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Background: This study aimed to evaluate the histopathological concordance rates between prostate biopsies and radical prostatectomy specimens according to the applied biopsy approach (transrectal or transperineal). Methods: We studied patients who had been newly diagnosed with clinically significant prostate cancer and who underwent a radical prostatectomy between 2018 and 2022. Patients were included if they underwent a prebiopsy magnetic resonance imaging and if they had not been previously treated for prostate cancer. Histopathological grading on prostate biopsies was compared with that on radical prostatectomy specimens. Univariable and multivariable logistic regression analyses were performed to assess the effect of the applied biopsy approach on histopathological concordance. Additional analyses were performed to assess the effect of the applied biopsy approach on American Urological Association risk group migration, defined as any change in risk group after radical prostatectomy. Results: In total, 1058 men were studied, of whom 49.3% (522/1058) and 50.7% (536/1058) underwent transrectal and transperineal prostate biopsies, respectively. Histopathological disconcordance was observed in 37.8% (400/1058) of men while American Urological Association risk group migration was observed in 30.2% (320/1058) of men. A transperineal biopsy approach was found to be independently associated with higher histopathological concordance rates (OR 1.33 [95% CI 1.01–1.75], p= 0.04) and less American Urological Association risk group migration (OR 0.70 [95% CI 0.52–0.93], p= 0.01). Conclusions: The use of a transperineal biopsy approach improved histopathological concordance rates compared to the use of a transrectal biopsy approach. A transperineal biopsy approach may provide more accurate risk stratification for clinical decision-making. Despite recent improvements, histopathologic concordance remains suboptimal and should be considered before initiating management.

Abstract:: Bladder cancer is seen mainly in men. The incidence in women is increasing, but is still approximately three to four times lower than in men. In particular transitional cell cancers seem relatively more common in men then in women (ratio 4:1), but non-transitional cell cancer is also more frequent in men (ratio 2.7:1). As for men, smoking is the most important known factor for bladder cancer in women. Coffee-drinking also showed a weak correlation, the odds ratio being found to be twice as high for women (5.2) as for men (2.6). It was estimated that the percentage of bladder cancers attributed to occupational exposure in the United States is 11% in women, compared to 21% in men. Urinary tract infections are related to bladder cancer. The role of human papilloma virus infections, important in cervical cancer, is unclear in bladder cancer development. Surprisingly, bladder cancer is more often of a higher stage at initial diagnosis in women. With current tumor markers no explanation for the different prognosis in men and women can be postulated. The treatment of superficial bladder cancer tumors is similar for men and women. In recent years orthotopic bladder replacement has improved quality of life after cystectomy in invasive disease.

Summary The reproducibility of cytomorphometrical nuclear area measurements on transitional cell carcinoma is studied. The inter-individual consistency is low (r=0.55,P=0.0005) when nuclei for measurement are chosen at random. When we use a systematic analysis based on cell situation and cytological features of malignancy to select the 50 nuclei for measurement per slide, the consistency between two technicians appears to be significantly higher (r=0.90,P=0.015). Not only interindividual consistency increases using the selection, but the correlation with histological tumour grade also improves significantly for both technicians. The results show that cytomorphometry is a method of grading bladder carcinoma when an accurate selection of nuclei to measure is used. Cytomorphometrical studies should contain a clear description of the way the nuclei for measurement are chosen.

Abstract: The genetic and epigenetic changes that occur during cancer development result in apparent morphological changes. Light microscopic image analysis provides objective assessment of cellular and nuclear morphology. The complexity of changes reflects the basic nature of dedifferentitation: a multi-hit process. Image analysis methods proved valuable for the assessment of malignancy in bladder cancer. Clinically applicable systems have been developed to diagnose urothelial cell cancer and predict prognosis. What is the place of these systems in daily practice?