The Role of TRUS Guided Biopsies for Determination of Internal and External Spread of Prostate Cancer

THE ROLE OF TRUS GUIDED BIOPSIES FOR DETERMINATION OF INTERNAL AND EXTERNAL SPREAD OF PROSTATE CANCER

February 1997

F. Lee (1), D.K.Bahn (1), D. Siders (2), C. Greene (2)
(1)Crittenton Hospital, Rochester, MI; (2)St.Joseph Hospital, Ann Arbor

Objective: This study hopes to define local extent of newly diagnosed prostate cancer by comparing sextant biopsy vs TRUS guided diagnostic and staging biopsies.
Methods and Materials: This study group consisted of 108 men with sextant biopsy proven prostate cancer who presented for our opinion as regards prognosis and treatment options. All patients were re-diagnosed and staged by TRUS guided and staging biopsies.
Results: Tumor diagnosis was substantiated in (102/108) 94.4%. For the (6/108) 5.5% of non-detected cancer, review of outside slides revealed cancer £ 2mm with gleason score of £6. These patients all have the criteria of being latent cancer. For the remaining 102 patients with TRUS proen prostate cancer, 30% had extracapsular extension (ECE). For clinical stages T1c and T2, 20% and 30%, had ECE, respectively. The gleason sum and perineural invasion were significantly greater for directes biopsies than sextant biopsies. These are pathological high-risk factors for ECE. For these 102 patients, 50% had perineural invasion and 39% had proven ECE.
Conclusion: In our hands, TRUS directed and staging biopsies offers more substantive findings than sextant biopsies for defining ECE. For our series of clinical T1-T2 cancer, 30% were upstaged to T3. TRUS guided staging biopsies have the ability to diagnose and substantiate a number of patients with non-confined cancer which will influence the choice of treatment.

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