Visual inspection of the prostate biopsy specimen: aid to diagnosis and management

The purpose of this article is to assess if the visual inspection of the prostate biopsy specimen can be used as a guide when deciding whether to attempt to sample another core of tissue from the same area if a less than adequate specimen was obtained during the first attempt. Five hundred thirty-seven specimens from 84 patients, referred because of an increased prostate-specific antigen (PSA) level and/or a suspicious result on digital rectal examination (DRE), were sampled and prospectively graded based on the lack of formation and amount of liquid in the specimen (grade I) compared to a highly rigid, solid core (grade V). Specimens were then fixed in formalin and retrospectively compared, and the pathologic diagnosis was compared with the subjective visual grade assigned to the specimen. Receiver-operator curve techniques were used to quantify the results and to test for statistical significance. Rigid biopsy specimens were cancer, and liquid, formless specimens were benign. Most biopsy specimens were solid, with moderate consistency, and could not be diagnosed accurately by visual inspection. Diagnosis of prostate cancer, despite the use of PSA, DRE, or diagnostic endorectal ultrasound, requires biopsy for definitive confirmation. Although the use of spring-loaded biopsy needles routinely yields good-quality cores of tissue for pathologic analysis, there are many occasions when a less than optimal specimen is obtained. The question of whether a repeat biopsy in that region is indicated always arises. These data suggest that if the initial specimen is grade I or II, repeat biopsy is probably not indicated. If the initial specimen is grade IV or V, repeat biopsy is recommended.