NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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The Value Of Transition Zone (TZ) Biopsy In Patients Undergoing Repeat Prostate Biopsy
Mazen Abdelhady, MD, Msc, Ashraf J. Abusamra, MD, FRCSC, Jonathan Izawa, MD, BSc, FRCSC, Donal Downey, MD, FRCPC, Joseph Chin, MD, FRCSC.
London Health Sciences Centre, University of Western Ontario, London, ON, Canada.

The Value Of Transition Zone (TZ) Biopsy In Patients Undergoing Repeat Prostate Biopsy
Introduction: The value of TZ biopsy (Bx) is under some debate. However, it is routinely obtained in patients (pts) undergoing repeat prostate Bx. We reviewed our experience with repeat Bx and assessed the role of TZ Bx.
Methods: A retrospective review of transrectal ultrasound (TRUS) and pathology reports of all pts who underwent repeat TRUS Bx in a 1 year period was done. Pt age, family history of prostate cancer, digital rectal examination (DRE), PSA, free/total PSA, prostate volume, findings on pathology report [Gleason sum, percentage of cancer in biopsy, extraprostatic extension (EPE), perineural invasion (PNI), and lymphovascular invasion (LVI)], and history of High Grade Prostatic Intraepithelial Neoplasia (HGPIN) and Atypical Small Acinar Proliferation (ASAP) were reviewed according to Bx results. Statistical analysis using ANOVA and Fisher’s exact test was done
Results: Of 1005 TRUS Bx performed in 2004, 391 were repeat biopsies and of those 111 (28.4%) were diagnostic of prostate cancer. 90 pts (23%) had prostate cancer detected in PZ only on Bx, while 6 (1.5%) and 15 (3.8%) pts had prostate cancer detected in TZ only, and in both PZ & TZ, respectively. Clinicopathological characteristics of the prostate cancer pts and their statistical analyses are listed (Table)
Conclusions: Routinely including TZ in the repeat Bx detected only an additional 5% of cancers. However, the pts with prostate cancer detected in both PZ and TZ appear to have worse pathological features on Bx than the other groups (higher Gleason sum, higher percentage of cancer in biopsy, and presence of perineural invasion). Thus TZ Bx may have both diagnostic and prognostic value in repeat Bx situations

Clinicopathological characteristics of the prostate cancer pts

Clinicopathological characteristics

PZ Only (n=90)

TZ Only (n=6)

Both PZ & TZ (n=15)

p value

Age

64.1

59.7

66.1

.179

Total PSA

8.1

7.0

34.5

.011

Prostate Volume

59.4

48.3

47.0

.326

Free/Total

0.115

0.20

0.250

.112

Gleason Sum

6.3

6.3

7.0

.002

% In All Specimens

3.4

6.5

9.2

.034

DRE

25/90 (27.8%)

1/6 (16.7%)

8/15 (53.3%)

.111

Family History

13/85 (15.3%)

0/6 (0.0%)

1/13 (7.7%)

.616

PIN
ASAP
PNI

34/90(37.8%)
18/90(20.0%)
7/85(8.2%)

1/6 (16.7%)
1/6 (16.7%)
1/6 (16.7%)

8/15 (53.3%)
3/15 (20.0%)
5/14 (35.7%)

.296
> .999
.012


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