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Keywords:

  • prostate biopsy;
  • prostate cancer;
  • radiation therapy;
  • radical prostatectomy

Objective

  • 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%).

Results

  • 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.

Conclusions

  • 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.