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• W2078162311 abstract "No AccessJournal of UrologyAdult urology1 Feb 2006Evidence for a Biopsy Derived Grade Artifact Among Larger Prostate Glandsis accompanied byRefining Prostate Biopsy Strategies Girish S. Kulkarni, Rami Al-Azab, Gina Lockwood, Ants Toi, Andrew Evans, John Trachtenberg, Michael A.S. Jewett, Antonio Finelli, and Neil E. Fleshner Girish S. KulkarniGirish S. Kulkarni More articles by this author , Rami Al-AzabRami Al-Azab More articles by this author , Gina LockwoodGina Lockwood More articles by this author , Ants ToiAnts Toi More articles by this author , Andrew EvansAndrew Evans More articles by this author , John TrachtenbergJohn Trachtenberg More articles by this author , Michael A.S. JewettMichael A.S. Jewett More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , and Neil E. FleshnerNeil E. Fleshner Financial interest and/or other relationship with Bio-Advantex Pharma, Chiron, AstraZeneca and Aventis. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00236-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The PCPT has demonstrated a higher incidence of high grade (Gleason pattern 4 or greater) prostate cancers among men randomized to finasteride. One plausible explanation for this finding is that tumor grade as assigned by TRUS guided biopsy is artifactually associated with prostate volume. Materials and Methods: We evaluated our institutional data set of TRUS guided biopsies in the last 3 years and identified 369 cases of prostate cancer that fit the criteria of PSA less than 10 ng/ml, biopsy at our center and RP at our center. We identified risk factors for Gleason pattern 4 or greater on biopsy and then on RP specimens from the same patients using univariate and multiple logistic regression analyses. Assessed covariates included patient age, PSA and TRUS volume. Results: Risk factors for Gleason pattern 4 or greater in the biopsy specimens included age (p = 0.01), hypoechoic lesions on TRUS (p <0.001) and TRUS volume (p = 0.008). However, among RP specimens TRUS volume (p = 0.60) became nonsignificant of Gleason pattern 4 or greater on multivariable analysis. Although prostate volume was a predictor for biopsy derived high grade disease it was not predictive of true histological grade. Conclusions: These data suggest that simply having a larger prostate results in fewer high grade cancers diagnosed at biopsy. Prostatectomy results in the same men suggest sampling artifact, as the distribution of cancer grade is not associated with prostate volume. These findings provide evidence that the increase in higher grade tumors among men in the finasteride arm of PCPT may simply result from prostate volume reduction. References 1 : Cancer Statistics Presentation. : 2004. Available at: http://www.cancer.org. Accessed December 27, 2004. Google Scholar 2 : Canadian Cancer Statistics. : 2004. Available at: http://www.ncic.cancer.ca. Accessed December 27, 2004. Google Scholar 3 : The influence of finasteride on the development of prostate cancer. N Engl J Med2003; 349: 215. Google Scholar 4 : The prevention of prostate cancer – the dilemma continues. N Engl J Med2003; 349: 297. Google Scholar 5 : Clinical predictors of upgrading to Gleason grade 4 or 5 disease at radical prostatectomy: potential implications for patient selection for radiation and androgen suppression therapy. Int J Radiat Oncol Biol Phys1999; 45: 841. Google Scholar 6 : Discrepancies between Gleason scores of needle biopsy and radical prostatectomy specimens. Pathol Int2001; 51: 364. Google Scholar 7 : Outcome of sextant biopsy according to gland volume. Urology1997; 49: 55. Google Scholar 8 : Influence of prostate volume in the detection of prostate cancer. Urology2003; 61: 167. 