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
CK 34βΕ12
Carcinoma of the prostate In autopsies, 29% of men(30-40 yo) and in 64% of 60-70 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), 185.000 identified with cancer and 30.000 died from it. In 44.788 pairs of twin brothers in Scandinavia, 45% of prostatic cancer was familial and 55% sporadic (Lichtenstein et al, 2000,NEJM)
Παθολογοανατομικό Αρχείο Νεοπλασιών Ελληνική Εταιρεία Παθολογικής Ανατομικής Φεβρουάριος 2014
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
Νεοπλασίες 2009 2010 2011 Μαστός 6.383 6.222 6.454 Παχύ Έντερο 5.658 5.943 5.464 Προστάτης 5.067 4.878 4.612 Πνεύμονας 3.558 3.588 3.643 Στόμαχος 1.659 1.625 1.658 Νεφρός 1.041 967 1.019 Μελάνωμα 769 845 779 Ωοθήκη 527 789 685 Νευροενδοκρινείς όγκοι Αναπνευστικού Πεπτικού 453 537 502 Γλοιώματα 338 324 274 Στρωματικοί όγκοι Πεπτικού 175 200 195 Σύνολο 25.628 25.918 25.285
2% 2% 4% 1% 2% 1% 34% 33% 38% 59% 62% 62% Καρκίνωμα Προστάτου Είδος Επέμβασης 3500 3000 2500 2000 1500 1000 500 0 Βιοψία Προστατεκτομή Διουρηθρική Ν/Α Εκτομή 2009 2995 1941 94 37 2010 3045 1636 111 86 2011 2881 1507 166 58
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 1000 500 0 <40 40-50 50-60 60-70 70+ Ν/Α 2009 3 62 574 1668 2313 447 2010 1 52 552 1457 2288 528 2011 5 46 507 1418 2089 547
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
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
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 ΙI: features addequately analysed (bench and bedside) but results from large scale studies are needed Category IΙΙ: features inaddequatelly studied
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
Score 6 Score 7 Score 8 Score 10 Gleason scores
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
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
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
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
CK 34βE12
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
p53 overexpression
Racemase overexpression
Overexpression of ERG-gene
Does overdiagnosis with USGB lead to overtreatment?
In which cases USGB is recommended, post-therapy?
*effectiveness of therapy *checking relapse *active surveillance *choise of new therapy *new staging *new GLEASON SCORE *new clones?
FOR THE BENEFIT OF THE PATIENT AND A RELIABLE DIAGNOSIS Blind prostatic biopsies are of limited value ULTRASOUND GUIDED BIOPSIES ARE THE GOLD STANDARD
Thank you