Sampling of the anterior apical region results in increased cancer detection and upgrading in transrectal repeat saturation biopsy of the prostate.

OBJECTIVE: To evaluate whether biopsy cores taken via a transrectal approach from the anterior apical region of the prostate in a repeat-biopsy population can result in an increased overall cancer detection rate and in more accurate assessment of the Gleason score. PATIENTS AND METHODS: The study was a prospective, randomised (end-fire vs side-fire ultrasound probe) evaluation of 288 men by repeat transrectal saturation biopsy with 28 cores taken from the transition zone, base, mid-lobar, anterior and the anterior apical region located ventro-laterally to the urethra of the peripheral zone. RESULTS: The overall prostate cancer detection rate was 44.4%. Improvement of the overall detection rate by 7.8% could be achieved with additional biopsies of the anterior apical region. Two tumours featuring a Gleason score 7 could only be detected in the anterior apical region. In three cases (2.34%) Gleason score upgrading was achieved by separate analysis of each positive core of the anterior apical region. A five-fold higher cancer detection rate in the anterior apical region compared with the transition zone could be shown. CONCLUSION: Sampling of the anterior apical region results in higher overall cancer detection rate in repeat transrectal saturation biopsies of the prostate. Specimens from this region can detect clinically significant cancer, improve accuracy of the Gleason Scoring and therefore may alter therapy.

Relationship between prostate cancer gene 3 (PCA3) and characteristics of tumor aggressiveness.

BACKGROUND: Data supporting prostate cancer gene 3 (PCA3) as prognostic marker are still inconsistent. With special emphasis to Gleason pattern specific tumor volumes (TVs) the relationships between PCA3 score and different characteristics of tumor aggressiveness were meticulously analyzed. METHODS: In 127 patients treated with radical prostatectomy for clinically localized prostate cancer, urinary PCA3 score was quantified using Progensa™ PCA3 assay. Total TV and Gleason patterns' specific tumor volumes (GPTV) were assessed by computer-assisted planimetry. Spearman's rank correlations coefficients (r) were calculated to assess relationships between PCA3 and TV as well as GPTV. Regression analyses were performed to estimate the relationship between PCA3 and TV as well as non-organ confined disease. RESULTS: Mean patients' age was 60.8 years. Patients showed a mean PSA level of 8.1 ng/ml and a mean PCA3 score of 68.5. PCA3 was not significantly correlated with TV (r = 0.131, P = 0.142). Stratified by Gleason score groups ≤ 6, 7, and ≥ 8, PCA3 showed no significant correlations with TV. In a subgroup analysis of 50 patients with different primary and secondary Gleason patterns there was neither a correlation with the primary GPTV (r = 0.071, P = 0.626) nor with the secondary GPTV (r = 0.052, P = 0.722). The PCA3 score was neither an independent predictor for TV nor for non-organ confined disease. CONCLUSIONS: The PCA3 score did not show any significant correlation with TV, primary or secondary GPTV. Moreover, the PCA3 score was not an independent predictor for TV or for non-organ confined disease. Thus, the PCA3 score had no impact for the prediction of aggressive prostate cancers.