Increasing Prostate-Specific Antigen Levels Differently Influence Prostate Cancer Detection Rates of Two Different 12-Core Prostate Biopsy Schemes

Abstract

Objective: To compare two 12-core transrectal ultrasound-guided prostate biopsy schemes in respect to cancer detection rates. Methods: Retrospective, single-center analysis of consecutive patients (n = 897) who underwent prostate biopsy (S1) with all 12 cores from far lateral areas (n = 269) or prostate biopsy (S2) with 6 cores from parasagittal and 6 from far lateral areas (n = 628). Results: Crude cancer detection rates with S1 and S2 were similar (39.0 and 38.9% for the first biopsy and 29.4 and 31.3% for repeated biopsies, respectively). Abnormal digital rectal exam, lower prostate volume and higher prostate-specific antigen (PSA) levels were independently associated with higher odds of cancer detection. Regarding first biopsies (n = 747), there was significant interaction between biopsy scheme and PSA (p < 0.001). Overall, the adjusted odds of cancer detection were higher with S1 (S1/S2 odds ratio = 2.54, 95% CI: 1.12-5.74), but the S1-S2 relationship was conditional on PSA: odds ratios progressively increased with increasing PSA from 0.64 (95% CI: 0.40-1.02) at PSA 5 ng/ml to 39.1 (95% CI: 2.71-566) at 75 ng/ml. Conclusion: Higher PSA levels increase the probability of cancer detection with 12-core prostate biopsies, but relative efficiency of different procedures appeared conditional on the PSA level. Data suggest that PSA levels should be considered in the choice of prostate biopsy sampling scheme.

The diagnostic ability of an additional midline peripheral zone biopsy in transrectal ultrasonography-guided 12-core prostate biopsy to detect midline prostate cancer

“…In the subgroup analysis according to prostate volume, transition zone volume, serum PSA concentrations, and PSA density, a higher cancer detection rate was associated with decreased prostate volume and transition zone volume, and increased values of serum PSA concentration and PSA density. These results are consistent with recent studies suggesting that prostate volume [ 13 ] and PSA concentration [ 14 ] are associated with positive systematic biopsies. Interestingly, the positive midline biopsy rate was highest in the patients with a moderate prostate volume, ranging from 30 mL to 60 mL.…”

The Impact of Core Length on Prostate Cancer Diagnosis during a Standard 14-Core Prostate Biopsy Scheme

“…The diagnosis of PCa depends on adequately sampling the zones in which cancer is mostly located (13). According to the literature, the 12 cores extended scheme remains the recommended standard in the initial PBx setting (14, 15). Guichard et al (4) found that the cancer detection rates of 6, 12, 18, and 21-cores biopsy were 31.7%, 38.7%, 41.5%, and 42.5%, respectively.…”