Impact of extended prostate biopsy including apical anterior region for cancer detection and prediction of surgical margin status for radical prostatectomy

Abstract

Objectives: We investigated diagnostic yield of initial biopsy and repeated biopsy including apical cores. Methods: We investigated 573 consecutive men with PSA of ≤20 ng/ml who underwent prostate biopsy between 2004 and 2013. The initial 14-core biopsy consisted of the sextant type, lateral sites at the base and middle, lateral apices (la) at anterior horn sites, and apical anterior sites (aa). The repeated 18-core biopsy consisted of the initial 14-core biopsy with four transition zone (TZ) sites at the base (tzb) and middle (tzm). Results: Prostate cancer was diagnosed in 178 (38.9%) of 458 men with the initial 14-core biopsy, and 44 (38.3%) of 115 men with the repeated 18-core biopsy. In the initial biopsy setting, the unique cancer detection rate was high in apical sites (apex, la, and aa: 6.2%, 6.2% and 5.1%, respectively). In the repeated setting, it was high in the TZ site in addition to the apical site (apex, la, aa, tzm, and tzb: 6.8%, 6.8%, 11.4%, 9.1% and 11.4%, respectively). The positive SM rate at the apex was higher in patients whose cancer was detected only in sites other than the sextant region than for those in the sextant region (36.4% vs. 14.8%, P = 0.037). Conclusions: The initial 14-core and the repeated 18-core biopsy scheme including apical anterior cores are feasible for prostate cancer detection. We propose that apical biopsy cores can be used to predict not only the existence of cancer but also surgical margin status at the apex.

Prediction of surgical margin status and location after radical prostatectomy using positive biopsy sites on 12-core standard prostate biopsy

“…Moreover, it is important to know the risk of apical PSM before surgery 18 . According to the results of the current study, the rate of a positive apical margin, which has been shown to have a higher recurrence risk than other margins 19 , was significantly increased in men with a positive AL biopsy, consistent with a previous study 20 . On the basis of these data, during nerve-sparing radical prostatectomy, apical dissection of the prostate should be carefully performed in men with a positive AL biopsy to reduce the probability of PSM.…”

The value of transperineal apical prostate biopsy in predicting urethral/apical margin status after radical prostatectomy

“…[11–13] The location of tumor in different prostate zone might also influence the status of surgical margin. [14] However, these factors could not fully predict the occurrence of PSM. Therefore, it is critical to find out more accurate preoperative predictors to evaluate the incidence of PSM and to take some measures to minimize it.…”