Histopathology of ultrasound-guided biopsies of the prostate. L.Kaklamanis MD,D.Phil Department of Pathology Onassis Cardiac Surgery Center

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1 Histopathology of ultrasound-guided biopsies of the prostate L.Kaklamanis MD,D.Phil Department of Pathology Onassis Cardiac Surgery Center Euroson 2014, Athens 15-16/2/2014

2 CK 34βΕ12

3 Carcinoma of the prostate In autopsies, 29% of men(30-40 yo) and in 64% of yo, minute foci of histological malignancy have been identified (Sacr et al 1994, In Vivo) 1:6 men will aquire prostatic cancer in his lifetime and 1:30 will die from metastatic disease (Jemal et al, 2002,Cancer J Clin) In USA (2007), identified with cancer and died from it. In pairs of twin brothers in Scandinavia, 45% of prostatic cancer was familial and 55% sporadic (Lichtenstein et al, 2000,NEJM)

4 Παθολογοανατομικό Αρχείο Νεοπλασιών Ελληνική Εταιρεία Παθολογικής Ανατομικής Φεβρουάριος 2014

5 Γεωγραφική Κάλυψη Αθήνα (45) Θεσσαλονίκη (17) Αγ. Νικόλαος Αίγιο Αλεξανδρούπολη Άργος Άρτα Βέροια Βόλος Δράμα Έδεσσα Ηράκλειο Ιωάννινα Καβάλα Καλαμάτα Κάλυμνος Καρδίτσα Καρπενήσι Κέρκυρα Κοζάνη Κομοτηνή Κόρινθος Κυπαρισσία Κως Λαμία Λάρισα Λέρος Λιβαδειά Μολάοι Μυτιλήνη Ναύπλιο Ξάνθη Πάτρα Πρέβεζα Πτολεμαΐδα Πύργος Ρέθυμνο Ρόδος Σάμος Σέρρες Σητεία Σπάρτη Σύρος Τρίκαλα Τρίπολη Φιλιάτες Χαλκίδα Χανιά

6 Νεοπλασίες Μαστός Παχύ Έντερο Προστάτης Πνεύμονας Στόμαχος Νεφρός Μελάνωμα Ωοθήκη Νευροενδοκρινείς όγκοι Αναπνευστικού Πεπτικού Γλοιώματα Στρωματικοί όγκοι Πεπτικού Σύνολο

2% 2% 4% 1% 2% 1% 34% 33% 38% 59% 62% 62% Καρκίνωμα Προστάτου Είδος Επέμβασης 3500 3000 2500 2000 1500 1000

7 2% 2% 4% 1% 2% 1% 34% 33% 38% 59% 62% 62% Καρκίνωμα Προστάτου Είδος Επέμβασης Βιοψία Προστατεκτομή Διουρηθρική Ν/Α Εκτομή

0% 0% 0% 1% 1% 1% 11% 11% 11% 9% 11% 12% 33% 30% 31% 46% 47% 45% Καρκίνωμα Προστάτου Άνδρες - Ηλικίες 2500 2000 1500

8 0% 0% 0% 1% 1% 1% 11% 11% 11% 9% 11% 12% 33% 30% 31% 46% 47% 45% Καρκίνωμα Προστάτου Άνδρες - Ηλικίες < Ν/Α

9 Fine needle prostatic biopsy WITHOUT Ultrasound guidance Blind biopsies might identify the lesion or one lesion Blind biopsies will never show the extent of the disease Blind biopsies will identify some staging parameters only by chance Blind biopsies are usually followed by redos Blind biopsies will not pic up focal lesions and only positive results are regarded as true

10 Fine needle prostatic biopsy (20G) WITH Ultrasound guidance US-guided biopsy will frame the lesion US-guided biopsy will show the extent of the disease US-guided biopsy will safely identify staging parameters (TNM system) US-guided biopsy will safely guide therapy US-guided biopsy will catch focal lesions Negative results are negative results Additional findings will be identified

11 Important TNM features following One or two lobes? USGB Invasion of the prostatic capsule? Invasion of seminal vescicles? Invasion of the bladder neck? Invasion of striated muscle, neighbouring tissues and organs? Prognostic features? WHICH T?

Three groups of prognostic features have been proposed by CAP Category I: features with proven prognostic value, used in clinical practice Category

12 Three groups of prognostic features have been proposed by CAP Category I: features with proven prognostic value, used in clinical practice Category ΙI: features addequately analysed (bench and bedside) but results from large scale studies are needed Category IΙΙ: features inaddequatelly studied

13 Category I:, Gleason score, TNM stage group, surgical margins, PSA prior to therapy (?) Category ΙI: tumour size, histological type, DNA ploidy Category IΙΙ: perineural invasion microvascular density, proliferation markers, molecular markers

14 Score 6 Score 7 Score 8 Score 10 Gleason scores

16 Which features are important forτνμ staging? Extent of the disease (one or two lobes...) Capsular invasion Invasion of seminal vesicles Invasion of bladder neck Invasion of striated muscle and neighbouring tissues Prognostic features

18 Which features are important forτνμ staging? Extent of the disease (one or two lobes...) Capsular invasion Invasion of seminal vesicles Invasion of bladder neck Invasion of striated muscle and neighbouring tissues Prognostic features

22 Which features are important forτνμ staging? Extent of the disease (one or two lobes...) Capsular invasion Invasion of seminal vesicles Invasion of bladder neck Invasion of striated muscle and neighbouring tissues Prognostic features

24 Which features are important forτνμ staging? Extent of the disease (one or two lobes...) Capsular invasion Invasion of seminal vesicles Invasion of bladder neck Invasion of striated muscle and neighbouring tissues Prognostic features

30 CK 34βE12

31 Which features are important forτνμ staging? Extent of the disease (one or two lobes...) Capsular invasion Invasion of seminal vesicles Invasion of bladder neck Invasion of striated muscle and neighbouring tissues Prognostic features

32 p53 overexpression

33 Racemase overexpression

34 Overexpression of ERG-gene

35 Does overdiagnosis with USGB lead to overtreatment?

36 In which cases USGB is recommended, post-therapy?

37 *effectiveness of therapy *checking relapse *active surveillance *choise of new therapy *new staging *new GLEASON SCORE *new clones?

38 FOR THE BENEFIT OF THE PATIENT AND A RELIABLE DIAGNOSIS Blind prostatic biopsies are of limited value ULTRASOUND GUIDED BIOPSIES ARE THE GOLD STANDARD

39 Thank you

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