Lesion Spatial Distribution Based On The Pathological Results Of Transperineal Prostate Biopsy And Radical Prostatectomy

Objective:To demonstrate the lesion spatial distribution of whole-mounted radical prostatectomy (WMRP) specimens based on anterior and posterior zones and reveal the accuracy on tumor prediction by transperineal template-guided prostate biopsy (TPTB).Methods:This prospective study enrolled 61 consecutive patients diagnosed as prostate cancer with no more than 6 positive regions on TPTB between Nov.2013 and Mar. 2015. We evaluated the pathological results of TPTB and WMRP specimens. The tumor frequencies and characteristics were compared on anterior and posterior zones. The tumor loads were further calculated at at three levels:apex, mid-gland, and base.Results:Of all the 61 patients, The positive rates for regions 1 to 11 were 27.9%,31.1%, 29.5%,34.4%,32.8%,21.3%,27.9%,26.2%,36.1%,26.2%and 41.0%, respectively. The average positive rate for regions 1 to 10 was 29.3%, compared with 41.0% for region 11 (x2=1.760, P=0.185), which represented the apex of the prostate. The detection rates for the anterior and posterior zones were 42.9% and 46.4%(x2=0.195, P=0.659). Of the 61 predominant tumors, the anterior (APCs) and posterior prostate cancers (PPCs) were 32 (52.5%) and 29 (47.5%) (x2=0.295, P=0.587). There was no difference between proportion of clinically significant tumor, tumor volume, positive surgical margin and Gleason score (GS) in the two groups. The rumor loads of apex, mid-gland, and base were 105.17μl/ml,130.62μl/ml and 69.81μl/ml, respectively. Compared with the base, the apex had a higher tumor load (P=0.028).16 patients were pure anterior zone positive on biopsy and 13 (81.2%) of them were confirmed as anterior prostate cancers (APCs) on WMRP specimens.14 were pure anterior zone positive on biopsy and 11 (78.6%) of them were confirmed as posterior prostate cancers (PPCs). Compared with biopsy and the WMRP specimens,68.9% had no change in GS,24.6% were upgraded and 6.5% were downgraded.Conclusion:1. The detection rates of the anterior and posterior zones were concordant on TPTB.2. The tumor frequencies and pathological characteristics of the anterior and posterior zones were concordant on WMRP specimens.3. Compared with the base, the apex had a higher tumor load.4. The pathological results were highly concordant between the TPTB and WMRP specimens.