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

Abstract

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.

Prostate biopsy quality and patient experience with the novel Forsvall biopsy needle – a randomized controlled non-inferiority trial

“…In two recent retrospective studies of over 2000 biopsies each, the average biopsy length was between 11.3 and 13.3 mm [11,12]. In a study of over 17,000 biopsies the average length was 10.44 ± 2.36 mm [13]. Reis and co-workers found that, among patients undergoing radical prostatectomy, those presenting with underestimated Gleason score had a median core length of 11.4 mm while those with no change in Gleason score had a median core length of 13.7 mm [14].…”