The pathological interpretation and significance of prostate needle biopsyfindings: Implications and current controversies

Purpose: The widespread use of prostate specific antigen testing and digita l rectal examination has lead to the increasing application of prostate nee dle biopsy. A larger proportion of men undergoing biopsy have small foci of cancer, which coupled with the overall increase in needle biopsy has led t o a surge in the number of equivocal biopsy specimens interpreted. Materials and Methods: We reviewed the literature with an overview of the t opic of prostate needle biopsy pathology results with an emphasis on curren t controversies. Results: The diagnosis rendered on prostate needle biopsy pay be placed int o 4 major categories, including lj benign, 2) prostatic intraepithelial neo plasia, 3) atypical and suspicious for cancer, and 4) prostate cancer. Pros tatic intraepithelial neoplasia or a diagnosis of atypical and suspicious f or cancer mandates re-biopsy in a search for occult prostate cancer. Biopsy findings, including the location of positive cores, may help to guide re-b iopsy strategies. Prostate cancer on needle biopsy may be evaluated by nume rous techniques of quantifying tumor extent, Gleason score and perineural i nvasion. These modalities may help clinicians to assess the risk of extrapr ostatic disease and progression likelihood, and help men with prostate canc er choose among therapeutic options. Conclusions: The pathology reports returned on needle biopsy specimens may provide a wealth of information beyond the simple presence or absence of pr ostate cancer that may aid clinicians in patient treatment and counseling.