Detection rate of histologically insignificant prostate cancer with systematic sextant biopsies and fine needle aspiration cytology

Purpose: We evaluate the detection rate of insignificant prostate cancer an d the rate of significant prostate cancer overlooked in the results of syst ematic sextant biopsy and fine needle aspiration biopsy of the prostate of asymptomatic men with serum prostate specific antigen concentrations less t han 4.0 ng./ml. Materials and Methods: We analyzed specimens from 133 consecutive patients with a mean age of 60 years undergoing cystoprostatectomy for bladder cance r, Six systematic biopsy specimens and 2 fine needle aspiration cytology sa mples were taken from the prostate immediately after cystoprostatectomy, Th e specimens were step sectioned and examined for prostate cancer. Insignifi cant prostate cancer was defined as any cancer with an aggregate volume 0.5 cm.(3) or less. Results: Incidental prostate cancer was found in 58 of the 133 patients (44 %). Tumor volume was 0.5 cm.(3) or less in 47 cases. Sextant biopsy detecte d 7 cancers, including 4 of 47 (9%) that were insignificant and 3 of 11 (27 %) that were significant. Fine needle aspiration cytology also detected 7 c ancers, including 3 (6%) and 4 (36%) that were insignificant and significan t, respectively. Conclusions: Systematic sextant biopsy and fine needle aspiration cytology each diagnose prostate cancer in about 5% of asymptomatic men who have norm al digital rectal examination and serum prostate specific antigen less than 4.0 ng./ml. However, many of the cancers thus detected are insignificant a nd most of the significant cancers are missed. Therefore, routine screening of such patients with sextant biopsy or aspiration cytology does not appea r to be justified.