Prostate Needle Biopsy: The Pitfalls and the Role of the Pathologist – Patient Track
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Transcript of Prostate Needle Biopsy: The Pitfalls and the Role of the Pathologist – Patient Track
Prostate Needle Biopsy: The Pitfalls and the Role of the
Pathologist – Patient Track
Prostate Cancer Symposium“Intriguing Cases / Emerging Strategies in
Awareness and Management”The Prostate NetOctober 6, 2009
New York, NYAngelo M. De Marzo, MD PhD
The Johns Hopkins University School of Medicine, Departments of Pathology, Urology and Oncology, The Brady Urological Research
Institute, The Kimmel Comprehensive Cancer Center at Johns Hopkins
What is a Pathologist? All biopsy tissue is
sent to a pathologist who uses a microscope to determine the diagnosis (e.g. cancer or not)
What is a prostate biopsy? Usually 8-12 or more
“cores” of tissue are taken using Transrectal Ultrasound (TRUS) guidance.
Actual Prostate Core Needle Biopsies Under Microscope: Low Magnification
What if cancer is not present on biopsy? If the biopsy diagnosis is:
Atypical: “Small focus of atypical gland suspicious for but not
diagnostic of cancer” “Atypical small acinar proliferation” (ASAP) Up to 50% (or more) of men with a diagnosis of atypical will
be found to have cancer on a repeat biopsy Most recommend a repeat biopsy
High grade PIN a repeat biopsy should be based on a number of factors
that you discuss with your physician
What if cancer is not present on biopsy? If biopsy is called benign:
For example benign prostatic tissue; should not be called BPH Inflammation (acute or chronic)
Since the biopsy sampling technique is imperfect, up to 20% (or more) of men with a negative prostate biopsy may be found to have cancer on a repeat biopsy
The decision for a repeat biopsy should be based on a number of factors that you discuss with your physician
What you need to know from your prostate biopsy results if there is cancer present
Gleason Grading What is the Gleason score?
(two separate numbers from 1-5 added together; most common is 3+3=6)
What is the number of tissue cores positive for cancer and what is the total number of tissue cores taken?
Gleason Score Grade 2-6: low aggressiveness Grade 8-10: high aggressiveness Grade 7: intermediate aggressiveness
Gleason Patterns
Gleason Pattern 3 Gleason Pattern 5
Microscopic appearance of prostate cancer (adenocarcinoma) under higher magnification
Active Surveillance Some patients with limited Gleason score 6 (e.g. less than 3
cores positive and no core with more than 50% cancer) elect to forego immediate treatment and undergo active surveillance
A potential pitfall with this is: Up to 25% of patients with a Gleason grade 6 tumor on biopsy
will be found to have a Gleason 7 or higher if their prostate is removed
Researchers are attempting to find biological factors in the biopsy to help predict who will have higher grade or more aggressive disease
The “good news” is that even in men who “progress” to more advanced pathology on an active surveillance program, most still have curable disease when the prostate is removed Most “progression” events occur within 2 years suggesting that
undersampling, rather than disease progression, is responsible
J. Urology, Vol. 181, 1628-1634, April 2009
J. Urology, Vol. 182, 2274-2279, November 2009
Discussion Topics Should I get a second opinion on my
pathology slides? Should I get my prostate biopsy tissue
evaluated by Aureon Laboratories Prostate Px+?