Tissue-marking scheme for a cost-effective extended prostate biopsy protocol

Extended biopsy schemes are now the standard of care for detection of prostate cancer. Submitting biopsy cores individually raises the cost of pathologic evaluation significantly while important prognostic information is lost when the samples are bundled into fewer containers. We devised a protocol for bundling biopsy cores to reduce the cost while maintaining our ability to identify important biopsy features.

Four hundred fifty-two consecutive men underwent a prostate biopsy using our prospectively designed protocol. The lateral peripheral cores were marked with India ink and combined with cores from the corresponding sextant site into one container (maximum containers = 6). Prognostic information from each core was recorded. Cost analysis was based on the reimbursement rates for variable number of containers.

Tissue-labeling protocol did not increase the procedure time or introduce any tissue artifacts. Cancer was detected in 177 (39%) men with mean Gleason score of 7. A single core with cancer was noted in 28%, and cancer in < or =25% of the core was found in 41%. Thirteen of 64 (20%) men undergoing radical prostatectomy had extracapsular extension (ECE) and 10 (15%) had a positive surgical margin. The location of ECE on prostatectomy specimen correlated with a positive biopsy site in 9 (70%) patients. The cost of histopathologic evaluation is based on number of individually labeled specimen containers. By reducing the number of specimen containers from 12 to 6, the potential savings may be in hundreds of million per year.

This simple tissue-labeling protocol facilitates extended prostate biopsies in a cost-effective manner, while maintaining our ability to glean important prognostic information from each core.