26 (14%) were clinical stage ≥T3, with 13% of PRBs with Gleason score ≥8.</p> </list-item> <list-item> <p>Cancer was unilateral in 120 (61%) biopsies, with contralateral or bilateral prostate cancer at SRP in 49%. In the SRP specimen, cancer was multifocal in 57%.</p> </list-item> <list-item> <p>Cancer was upgraded at SRP in 58% of men, with 20% having an increase in primary Gleason grade.</p> </list-item> <list-item> <p>The accuracy of PRB varied by region from 62% to 76%, with undetected cancers ranging from 12% to 26% and most likely to occur at the mid‐gland.</p> </list-item> </list> </p> </sec> <sec id="bju12015-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12015-list-0004" list-type="bullet"> <list-item> <p>Radiation‐recurrent prostate cancers were often multifocal, and biopsy missed up to 20% of tumours.</p> </list-item> <list-item> <p>More than half of the cancers were upgraded at SRP, and many that were unilateral on PRB were bilateral at SRP.</p> </list-item> </list> </p> </sec> </abstract>