Differences and significance of pathohistological findings from core biopsy and radical prostatectomy in prostate cancer patients

Aim: This study analyzes the differences between pathohistological findings from prostate core biopsy and radical
prostatectomy in patients with prostate cancer, with special emphasis on prostate volume, tumor involvement,
Peri neural invasion (PNI), lymphatic and vascular emboli, and resection margin status.
Methods: Twenty-one patients with adenocarcinoma of the prostate diagnosed by core needle biopsy, later subjected
to radical prostatectomy, were included. Data from the biopsy and surgical specimen were compared. Statistical
analysis was performed on the frequency of PNI in the biopsy and prostatectomy, the extent of tumor involvement
(% involvement) in the final specimen, the presence of lympho vascular invasion, as well as the surgical margin
status.
Results: The mean age of patients was ~70 years, with a median prostate volume of 49 cc (range 28–80 cc). The
average tumor involvement in the radical specimen was 14% (median 12%, range 3–30%). Peri neural invasion
was observed in only 5 patients (23.8%) on biopsy, whereas in the prostatectomy specimen PNI was present in 16
patients (76.2%), a statistically significant increase (McNemar p < 0.01). Lymphatic and/or vascular tumor emboli
were detected in 8 patients (38%) in the surgical specimen (7 cases only lymphatic, 7 cases only vascular, with
6 patients having both types of emboli). Positive resection margins (tumor at the cut surface) were found in 6
patients (28.6%).
Conclusion: Pathohistological findings from radical prostatectomy often reveal a greater extent of disease than
the initial biopsy. The biopsy has limited sensitivity for certain prognostic factors (such as PNI and lympho vascular
invasion), which significantly influence subsequent treatment and prognosis. Detection of PNI, lymphatic/vascular
invasions, and positive margins in the final specimen indicates a more aggressive disease and helps identify
patients who require adjuvant therapy or more intensive monitoring.