Histopathology reports of findings of prostate needle biopsies. Individual treatment

• Published in: Urologe. Ausgabe A Vol. 52; no. 2; pp. 226 - 239
• Main Authors: Damjanoski, I, Müller, J, Schnöller, T J, Küfer, R, Rinnab, L
• Format: Journal Article
• Language: German
• Published: Germany 01-02-2013
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Attitude of Health Personnel; Biomarkers, Tumor - blood; Biopsy, Needle; Cell Proliferation; Cooperative Behavior; Decision Support Techniques; Disease Progression; Finasteride; Germany; Guideline Adherence; Humans; Interdisciplinary Communication; Male; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Palliative Care; Patient Care Planning; Phosphodiesterase 5 Inhibitors; Precision Medicine; Prognosis; Prostate - pathology; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Intraepithelial Neoplasia - pathology; Prostatic Intraepithelial Neoplasia - surgery; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Surveys and Questionnaires; Germany
• ISSN: 1433-0563
• DOI: 10.1007/s00120-012-3008-1

This survey-based study examined which information urologists extract from prostate needle biopsy reports and what is needed for clinical management of prostate cancer patients.
A questionnaire was developed to investigate several topics related to prostate cancer biopsies and four different clinical situations were explored separately, depending on whether the urologist intended a curative or palliative treatment.
A total of 95 out of 282 (33 %) urologists responded to the questionnaire and returned anonymous responses. On average the participants had a professional career of 13 years (range 6 months to 38 years), 22 (23 %) urologists performed radical prostatectomy, 73 (77 %) were not surgically active, 55 (58 %) took 10-12 scores within the framework of the proposed first biopsy setting, 32 (34 %) took 6-8 scores and 6 (6 %) > 12 scores. Urologists with a professional career <15 years took significantly more biopsies. The primary and secondary Gleason patterns were required for only 36 (38 %) respondents to make treatment decisions. In prostate needle biopsies containing only a single focus of prostate cancer only 44 (48 %) of the respondents would request a Gleason score if not provided in the initial report. In addition to the Gleason score other information used by urologists to make treatment decisions included perineural invasion (60 %), periprostatic infiltration (57 %), extraprostatic spread (57 %) and the percentage of core involvement by cancer (13 %). Interestingly, in biopsies with multiple positive cores from separate locations 84 out of 95 urologists (88 %) used the highest Gleason grade to determine the treatment plan. The term atypical small acinar proliferation (ASAP) was uniformly considered sufficient to retake biopsies by 44 % (42/92) of urologists and only 53 % (49/92) of urologists performed rebiopsies in the case of high grade prostatic intraepithelial neoplasia (PIN).
In this sample of 95 urologists there was high variability in the way clinicians used prostate needle biopsy pathology reports. The results of this survey underline that improved communication between urologists and pathologists is necessary.