Comparative analysis of pathohistological results from prostate biopsy samples and radical prostatectomy specimens our experiences

Introduction: The diagnosis of prostate cancer has seen significant advancements in recent decades, primarily due to the increased accuracy of diagnostic tools and histopathological techniques. Among these, prostate biopsies and specimens from radical prostatectomies play key roles in the diagnosis, staging, and treatment of prostate cancer (Ca) (1). This paper focuses on a comparative analysis of the pathohistological results obtained from prostate biopsy samples and specimens after radical prostatectomy, explaining their differences and implications for clinical practice. Prostate cancer remains one of the most common malignancies among men worldwide. Early detection and accurate histopathological analysis are crucial for effective treatment and improving patient outcomes. Prostate biopsy, often guided by ultrasound, it is the standard diagnostic procedure for detecting prostate cancer. However, it provides limited tissue samples that often fail to represent the full extent of the tumor or its heterogeneity. Compared to this, specimens from radical prostatectomies, obtained after the surgical removal of the prostate gland, offer a clearer picture of the malignancy’s characteristics by determining tumor size and location, the degree of invasiveness, and the status of surgical margins (2). Materials and Methods: The study includes 105 patients who underwent TRUS (transrectal ultrasound-guided prostate biopsy) at the Urology Department of the General Hospital “8th September” in Skopje over a three-year period (from early 2021 to the first half of 2024). The biopsy samples were processed and analyzed at the Pathohistology Department. After confirming prostate cancer, patients underwent surgical treatment—radical prostatectomy (open or laparoscopic)—and the specimens obtained during the operation were analyzed again at the same Pathohistology Department in the General Hospital “8th September” in Skopje. Demographic data, serum PSA levels, prostate size, pathological stage, and malignancy grade were recorded. The data obtained from the study were statistically analyzed and presented using mean values, percentages, tables, and graphs. Objectives: To determine the pathohistological characteristics of TRUS biopsy samples to make informed decisions regarding surgical or conservative treatment for prostate cancer. Comparative analysis of pathohistological findings and differences between Gleason Scores from prostate biopsy samples and radical prostatectomy specimens. Identifying the most common pathohistological characteristics of prostate cancer as predictive factors for determining appropriate postoperative treatment. Results:Out of the 105 patients included in the study, 50 patients (48%) showed identical pathohistological findings (Gleason Score) in both the biopsy and radical prostatectomy specimens. However, in 55 patients (52%), there was a significant difference, with the Gleason Score from radical prostatectomy specimens being higher in most cases. Conclusion: The comparative analysis of pathohistological results from prostate biopsy samples and radical prostatectomy specimens highlights the complementary nature of these diagnostic methods. While biopsies are indispensable for initial diagnosis and treatment planning, radical prostatectomy specimens provide a definitive pathological assessment, offering insights that guide postoperative monitoring and long-term care. Understanding the advantages and limitations of each method is crucial for optimizing patient outcomes. Future advancements in imaging diagnostics, molecular diagnostics, and artificial intelligence are expected to bridge the gap between biopsy and prostatectomy findings, enhancing the precision of prostate cancer diagnosis and treatment.