Accuracy of post-radiotherapy biopsy before salvage radical prostatectomy
- Supported by the Sidney Kimmel Center for Prostate and Urologic Cancers.
Correspondence: James A. Eastham, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY 10021, USA.
- 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.
Patients and Methods
- SRP was performed between 1998 and 2011 on 198 patients.
- 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%).
- Of the men undergoing SRP, 26 (14%) were clinical stage ≥T3, with 13% of PRBs with Gleason score ≥8.
- 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%.
- Cancer was upgraded at SRP in 58% of men, with 20% having an increase in primary Gleason grade.
- 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.
- Radiation-recurrent prostate cancers were often multifocal, and biopsy missed up to 20% of tumours.
- More than half of the cancers were upgraded at SRP, and many that were unilateral on PRB were bilateral at SRP.