Needle biopsy of recurrent adenocarcinoma of the prostate after radical prostatectomy

The objective of this study was to evaluate needle biopsy of recurrent pros tate cancer after radical prostatectomy. We evaluated 37 cases of recurrent prostate cancer after radical prostatectomy that were diagnosed by needle biopsy between March 1984 and July 1998, Fifteen were from consultations in which contributors were uncertain of the diagnosis, and 22 were from men w ho had come to The Johns Hopkins Hospital for treatment. The median interva l from radical prostatectomy to biopsy showing recurrent tumor was 40 month s, There was no correlation between the interval to recurrence and either p athologic features of the biopsy and radical prostatectomy or various clini cal features. The mean extent of adenocarcinoma in the biopsies was 3.2 mm (range, 0.1 to 18 mm; median, 2 mm). The length of recurrent cancer on biop sy correlated with an abnormal rectal examination (P = .001), The mean Glea son score for the recurrent tumors was 6.5, which correlated with the grade of the radical prostatectomy cancer (P = .005). The cancers often lacked o vert histologic features of malignancy. Benign prostatic acini were seen in five cases (14%), usually separate from the cancer. In 5 (33%) of the cons ultation cases, we would not have been able to diagnose cancer if not for t he fact that atypical prostate glands should not be present after radical p rostatectomy. In well-sampled radical prostatectomies, margins were almost always positive, as was extraprostatic extension. In cases with less sampli ng, there was a higher incidence of organ-confined disease and margin-negat ive disease implying suboptimal processing of the radical prostatectomy. Af ter radical prostatectomy, recurrent cancer on needle biopsies may be focal and difficult to diagnose and must be assessed differently than in patient s who have not had surgery.