ACCURACY OF PROSTATE NEEDLE-BIOPSY IN PREDICTING EXTRACAPSULAR TUMOR EXTENSION AT RADICAL RETROPUBIC PROSTATECTOMY - APPLICATION IN SELECTING PATIENTS FOR NERVE-SPARING SURGERY

Objectives. To evaluate prostate biopsy outcomes along with other clin ical parameters in an effort to define the cancer-specific safety of n erve-sparing surgery. Methods. Sixty-six consecutive men underwent rad ical retropubic prostatectomy for clinically localized prostate cancer (T1e = 36, T2 = 30). Preoperative prostate needle biopsies were perfo rmed on all patients, and radical prostatectomy specimens were process ed in their entirety. Our pathologic end point was capsular perforatio n extending entirely through the prostatic capsule. Each prostatic sid e was analyzed individually, for a total of 132 specimens. The specime ns were further divided into four categories on the basis of biopsy gr ade (no cancer = 44, low = 20, moderate = 60, high = 8). Additional st udy variables included preoperative prostate-specific antigen (PSA) an d number of positive biopsy cores. Results. Overall, 40 of the 132 spe cimens had evidence of capsular perforation. Of the 40 capsular perfor ations, 39 were observed in specimens (sides) that had cancer identifi ed on biopsy. The one specimen with capsular perforation and a negativ e biopsy result occurred in the setting of high-grade contralateral ca ncer. PSA, digital rectal examination, and number of positive biopsy c oves did not reliably predict capsular perforation. Conclusions. Our f indings suggest that in patients with low- and moderate-grade tumors, the neurovascular bundle can be safely preserved on the side without e vidence of cancer having obtained at least three biopsy cores. No safe parameters for considering nerve-sparing surgery were observed in the small number of patients with high-grade tumors, or in any specimen w ith cancer present on biopsy. Other clinical parameters, such as PSA o r number of positive cores, did not aid in identifying candidates for nerve-sparing surgery. (C) 1998, Elsevier Science Inc. All rights rese rved.