Pathological findings in TRUS prostatic biopsy - Diagnostic, prognostic and therapeutic importance

Objectives: This report reviews the diagnostic, prognostic and therapeutic importance of pathological findings in prostate needle biopsies. Methods: Emphasis is placed on contemporary biopsy reporting of diagnostic results and predictive factors, and clinical nomograms for predicting stage and outcome based on biopsy findings. Results: The morphological diagnosis may be placed into one or more of five categories, e.g. prostate cancer (Prostate cancer), atypical small acinar proliferation (ASAP), prostatic intraepithelial neoplasia (PIN), inflammation and benign prostatic tissue. The pathology report of a biopsy with cancer should include a number of morphological features that may help urologists to assess the risk of extraprostatic disease and progression: cancer location, extent and volume of cancer in each specimen, and Gleason score; optional features that may add predictive value include the presence of perineural invasion, vascular/lymphatic invasion, microvessel density (MVD), and DNA ploidy expression. Further, cancer expression of select biomarkers may be of value. As a subsequent diagnosis of carcinoma has been made in a high proportion of patients with ASAP or PIN, re-biopsy is recommended. Conclusions: In combination with other clinical factors, the pathologic findings obtained from the biopsy specimen provide enhanced predictive accuracy for stage and individual outcome. (C) 2002 Elsevier Science B.V. All rights reserved.