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Despite the unequivocal contribution of targeted MRI fusion biopsy, it is known that ultrasoundguided biopsy with systematic sampling still is the main tool for prostate cancer (PC) diagnosis in developing countries. However, the number of sampled fragments remains a matter of controversy. Our objective was to compare the cancer detection rate (CDR) and the complications of 12 versus 20-core ultrasound guided transrectal prostate biopsy.METHODS: A prospective controlled study was conducted enrolling 758 consecutive patients who underwent biopsy with 1:1 randomization ratio for 12-core versus 20-core biopsy under periprostatic block local anesthesia. 76 patients were on active surveillance and 284 had at least one previous biopsy. The overall and the significant (Gleason 7) CDR were compared between the 2 techniques. We also evaluated the CDR according to PSA, free PSA, PSA density, prostate volume, previous biopsy and suspicious digital rectal examination. We assessed the occurrence of complications and the pain immediately after the procedure using the visual analogue pain intensity scale.RESULTS: The CDR was 47.7% and 37.7% in 20-core and 12core groups, respectively (OR 1.510; 95% CI: 1.130 to 2.018, p¼0.0052). An overall 18.5% significant increase in Gleason score 7 detection rate was found in the 20-core group (83.7 vs. 65.2% p¼0.0463). The CDR was also in favor of the 20-core when the active surveillance patients were excluded 45.6% and 32.9% (OR 1.712; CI 95% 1.215 to 2.412 p¼0.002). Considering only the surveillance patients the 20-core protocol also showed higher CDR 66.7 vs. 52.5% (p¼0,209). The CDR between the two techniques were similar according to PSA levels (p¼0.874), prostate volume p¼0.619), previous biopsy (p¼0.5973), age (p¼0.070), suspicious DRE (p¼0.146), free-tototal (p¼0.542) and PSA density (p¼0.585).The occurrence of any complication and acute prostatitis were similar between the 20-and 12core groups: 10.7 vs. 10.4% (p¼0.899) and 6.5 vs. 4.2% (p¼0.2166), respectively. The mean visual analogue pain intensity scale were also similar in 20-core when compared to 12-core group 2.35 vs. 2.19 (p¼0.7977).CONCLUSIONS: Our randomized trial revealed that the overall cancer positivity and the diagnosis of aggressive tumors were significantly higher in the 20-core prostate biopsy when compared to the 12core protocol. The complication rates and the pain experienced by the patients were similar in both groups.ClinicalTrials.gov NCT02825225

INTRODUCTION AND OBJECTIVES: PSA density (PSAD) is a PSA derivative that has been used to help predict for prostate cancer on biopsy. PSAD cut offs were formulated from cohorts consisting of mostly Caucasian (CA) men who underwent a sextant biopsy. We sought to evaluate PSAD in a more modern cohort of men to predict prostate cancer, to predict significant cancer, and to compare the performance of PSAD in African Americans (AA) and CA.METHODS: After IRB approval, we performed a retrospective chart review of all men who underwent a 12 core prostate biopsy between 2015 and 2017 at LSU Shreveport. Data collected included age, race, BMI, finasteride use, PSA, prostate volume (PV), biopsy pathology, T stage and Gleason score. PSA was corrected for finasteride use. PSA density was calculated by PSA divided by PV. Receiver operator characteristic (ROC) curve analysis was performed using the entire cohort, the AA cohort, and the CA cohort to predict for prostate cancer and significant cancer. Significant cancer was defined two ways using the AUA risk groups: 1. Intermediate (favorable and unfavorable) and high risk groups 2. Unfavorable intermediate and high risk groups.RESULTS: Of the entire cohort (n[239), 68.2% (n[163), 28.8% (n[69), and 2.9% were AA, CA, and other, respectively. Including 91 AA and 27 CA, 49.3% had a positive biopsy.The area under the curve (AUC) to predict prostate cancer was 0.784 (95% CI 0.726-0.841), 0.761 (95% CI 0.688-0.834), and 0.814 (95% CI 0.711-0.916) using the entire, AA, and CA cohorts, respectively.Using definition 1 for significant cancer, the AUC for the entire, AA, and CA cohorts was 0.796 (95% CI 0.738-0.854), 0.777 (95% CI 0.705-0.85), and 0.824 (95% CI 0.714-0.935), respectively.Using definition 2 for significant cancer, the AUC for the entire, AA, and CA cohorts was 0.841 (95% CI 0.786-0.895), 0.814 (95% CI 0.745-0.883), and 0.905 (95% CI 0.83-0.98), respectively.Table 1 lists the sensitivity (Se) and specificity (Sp) for selected PSAD cut off scores to predict a positive biopsy for the entire, AA, and CA cohorts.CONCLUSIONS: PSAD is still a useful tool and can be used to help counsel patients about undergoing a prostate biopsy. PSAD performed better in Caucasian men than African American men in predicting prostate cancer and significant cancer.