[Fine needle puncture of prostatic cancer]

Before commencing treatment for prostatic cancer the diagnosis must be confirmed by microscopic examination of prostatic tissue. Fine-needle aspiration biopsy by an experienced clinician is as accurate as the more invasive Tru-cut or Vim-Silverman needle biopsies. It involves fewer complications such as hemorrhage or infection, and does not require anesthesia. From 1971 to 1981 we performed more than 2300 fine needle biopsies including 2209 in outpatients. Only 4 patients (0.18%) needed hospitalizing for severe complications. Where the clinical examination prompts suspicion of prostatic cancer and the first fine needle biopsy is negative, the procedure should be repeated. When repeated aspirations were performed only 4 (2%) false negative cytologies were found out of 195 patients in whom prostatic cancer was clinically evident and confirmed by either cytology or histology. False negative cytological results are usually due to sampling errors by the physician rather than interpretation by the cytologist. The histology was false negative in 11.5% of 200 cases and this was due to failure of transurethral resection to reach a focal carcinoma situated in the capsule or sphincter region. Identical histological and cytological grading was found in 66% of the 168 cases where both investigations were positive. If a difference of one grade was accepted, the concurrence is 99%. The results of fine needle biopsy depend on the skill of the clinician in obtaining the right sample, and especially on the experience of the cytologist in its interpretation.