The role of fine-needle aspiration biopsy of the prostate in staging adenocarcinoma.

Stage A prostate cancer is defined as the incidental finding of cancer in specimens obtained by transurethral resection of the prostate (TURP) in a clinically benign gland. A low-to-moderate grade tumor involving less than 5% of the TURP specimen has been termed Stage A1; a high-grade tumor or tumor involving more than 5% of the TURP specimen is termed Stage A2. Most investigators agree that Stage A1 disease has a significantly better prognosis than Stage A2 disease and may not warrant radical prostatectomy. However, the problem of correctly differentiating A1 and A2 disease remains. The authors prospectively studied 100 consecutive patients undergoing TURP for outlet obstruction without clinical suspicion of prostate cancer by digital examination. Each patient underwent fine-needle aspiration biopsy (FNAB) of each side of the prostate immediately before TURP. These data show that the addition of preprostatectomy FNAB increased the incidence of finding adenocarcinoma of the prostate from 10% to 14%. An additional 3% had FNAB results that were highly suspicious. A positive correlation between cytologic and histologic findings was seen in 83% of patients. Of three patients with Stage A2 prostate cancer, none had malignant cytologic findings. Of seven patients with Stage A1 disease, five (71%) had suspicious or malignant cytologic findings. Seven patients (7%) had suspicious or malignant cytologic findings with no histologic evidence of tumor. In conclusion, preprostatectomy FNAB cannot differentiate Stage A1 from Stage A2 prostate cancer. However, the procedure does increase the yield of finding incidental prostate cancer. The therapy of patients with either (1) malignant cytologic findings alone (Stage A0 disease), or (2) Stage A1 histologic and malignant cytologic findings (Stage A1+) is unclear at present.

Expanded role for fine needle aspiration of the prostate. A study of 335 specimens.

In 279 patients, 335 cytologic samples were obtained from the prostate and correlated with histology obtained by core needle biopsy in 189 cases. Approximately 6% of the cytologic specimens were inadequate for diagnosis. The unconfirmed positive rate for malignancy was 1.6%, the false-negative rate was 27.9%, and the accuracy rate was 89.6%. Granulomatous inflammation was diagnosed in 19 cases, and three cases of tumors other than acinar carcinoma of the prostate were encountered. Based on our experience, cytologic criteria for the diagnosis of prostatic adenocarcinoma are described.

Granulomatous prostatitis following bacillus Calmette-Guerin immunotherapy of bladder cancer.

Granulomatous prostatitis is a recognized complication of intravesical bacillus Calmette-Guerin immunotherapy of superficial bladder cancer. Of 32 patients receiving such therapy 13 underwent prostatic core biopsy and/or fine needle aspiration for clinical indications. Prostatic induration or nodularity developed in 12 patients and 1 underwent biopsy for staging of known prostatic carcinoma. Granulomatous prostatitis was found in 100 per cent of those patients who underwent biopsy or aspiration, indicating that the incidence of this finding is at least 41 per cent following bacillus Calmette-Guerin immunotherapy. Acid-fast bacilli were demonstrated within the prostate of 3 patients with granulomatous prostatitis. The mean interval between the initiation of therapy and diagnosis of granulomatous prostatitis was 11.5 months. Bacillus Calmette-Guerin related granulomas of the prostate may be differentiated histologically from nonspecific granulomatous prostatitis, allergic prostatitis and postoperative granulomas. The clinical implications of these findings are discussed.

Cytologic evaluation of urine after kidney transplantation.

Over a ten-month period, 54 kidney transplant patients returning for routine clinic visits were prospectively evaluated utilizing urinary cytology; 101 urine specimens were examined. The incidence of undetected infection was low. Two patients were noted to have polyomavirus infections, and two had candiduria. No patient had urinary tract malignancy.