Clinical staging error in prostate cancer: localization and relevance of undetected tumour areas
Article first published online: 22 DEC 2008
© 2008 THE AUTHORS. JOURNAL COMPILATION © 2008 BJU INTERNATIONAL
Volume 103, Issue 9, pages 1184–1189, May 2009
How to Cite
Bolenz, C., Gierth, M., Grobholz, R., Köpke, T., Semjonow, A., Weiss, C., Alken, P., Michel, M. S. and Trojan, L. (2009), Clinical staging error in prostate cancer: localization and relevance of undetected tumour areas. BJU International, 103: 1184–1189. doi: 10.1111/j.1464-410X.2008.08243.x
- Issue published online: 7 APR 2009
- Article first published online: 22 DEC 2008
- Accepted for publication 10 September 2008
- prostate cancer;
- needle biopsy;
- tumour staging;
- diagnostic error
To describe the localization and to assess the clinical implications of areas of undetected prostate cancer in radical prostatectomy (RP) specimens, focusing on patients with unilaterally negative preoperative biopsy cores.
PATIENTS AND METHODS
The study included 149 of 559 consecutive patients (26.7%) who had RP for prostate cancer. Unilateral prostate cancer was diagnosed from prostate biopsies, taken by several physicians, but ≥ pT2c disease was present in the RP specimen. The prostate was dissected by standardized transversal cuts and tumour areas were mapped by one genitourinary pathologist. To estimate the tumour size and location, areas of prostate cancer were transferred to a digital grid database representing the prostate by 794 units.
The most frequent location of undetected prostate cancer was in the dorsalateral region and in the apex of the prostate. The mean tumour volume of the false-negative lobe was significantly lower than contralaterally (18.9 vs 47.5 units, P < 0.001). In 36 of 149 patients (24.2%), the tumour volume on the negative biopsy side was equal or higher than on the positive biopsy side; in the final RP specimen, 60 patients (40.3%) had capsular involvement on the negative biopsy side.
Significantly many patients with newly diagnosed prostate cancer remain clinically understaged. The apical and dorsolateral region of the prostate are not adequately represented in current biopsy strategies. Undetected tumour areas are often clinically significant by size and capsular involvement, indicating a direct clinical implication when planning nerve-sparing RP or focal therapy. Our results show a continuing need for optimized and standardized biopsy protocols.