Increased accuracy of biopsy Gleason score obtained by extended needle biopsy

Purpose: Accurate tumor grading is critical for adequate prostate cancer treatment. Nonetheless, the Gleason score of standard sextant biopsy correctly predicts the Gleason score of the radical prostatectomy specimen in about 50% of cases. We investigated if extended needle biopsy could improve biopsy Gleason score accuracy. Materials and Methods: Laparoscopic transperitoneal radical prostatectomy was performed in 135 patients. Prostate cancer was diagnosed in 89 cases by standard sextant transrectal (6 to 8 cores) biopsy and in 46 by extended needle (12 core transperineal under transrectal guidance) biopsy. Preoperative evaluation included digital rectal examination, prostatic specific antigen measurement, transrectal ultrasonography and endorectal coil magnetic resonance imaging in all patients. All biopsy and prostatectomy specimens were reviewed by a single pathologist. Results: Clinical characteristics were similar in the 2 groups. The concordance between prostate biopsy and radical prostatectomy Gleason score was 32 of 46 cases (70%) and 44 of 89 (49%) for 12 core and standard transrectal biopsy, respectively (z test p = 0.0127). Biopsy under grading was found in 11 of 46 cases (24%) and 35 of 89 (39%) (z test p = 0.0366), and biopsy over grading was found in 3 of 46 (6%) and 10 of 89 (11%) (z test p = 0.1894) with 12 core and standard transrectal biopsy, respectively. Primary Gleason pattern was predicted exactly by biopsy in 40 of 46 cases (87%) and 56 of 89 (63%) with 12 core and standard sextant biopsy, respectively (z test p = 0.0018). Conclusions: Extended needle biopsy significantly increases the accuracy of biopsy Gleason score for assessing final prostate cancer grade.