Detection Rate of Anterior Prostate Cancer in 226 Patients Submitted to Initial and Repeat Transperineal Biopsy

Abstract

Objective: To evaluate the detection rate of anterior zone (AZ) prostate cancer (PCa) in patients submitted to initial and repeat transperineal prostate biopsy. Methods: From January 2013 to August 2013, 226 patients (median age 64 years) with negative digital rectal examination underwent initial (144 cases) and repeat (82 cases) transperineal prostate biopsy for PSA >10 ng/ml, PSA 4.1-10.0 or 2.6-4.0 ng/ml with free/total PSA ≤25% and ≤20%, respectively. A median of 22 versus 32 cores were performed, including 4 cores of the AZ versus 6 cores (4 anterior plus 2 cores of the transition zone, TZ) at initial versus repeat biopsy, respectively. The detection rate of PCa of the peripheral zone (PZ), AZ and TZ was prospectively evaluated. Results: The median PSA was 7.6 ng/ml; overall, a stage cT1c PCa was found in 104/226 (46%) patients, in 70 (48.6%) and 34 (41.5%) of the men who underwent initial and repeat biopsy, respectively. An AZ PCa was found in 11.5 vs. 8.8% (p = 0.32) of the patients submitted to initial versus repeat biopsy, respectively. AZ cancers demonstrated a number of positive cores (p = 0.03), greatest percentage of cancer (p = 0.001) and total percentage of cancer (p = 0.001) significantly lower in comparison with PZ PCa; moreover, 56.2 vs. 36.5% of AZ versus PZ PCa were characterized by a microfocus of cancer (p = 0.001), respectively. Conclusions: AZ biopsies increase the detection rate of PCa (about 10% of cases) at initial and repeat biopsy, allowing reduction of the biopsy false-negative rate.

Prediction of Significant Prostate Cancer at Prostate Biopsy and Per Core Detection Rate of Targeted and Systematic Biopsies Using Real-Time Shear Wave Elastography

“…Based on these technical limits, enlarged prostate glands or multiple calcifications may decrease SWE performance, especially for detection of anterior tumors, whereas MRI and perineal biopsy are superior [24,25]. Data directly comparing SWE and MRI regarding performance rates in anterior tumors, that is, enlarged prostate glands are not available.…”

Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance?

“…Linder et al [19] found that 214 AS candidates undergoing extended biopsy (124 cases) versus saturation biopsy (94 cases) showed no difference in the rate of upgrading and upstaging at definitive specimen based on biopsy technique (p = 0.26); on the contrary, Abouassaly et al [20] reported a more accurate assessment of the extent and grade of disease in men enrolled in AS protocol using saturation biopsy in when compared to extended biopsy. In addition, the saturation biopsy scheme increases progression to treatment in AS on comparison with extended prostate biopsy (10 cores) [21], thus improving the detection rate of PCa located solely in the anterior zone of the gland (about 10 % of the cases) [22]; on the other hand, no significant difference was detected in upgrading or morbidity between a 24-core template or a template gland based on volume gland with an average of 1 core per cc. [23].…”

Sampling of the anterior apical region results in increased cancer detection and upgrading in transrectal repeat saturation biopsy of the prostate

“…Pepe et al. as well as Danforth et al. , using different transperineal regimens with up to 48 cores in repeat biopsies could reach overall cancer detection rates of 41.5% and 31.4%, respectively, with partially low rates in the anterior region.…”