Initial Extended Transrectal Prostate Biopsy—Are More Prostate Cancers Detected With 18 Cores Than With 12 Cores?

Scattoni, Vincenzo; Roscigno, Marco; Raber, Marco; Dehò, Federico; Maga, Tommaso; Zanoni, Matteo; Riva, Mattéo; Sangalli, Mattia; Nava, Luciano; Mazzoccoli, B.; Freschi, Massimo; Guazzoni, G.; Rigatti, Patrìzio; Montorsi, Francesco

doi:10.1016/j.juro.2007.11.052

Cited by 63 publications

(43 citation statements)

References 20 publications

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“…[4][5][6] Additionally, we found PCa in 41.5% of the patients which is compatible with the literature. [14][15][16][17] However, TCL and ACL were not significantly associated with PCa in our multivariate analysis. Furthermore, when we pooled all cores, we found no significant difference among cores regarding MCL.…”

Section: Discussioncontrasting

confidence: 51%

Longer biopsy cores do not increase prostate cancer detection rate: A large-scale cohort study refuting cut-off values indicated in the literature

Yılmaz

Yavuz²,

Üstüner³

et al. 2017

Turkish Journal of Urology

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Objective: Only a few papers in the literature aimed to evaluate biopsy core lengths. Additionally, studies evaluated the core length with different approaches. We aimed to determine whether prostate cancer (PCa) detection is affected from core lengths according to three different approaches in a large standard cohort and compare our cut-off values with the published cut-offs. Material and methods:We retrospectively analyzed 1,523 initial consecutive transrectal ultrasound-guided 12-core prostate biopsies. Biopsies were evaluated with respect to total core length (total length of each patients' core) average core length (total core length divided by total number of cores in each patient), and mean core length (mean length of all cores pooled), and compared our cut-off values with the published cut-offs. The prostate volumes were categorized into four groups (<30, 30-59.99, 60-119.99, ≥120 cm 3 ) and PCa detection rates in these categories were examined.Results: PCa was found in 41.5% patients. There was no difference between benign and malignant mean core lengths of the pooled cores (p>0.05). Total core length and average core length were not significantly associated with PCa in multivariate logistic regression analyses (p>0.05). The core lengths (mean, average and total core lengths) increased (p<0.001) and PCa rates decreased (p<0.001) steadily with increasing prostate volume categories. PCa percentages decreased in all categories above the utilized cut-offs for mean (p>0.05), average (p<0.05), and total core lengths (p>0.05). Conclusion:There was no difference between mean core lengths of benign and malignant cores. Total core length and average core length were not significantly associated with PCa. Contrary to the cut-offs used for mean and average core lengths in the published studies, PCa rates decrease as these core lengths increase. Larger studies are necessary for the determination and acceptance of accurate cut-offs.

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Section: Discussioncontrasting

confidence: 51%

Longer biopsy cores do not increase prostate cancer detection rate: A large-scale cohort study refuting cut-off values indicated in the literature

Yılmaz

Yavuz²,

Üstüner³

et al. 2017

Turkish Journal of Urology

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“…Alternatively, several groups have noted the need for more biopsy cores from larger glands. [24][25][26] Scattoni et al…”

Section: Discussionmentioning

confidence: 99%

Development and external validation of a nomogram for predicting cancer probability at initial prostate biopsy using the life expectancy- and prostate volume-adjusted biopsy scheme

Nomura

Ito

Miyakubo

et al. 2011

Prostate Cancer Prostatic Dis

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BACKGROUND:We previously reported the diagnostic efficacy of the age-and prostate volume-adjusted prostate biopsy method (the adjusted biopsy method). Here, we developed a new nomogram for predicting cancer probability at initial biopsy using the adjusted method. METHODS:Between 2002 and 2010, 1059 Japanese men with PSA levels between 1.1 and 40 ng ml À1 and biopsied for the first time using the adjusted method at Gunma University Hospital were enrolled. All subjects underwent digital rectal examination (DRE) and transrectal ultrasonography (TRUS). Data from the initial 849 subjects were used for development of the nomogram and those from the final 210 subjects were used for internal validation. External validation was conducted using data from two affiliated hospitals where the same adjusted biopsy method was used. The nomogram was developed through logistic regression analysis, and predictive accuracy and performance characteristics were assessed using the area under the curve (AUC) of the receiver operating characteristics and calibration plots. Furthermore, we compared the predictive accuracy of the newly developed nomogram with the 'Prostate Risk Indicator' using the development data set, as well as the two external data sets. RESULTS:The AUC of the logistic regression-based nomogram was significantly higher than those of any single clinical parameter. External validation showed significant correlations with the present model. The AUC-receiver operating characteristic of the 'Prostate Risk Indicator' was the second largest following the new nomogram using the development data set and one external data set and almost equal to the new nomogram using the other external data set.CONCLUSIONS: Nevertheless the present model does not include somewhat subjective findings on TRUS abnormality, which is necessary for the estimation by 'Prostate Risk Indicator', the predictive accuracy of the present simple nomogram could be excellent enough to contribute to accurate shared decision-making between doctors and men who are candidates for the adjusted biopsy scheme.

