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

Purpose: The widespread use of prostate specific antigen testing and digital rectal examination has lead to the increasing application of prostate needle biopsy. A larger proportion of men undergoing biopsy have small foci of cancer, which coupled with the overall increase in needle biopsy has led to a surge in the number of equivocal biopsy specimens interpreted. Materials and Methods: We reviewed the literature with an overview of the topic of prostate needle biopsy pathology results with an emphasis on current controversies. Results: The diagnosis rendered on prostate needle biopsy pay be placed into 4 major categories, including 1) benign, 2) prostatic intraepithelial neoplasia, 3) atypical and suspicious for cancer, and 4) prostate cancer. Prostatic intraepithelial neoplasia or a diagnosis of atypical and suspicious for cancer mandates re-biopsy in a search for occult prostate cancer. Biopsy findings, including the location of positive cores, may help to guide re-biopsy strategies. Prostate cancer on needle biopsy may be evaluated by numerous techniques of quantifying tumor extent, Gleason score and perineural invasion. These modalities may help clinicians to assess the risk of extraprostatic disease and progression likelihood, and help men with prostate cancer 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 prostate cancer that may aid clinicians in patient treatment and counseling.