Can transrectal ultrasound-guided biopsy of the prostate with extended 14-core scheme improve the predictive accuracy of Gleason score and tumor site in prostate cancer treatment?

PURPOSE Several studies have reported upgrading of patients with Gleason score (GS) at the time of prostate biopsy to GS following radical prostatectomy (RP). We reviewed the predictive accuracy of extended 14-core prostate biopsies, in terms of GS and tumor location in patients with prostate cancer (PCa) treated by RP. METHODS We retrospectively reviewed 163 patients who underwent RP for clinically localized PCa. Preoperatively, all patients underwent a transrectal ultrasound-guided biopsy of the prostate (TRUSBP) with 14-core scheme for suspected PCa. According to GS, patients were categorized as low (GS 2-6), moderate (GS 7), and high (GS 8-10). A comparison between GS and tumor laterality of the needle biopsy and RP specimens was carried out. RESULTS Bioptic GS was low (≤ 6) in 55.9%, moderate (7) in 34.9%, and high (≥8) in 9.2% of the patients. Pathological GS was 40.5, 46.6, and 12.9%, respectively. Of the 66 patients with low GS by RP, 41 (62.1%) were in agreement with TRUSBP, whereas 25 (37.9%) were underestimated by TRUSBP. Of the 76 patients with moderate GS by RP, 47 were in agreement with TRUSBP (61.8%), and 4 were underestimated by TRUSBP (5.3%). In the assessment of tumor laterality, TRUSBP falsely showed 51 cases as unilateral tumors, whereas RP diagnosed that both sides had PCa (p<0.001). CONCLUSION These data are in line with those of the literature, although the group of low-risk tumors remained the same only in 40.5% of the cases. Therefore, we conclude that this type of biopsy (14-core TRUSBP) should not be used alone to guide therapy in PCa.