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Link, Google Scholar 15 : Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy. J Urol2003; 169: 136. Link, Google Scholar 16 : Prevention of prostate cancer with finasteride. N Engl J Med2003; 349: 1569. Google Scholar 17 : The effects of long term finasteride treatment on prostate cancer morphology. J Urol2005; 173: 129. abstract 473. Abstract, Google Scholar 18 : A prostate gland volume of more than 75 cm3 predicts for a favorable outcome after radical prostatectomy for localized prostate cancer. Urology1998; 52: 631. Google Scholar 19 : Prevention of prostate cancer with finasteride: US/European perspective. Eur Urol2003; 44: 650. Google Scholar Division of Urology, Princess Margaret Hospital, University of Toronto, Toronto, Canada© 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byBonde Miranda T, Garmo H, Stattin P and Robinson D (2020) 5α-Reductase Inhibitors and Risk of Prostate Cancer DeathJournal of Urology, VOL. 204, NO. 4, (714-719), Online publication date: 1-Oct-2020.Anderson C, Sternberg I, Karen-Paz G, Kim P, Sjoberg D, Vargas H, Touijer K, Eastham J and Ehdaie B (2015) Age is Associated with Upgrading at Confirmatory Biopsy among Men with Prostate Cancer Treated with Active SurveillanceJournal of Urology, VOL. 194, NO. 6, (1607-1611), Online publication date: 1-Dec-2015.Ankerst D, Till C, Boeck A, Goodman P, Tangen C, Feng Z, Partin A, Chan D, Sokoll L, Kagan J, Wei J and Thompson I (2013) The Impact of Prostate Volume, Number of Biopsy Cores and American Urological Association Symptom Score on the Sensitivity of Cancer Detection Using the Prostate Cancer Prevention Trial Risk CalculatorJournal of Urology, VOL. 190, NO. 1, (70-76), Online publication date: 1-Jul-2013.Ngo T, Conti S, Shinghal R and Presti J (2011) Prostate Size Does Not Predict High Grade CancerJournal of Urology, VOL. 187, NO. 2, (477-481), Online publication date: 1-Feb-2012.Davies J, Aghazadeh M, Phillips S, Salem S, Chang S, Clark P, Cookson M, Davis R, Herrell S, Penson D, Smith J and Barocas D (2011) Prostate Size as a Predictor of Gleason Score Upgrading in Patients With Low Risk Prostate CancerJournal of Urology, VOL. 186, NO. 6, (2221-2227), Online publication date: 1-Dec-2011.Newton M, Phillips S, Chang S, Clark P, Cookson M, Davis R, Fowke J, Herrell S, Baumgartner R, Chan R, Mishra V, Blume J, Smith J and Barocas D (2010) Smaller Prostate Size Predicts High Grade Prostate Cancer at Final PathologyJournal of Urology, VOL. 184, NO. 3, (930-937), Online publication date: 1-Sep-2010.Fowke J (2009) Editorial CommentJournal of Urology, VOL. 182, NO. 1, (110-111), Online publication date: 1-Jul-2009.Fowke J, Motley S, Smith J, Cookson M, Concepcion R, Chang S and Byerly S (2009) Association of Nonsteroidal Anti-Inflammatory Drugs, Prostate Specific Antigen and Prostate VolumeJournal of Urology, VOL. 181, NO. 5, (2064-2070), Online publication date: 1-May-2009.Al-Ghamdi A, Lockwood G, Toi A, Kulkarni G, Evans A, Finelli A, Zlotta A and Fleshner N (2008) Extended Pattern Prostate Biopsy Does Not Minimize the Volume-Grade Bias in Prostate Cancer DetectionJournal of Urology, VOL. 179, NO. 4, (1332-1334), Online publication date: 1-Apr-2008.Turley R, Hamilton R, Terris M, Kane C, Aronson W, Presti J, Amling C and Freedland S (2007) Small Transrectal Ultrasound Volume Predicts Clinically Significant Gleason Score Upgrading After Radical Prostatectomy: Results From the SEARCH DatabaseJournal of Urology, VOL. 179, NO. 2, (523-528), Online publication date: 1-Feb-2008.Kassouf W, Nakanishi H, Ochiai A, Babaian K, Troncoso P and Babaian R (2007) Effect of Prostate Volume on Tumor Grade in Patients Undergoing Radical Prostatectomy in the Era of Extended Prostatic BiopsiesJournal of Urology, VOL. 178, NO. 1, (111-114), Online publication date: 1-Jul-2007.Pitts W (2018) Re: The Effects of 5α-Reductase Inhibitors on the Natural History, Detection and Grading of Prostate Cancer: Current State of KnowledgeJournal of Urology, VOL. 176, NO. 1, (408-409), Online publication date: 1-Jul-2006.Thompson I and Lucia M (2018) Diagnosing Prostate Cancer: Through a Glass, DarklyJournal of Urology, VOL. 175, NO. 5, (1598-1599), Online publication date: 1-May-2006.Related articlesJournal of Urology9 Nov 2018Refining Prostate Biopsy Strategies Volume 175Issue 2February 2006Page: 505-509 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsprostateprostatic neoplasmsbiopsyneedleMetricsAuthor Information Girish S. Kulkarni More articles by this author Rami Al-Azab More articles by this author Gina Lockwood More articles by this author Ants Toi More articles by this author Andrew Evans More articles by this author John Trachtenberg More articles by this author Michael A.S. Jewett More articles by this author Antonio Finelli More articles by this author Neil E. Fleshner Financial interest and/or other relationship with Bio-Advantex Pharma, Chiron, AstraZeneca and Aventis. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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