Polyfocal trephine biopsy of the prostate gland (up to 6 locations) (PG054)

Polyfocal trephine biopsy — is a method of obtaining samples of prostate tissue from several anatomical areas (locations) using a special biopsy needle. This code (PG054) involves the study of material taken from six or fewer points. This targeted study allows the pathologist to study the architectonics of tissues in the most suspicious areas of the gland.

Research objective: The main task is microscopic confirmation or exclusion of prostate cancer. Since the tumor is often multifocal (several foci in different parts of the organ), taking material from different locations significantly increases the accuracy of diagnosis compared to a single puncture.

What does the pathologist evaluate:

• Histological structure: differentiation of normal glandular tissue from benign prostatic hyperplasia (BPH) or cancer.

• Gleason Score: If adenocarcinoma is detected, the pathologist assesses the degree of its aggressiveness on a scale from 2 to 10.

• Prevalence of the process: analysis of how many of the six locations contain tumor cells and what percentage of the column they occupy.

• Presence of PIN (prostatic intraepithelial neoplasia): detection of precancerous changes in the epithelium.

• Inflammatory processes: diagnosis of acute or chronic prostatitis, which can also be the cause of increased tumor markers.

Clinical significance: The PG054 results are the basis for staging the disease and choosing a treatment method. Accurate determination of the tumor's aggressiveness (Gleason score) and its location helps the doctor decide whether observation alone is sufficient or whether the patient needs surgery, radiation, or hormonal therapy.

When is it prescribed:

• suspicion of prostate cancer with an increased level of PSA (prostate-specific antigen);

• detection of dense nodes or asymmetry of the gland during a digital rectal examination;

• detection of focal changes during CT scan or MRI (PI-RADS scale);

• the need for a control biopsy in case of previously detected atypical proliferation.