Biopsies, diagnosis and prognosis in prostate cancer

Prostate cancer is the third most common cancer in men worldwide, and poses a challenge both for patients and health care systems. Many aspects of prostate cancer are controversial, from screening for early detection to the concept of insignificant cancer that does not need curative treatment. This study deals with different aspects of the diagnostic process, including biopsy procedures, histopathological diagnosis and biomarkers for carcinogenesis and progression. Biopsies of the prostate are the prerequisite for histopathological diagnosis of cancer. The standard biopsy instrument uses an inner needle with a side-notch. The tissue yield of a novel end-cutting instrument was investigated and compared with that of the standard instrument. The new instrument provided thicker biopsies, flatter embedding in paraffin blocks and an optional greater stroke length. These advantages were countered by loss of some biopsy cores. The new instrument can be recommended primarily for men with large prostates or repeat biopsies when there is a persistent serum PSA elevation and suspicion of anterior tumour. Tumour volume of prostate cancer correlates with progression after radical prostatectomy, but its clinical utility is limited by difficulties in the preoperative assessment. The prediction of large volume prostate cancer by prostate biopsies was studied. Biopsy cancer length and percentage cancer length predicted large tumours better than number and percentage of cores positive for cancer. A cancer length of 30 mm predicted a tumour volume of >4 ml in 95% of cases. Gleason score and serum PSA were weaker predictors. Tumour volumes of