Rodolfo Montironi: How reliable is the pathological examination to make clinical decisions?

In two weeks, one of the EAU’s most successful events will kick off in Prague: the 11th Meeting of the EAU Section of Oncological Urology. One of the exciting features of the meeting is its extensive and in-depth debates, including the debate on prostate biopsy and pathological evaluation “How to achieve maximum information”. As part of this debate, Prof. R. Montironi (Ancona, IT) will give a lecture, aiming to answer one of today’s pressing questions in oncological urology: How reliable is the pathological examination to make clinical decisions?

In his commentary to Uroweb, Prof. Montironi offered an overview of this upcoming presentation:

“The primary goal of a needle biopsy is to diagnose prostatic adenocarcinoma (PCa). Once PCa is detected further descriptive information regarding the type of cancer, amount of tumour and grade in prostate needle cores is crucial for management of the patient and to assess potential for local cure and the risk for distant metastasis.

This review gives an update on selected pathology-related issues on routine workup of prostate biopsy with special reference to adequate histologic sectioning necessary to maximize cancer yield, tumour extent measurements and methodologies, specimen orientation, and the role of immunohistochemistry in the evaluation of the prostate. Multiple factors influence the diagnostic yield of prostate biopsies. Many of these factors are fixed and uncontrollable. Others are controlled by the urologist, including the number of cores obtained, method and location of biopsy, and amount of tissue obtained. The yield of cancer is also controlled by the pathologist and histotechnologist.

It is necessary to report the number of cores submitted and the number of positive cores, thereby giving the fraction of positive cores. The percentage involvement by carcinoma with or without the linear extent of carcinoma of the single core with the greatest amount of tumour should also be provided. Cancer or atypical lesions can be accurately located within the biopsy specimen and integrated to biopsy approach. Probably the most common use of immunohistochemistry in the evaluation of the prostate is for the identification of basal cells, which are absent with rare exception in adenocarcinoma of the prostate and in general positive in mimickers of prostate cancer. If a case is still considered atypical by a uropathology expert after negative basal cell staining, positive staining for AMACR can help establish in 50% of these cases a definitive diagnosis of cancer.”

Learn more about the upcoming meeting at register at: http://esou2014.uroweb.org/