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Can prostate biopsies predict suitability for nerve-sparing radical prostatectomy?
Stephen S Connolly1, Kiaran J O'Malley, Anne O'Brien
1Department of Urology, University College Dublin, St Vincent's University Hospital, Dublin, Ireland.
Scandinavian Journal of Urology and Nephrology
|June 19, 2004
Summary
Prostate biopsies often misidentify unilateral cancer, leading to nerve-sparing radical prostatectomy (NSRP) in patients with bilateral disease. This results in positive surgical margins and potential recurrence, questioning biopsy
Area of Science:
- Urology
- Surgical Oncology
Background:
- Patient selection for nerve-sparing radical prostatectomy (NSRP) is critical for preserving function.
- The efficacy of prostate biopsies in accurately determining unilateral versus bilateral cancer for NSRP candidacy is debated.
Purpose of the Study:
- To evaluate the accuracy of prostate biopsies in selecting patients for NSRP.
- To assess the correlation between biopsy findings and final histopathology of radical prostatectomy specimens.
Main Methods:
- Retrospective analysis of 133 patients undergoing radical retropubic prostatectomy.
- Patients categorized based on biopsy results: unilateral (confined to one side) or bilateral carcinoma.
- Comparison of biopsy categorization with final histopathology of resected prostatectomy specimens.
Main Results:
- Prostate biopsies suggested unilateral carcinoma in 52% (TRUS-guided) and 60% (TP-guided) of cases.
- Final histopathology revealed bilateral malignancy in 86% (TRUS) and 84% (TP) of these patients.
- Positive surgical margins on the 'benign' side occurred in 20% (TRUS) and 27% (TP) of patients with biopsy-suggested unilateral disease.
Conclusions:
- Biopsy-based selection for NSRP frequently overestimates unilateral disease, underestimating bilateral prostate cancer.
- This inaccuracy leads to a significant rate of positive surgical margins on the 'benign' side, compromising oncological outcomes.
- Current biopsy strategies are insufficient for reliable patient selection for NSRP, necessitating improved diagnostic methods.