Radical prostatectomy: The value of preoperative, individually labeled apical biopsies

Purpose: Involvement of the prostatic apex with adenocarcinoma is a relativ ely common finding, as is a positive surgical margin at this location. We e valuated whether a positive apical core biopsy provides preoperative inform ation that may be used as a basis for the subsequent surgical approach in i ndividuals. Materials and Methods: We evaluated apical prostate cancer in 240 individua lly labeled, preoperative apical core biopsies and the corresponding prosta tectomy specimen in 120 patients who underwent radical prostatectomy for cl inically localized prostate cancer. Sensitivity, specificity, and positive and negative predictive values were calculated for the ability of an indivi dual apical core to predict the side of tumor in the surgical specimen usin g 2 x 2 contingency tables. Moreover, univariate subset analysis was done f or positive biopsies to assess the ability of histopathological characteris tics, including Gleason score, cancer length, percent of cancer in the core and distance of cancer from the inked rectal core end, to predict a positi ve surgical margin at the apex. Results: The positive predictive value of a single positive apical core for identifying tumor location correctly in the prostatectomy specimen was 71. 1%, while absent cancer in the apical biopsy had a negative predictive valu e of 75.5%. Sensitivity was 44.5% for a positive biopsy core. In this conte xt the predictive value of an individual positive apical core biopsy was on ly 28.8% for predicting surgical margin positivity at the apex. Conclusions: Cancer and its histopathological characteristics in an individ ual core biopsy failed to predict apical tumor involvement as well as a pos itive apical margin at subsequent radical prostatectomy.