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“…[24] first examined 13 cores; they found that this particular scheme resulted in a 35% increase in the PCa detection rate. Similarly, Scattoni et al [25] assessed the diagnostic yield of a scheme using 18 cores in 1776 patients and compared it with the 12-core biopsy strategy. No statistically significant difference in the PCa detection rate was observed between the 2 strategies except in patients with a prostate volume of less than 55 cc (+6.7% gain was recorded).…”

Section: Extended Biopsy Schemementioning

confidence: 99%

“…No statistically significant difference in the PCa detection rate was observed between the 2 strategies except in patients with a prostate volume of less than 55 cc (+6.7% gain was recorded). [25] It is clear that the yield of sextant biopsy can be significantly improved when extended biopsy is performed. However, as the number of cores exceeds 10, the gain becomes more marginal.…”

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confidence: 99%

When prostate cancer remains undetectable: The dilemma

Mustafa

Pisters

2015

Turkish Journal of Urology

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Since the first report on the efficacy of sextant biopsy under transrectal ultrasound guidance, there have been many modifications related to the total number of cores and the localization of biopsies to improve the prostate cancer (PCa) detection rate. The 2010 National Comprehensive Cancer Network Early PCa Detection Guidelines noted the 12-core biopsy scheme as the standard. However, this extended biopsy scheme still fails to detect 20% of high-grade PCa that can be detected by detailed pathological evaluation of radical prostatectomy; therefore, there is need for saturation biopsies. The existence of suspicions of PCa after previous negative biopsy or biopsies represents a valid indication for saturation biopsy. There has been no significant increment in morbidity or in insignificant PCa detection rates when a saturation biopsy scheme was used with an extended biopsy scheme. Along with the improvement in the PCa detection rate, accurate oncological mapping of PCa is another important consideration of saturation biopsies. The ideal number of cores and the diagnostic value of saturation biopsy after the failure of initial therapy are some of the issues that need to be addressed. Preliminary reports have shown that magnetic resonance imaging can improve the PCa detection rate, save patients from unnecessary biopsies, and decrease the need for a high number of cores; however, multiple limitations continue to exist.Keywords: Prostate; prostate biopsy; prostate cancer History of prostate biopsy (PBx)Watanabe et al. [1] first introduced the use of transrectal ultrasound-guided (TRUSG) biopsy into the armamentarium of prostate cancer (PCa). Hodge et al. [2] reported on the efficacy of sextant biopsy under TRUS guidance for PCa detection. Initially, only ultrasonically detected hypoechoic areas were sampled. [3,4] In 1995, Stamey et al. [5] suggested that biopsy should be obtained from a more lateral location to better sample the anterior horn of the peripheral zone. Similarly, Norberg et al. [6] noticed that the second set of sextant biopsies performed immediately after the first set increased the PCa detection rate by as much as 30%. These findings prompted investigators to seek alternative biopsy schemes with an increased number of biopsy cores and/or sampling of the lateral peripheral zones for improved PCa detection. [7][8][9][10][11][12][13][14][15] Mc Neal et al. [16] provided the ground for better sampling of peripheral zones with special attention to the anterior horn. These modifications related to the total number of cores and the localization of biopsies improved the PCa detection rate. Extended biopsy schemeUzzo et al. [17] and Karakiewcz et al. [18] were the first to demonstrate an increase in the PCa detection rate in proportion to the number of biopsy cores obtained. Their findings provided the foundation for extended PBx where at least 10 cores are taken. Chen et al. [19] examined various biopsy schemes to define the approach associated with the highest PCa detection rate. They suggested that...

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Initial Extended Transrectal Prostate Biopsy—Are More Prostate Cancers Detected With 18 Cores Than With 12 Cores?

Abstract: Compared with 12-core prostate biopsy, 18-core prostate biopsy detects significantly more cases of high grade prostatic intraepithelial neoplasia. However, 18-core prostate biopsy detects a significantly higher number of cancer only in patients with a prostate volume of 55 cc or greater.

Cited by 63 publications

References 20 publications

Longer biopsy cores do not increase prostate cancer detection rate: A large-scale cohort study refuting cut-off values indicated in the literature

Longer biopsy cores do not increase prostate cancer detection rate: A large-scale cohort study refuting cut-off values indicated in the literature

Development and external validation of a nomogram for predicting cancer probability at initial prostate biopsy using the life expectancy- and prostate volume-adjusted biopsy scheme

When prostate cancer remains undetectable: The dilemma

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