Improving prostate cancer detection with an extended-core transrectal ultrasonography-guided prostate biopsy protocol

Abstract

Objective To investigate whether taking two transition zone (TZ) and four lateral peripheral zone (PZ) biopsies in addition to routine parasaggital sextant biopsies would improve detection rates in men with suspected prostate cancer. Patients and methods The study included 493 consecutive men (mean age 68.7 years, SD 8.2) with elevated serum prostate-speci®c antigen (PSA) levels and/or abnormal ®ndings on a digital rectal examination who underwent transrectal ultrasonography-guided prostate biopsy. In addition to sextant biopsies, six further biopsies were obtained, two from the TZ (mid-gland) and four from the lateral PZ (base and mid-gland).Pathological ®ndings for the additional biopsies were compared with those of the sextant regions. Results Prostatic adenocarcinoma was diagnosed in 164 of the 493 (33%) men biopsied. Men with cancer were older, had smaller prostates and higher median PSA levels than men with negative biopsies. Sextant biopsies were positive for cancer in 133 of 164 (81%) men. All three sets of biopsies were positive in 53 (32%) cases. In 50 (30%) men both the sextant and lateral PZ biopsies were positive, while in six (4%) men, both sextant and TZ biopsies were positive. Thirty-one (19%) tumours were not detected by sextant biopsies, 10 (6%) where the lateral PZ biopsies alone were positive, 17 (10%) where the TZ biopsies alone were positive and four (3%) where both the TZ and lateral PZ together were positive. There were no differences in median PSA concentration, total prostate volume or TZ volume between men with an isolated TZ cancer and men with cancer elsewhere in the prostate. However, 77% of men with TZ cancer had a PSA of >10 ng/mL, compared with 60% of men with cancer at other sites within the prostate (P=0.015). Conclusion An extended-core biopsy protocol signi®cantly improves the detection rate for prostate cancer when compared with the standard sextant biopsy protocol alone. Routine TZ biopsies should be considered for men with serum PSA levels of >10 ng/mL.

MultiParametric Magnetic Resonance Imaging-Based Nomogram for Predicting Prostate Cancer and Clinically Significant Prostate Cancer in Men Undergoing Repeat Prostate Biopsy

“…Systematic TRUS-guided prostate biopsy remains the recommended investigation for the histological diagnosis of PCa [ 2 ]. However, in approximately 60-70% of patients who are thought to harbour malignancy, PCa cannot be definitively diagnosed based on their first prostate biopsy [ 3 ]. Following negative biopsy, many of these patients continue to exhibit a clinical constellation consistent with PCa based on persistently elevated serum PSA, abnormal DRE findings, and/or suspicious mpMRI.…”

“…Prostate biopsy still remains the standard method for the diagnosis of PCa [ 2 ]. Despite advances in biopsy technology in recent decades, in approximately 60–70% of patients initial systematic prostate biopsy results are negative, due to the very limited or randomized sampling associated with the method [ 3 ]. In many of these patients a clinical suspicion of PCa persists, however, based on sustained elevated serum prostate-specific antigen (PSA), abnormal digital rectal examination (DRE) findings and/or suspicious lesions on magnetic resonance imaging (MRI).…”

Ten-core versus 16-core transrectal ultrasonography guided prostate biopsy for detection of prostatic carcinoma: a prospective comparative study in Indian population

“…The method introduced by Hodge et al [3] involving 6 systematic sextant TRUS-guided biopsies has been the gold standard protocol for this purpose. However, it is associated with a relatively high false-negative rate of 15% to 31% [4,5]. Because of concern about the possibility of missing clinically significant tumors, several investigators have considered different regimens involving more extensive sampling of the gland, particularly the far lateral aspects of the peripheral zone of the prostate [6,7].…”

Transrectal Ultrasound-Guided Prostate Biopsy; Back to the Future

“…sonuç olarak tZ biyopsilerinde kanser saptama oranı literatürde %2-31 arasında değişen farklılık göstermektedir ve güncel yaklaşımda ilk biyopside tZ örneklenmesi önerilmemektedir. (21,22) Biyopsi sayısının prostat hacmine göre ayarlanması tartışılan konulardan biridir. Yapılan çalışmalarda prostat hacmi 50 cc'den küçük olduğunda 12, büyük olduğunda 18 adet biyopsi alınması önerilmektedir.…”