Histopathological Correlation Between Transrectal Ultrasound-Guided Biopsy and Radical Prostatectomy Specimen of Filipino Men with Localized Prostate Cancer: A Local Experience

Abstract

Background: Prostate cancer is the most common malignant tumor among adult men worldwide and the second most common cause of cancer death. Gleason grading system is a powerful predictor in the prognosis and treatment outcome of prostate carcinoma.

Objective: This retrospective study aims to evaluate the accuracy of transrectal ultrasound (TRUS)- guided biopsy of the prostate compared to radical prostatectomy specimen in predicting the pathological grading of prostate adenocarcinoma using the Gleason scores between specimens. Methods: This is a review of 69 patients who underwent radical prostatectomy due to prostate cancer in 2010-2015. The Gleason scores of the transrectal ultrasound biopsies were compared with the surgical specimen.

Results: The biopsy Gleason scores obtained from the TRUS biopsy and the radical prostatectomy specimens were similar in 79.7% of the cases. In patients with moderately differentiated tumors on biopsy (Gleason score of 5 to 7), the concordance rate was 83% with upgrading after surgery in 16% of the cases. In poorly-differentiated tumors on biopsy (Gleason score of 8 to 10), 74% revealed the same score on histopathological examination after radical prostatectomy, while 25% of the cases were given lower Gleason scores after operation. Overall, 20.3% cases were discrepant by 1 or more Gleason scores after radical prostatectomy. There was a good histopathological correlation between TRUS biopsy and prostatectomy specimen {AUC =0.787(p=0.001)}.

Conclusion: The overall accuracy of Gleason score on transrectal ultrasound-guided biopsies in predicting prostatectomy specimen grade is favorable. It plays a significant role in clinical decision making of patients with prostate carcinoma.