Optimal Combinations of Systematic Sextant and Laterally Directed Biopsies for the Detection of Prostate Cancer

Gore, John L.; Shariat, Shahrokh F.; Miles, Brian J.; Kadmon, Dov; Jiang, Ning; Slawin, Kevin M.

doi:10.1097/00005392-200105000-00034

Cited by 43 publications

(52 citation statements)

References 16 publications

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“…Gore et al, in their well-designed study, compared classic sextant biopsies to 8-, 10-and 12-core biopsies with different location combinations of the added cores. 20 They demonstrated that two different strategies, both including 10 biopsy cores, caught 95.6 and 98.5% of cancers and are better than 6 or 8, but not worse than 12-core biopsies independent from Vp and PSA level, stating that 10-core biopsies strategy taken in either sets of locations are reasonable schemes with sufficient gland covering and cancer rates. On the basis of evident data and our own experiences, 10-core scheme has been the choice for prostate biopsies in our institution for over 5 years.…”

Section: Discussionmentioning

confidence: 95%

“…It has clearly been shown that added number of cores over the sextant scheme significantly improves cancer detection and that studies with 8, 10, 12 and even 21 cores and with regional biopsy techniques have been published, all demonstrating superior cancer detection rates when compared to sextant biopsies. [4][5][6]19,20 As the spirit is to achieve the highest cancer detection with minimal possible number of cores, there should be a limit. Gore et al, in their well-designed study, compared classic sextant biopsies to 8-, 10-and 12-core biopsies with different location combinations of the added cores.…”

Section: Discussionmentioning

confidence: 99%

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Sixteen gauge needles improve specimen quality but not cancer detection rate in transrectal ultrasound-guided 10-core prostate biopsies

Inal

Öztekin

Uğurlu

et al. 2008

Prostate Cancer Prostatic Dis

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Performance of 16 (16 g) (n ¼ 103) and 18 gauge (18 g) (n ¼ 101) biopsy needles in transrectal ultrasound (TRUS)-guided 10-core prostate biopsies were compared in terms of cancer detection and pre-defined specimen quality criteria in this prospective randomized study. Cancer detection rates of the two groups were similar, although the mean core volume of 16 g needles was almost twice that of 18 g needles. On the other hand, using 16 g needles significantly improved specimen quality by acquiring less empty cores, small cores and fragmented cores. There were no significant differences among the complication rates and VAS pain scores of the two groups. Sixteen gauge needles can safely be used in TRUS-guided prostate biopsies, as they improve specimen quality without increasing morbidity and patient discomfort.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Sixteen gauge needles improve specimen quality but not cancer detection rate in transrectal ultrasound-guided 10-core prostate biopsies

Inal

Öztekin

Uğurlu

et al. 2008

Prostate Cancer Prostatic Dis

View full text Add to dashboard Cite

show abstract

“…5,6 Although the application of extended laterally based biopsy techniques has improved the cancer detection rate for TRUS biopsies, a false negative rate of 17-21.2% has been reported even with systematic 12 core biopsy techniques. 7,8 Identification of clinical and histopathologic parameters which are associated with the diagnosis of pCA, therefore, is critical to help determine which patients require a repeat biopsy.…”

Section: Discussionmentioning

confidence: 99%

Intraluminal crystalloids are highly associated with prostatic adenocarcinoma on concurrent biopsy specimens

Svatek

Karam

Rogers

et al. 2007

Prostate Cancer Prostatic Dis

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Prostatic crystalloids are intraluminal eosinophilic structures with variable size and shape. Their presence has been described in conjunction with the occurrence of prostatic adenocarcinoma (pCA). We herein report the association of crystalloids and pCA in a prospective trial utilizing an extended multi-site transrectal ultrasound-guided (TRUS) prostate biopsy protocol. Three hundred and fortyfour consecutive patients were prospectively enrolled at the Dallas Veterans Administration Hospital from November 2002 to September 2003. Indications for biopsy included a prostatespecific antigen (PSA) X4 ng/ml and/or abnormal digital rectal exam. A single pathologist evaluated all biopsy cores and documented the presence or absence of significant histopathologic features. Univariate and multivariate logistic regression analysis were applied to test the association of these features with the presence of pCA on concurrent biopsy. Median number of core biopsies per patient was 12 (range 3-36). Overall cancer detection rate was 42.7%. pCA was diagnosed in 66 (81.5%) of 81 patients with crystalloids, 70 (69.3%) of 101 patients with high-grade prostatic intraepithelial neoplasia (HGPIN), and 32 (84.2%) of 38 patients with both HGPIN and crystalloids on biopsy. Multivariate analysis identified crystalloids (RR 4.53, 95% CI 2.30-8.88) and HGPIN (RR 3.20, 95% CI 1.84-5.57) as independent predictors of the presence of cancer on concurrent biopsy (Po0.001). In this prospective analysis, crystalloids were significantly associated with pCA on concurrent biopsy and more predictive of the presence of pCA than HGPIN. These findings suggest that the presence of crystalloids alone or in combination with HGPIN in prostate biopsies may be a more compelling indication for repeat biopsy than HGPIN alone.

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“…Recent studies found that extended biopsy schemes result in an increased detection rate for prostate carcinoma and, specifically, that biopsy locations outside of the standard sextant location are more likely to be positive. 17,18 Therefore, we examined data separately for men who underwent sextant biopsies and men who had Ͼ 6 cores obtained. We found that the ability of the percentage of cores positive from the dominant side to predict PSA failure was similar, whether it was examined among men who underwent sextant biopsy or men who underwent an extended biopsy scheme, and was superior to the total percentage of cores for both subsets.…”

Section: Discussionmentioning

confidence: 99%

The percentage of prostate needle biopsy cores with carcinoma from the more involved side of the biopsy as a predictor of prostate specific antigen recurrence after radical prostatectomy

Freedland

Aronson

Terris

et al. 2003

Cancer

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BACKGROUNDThe authors previously found that, although the total percentage of prostate needle biopsy cores with carcinoma was a significant predictor of prostate specific antigen (PSA) failure among men undergoing radical prostatectomy (RP), there was a trend toward a lower risk of recurrence in patients with positive bilateral biopsies, suggesting that high‐volume, unilateral disease was a worse predictor of outcome than an equivalent number of positive cores distributed over two lobes. In the current study, the authors sought to compare the total percentage of cores with carcinoma directly with the percentage of cores from the more involved or dominant side of the prostate with carcinoma for their ability to predict outcome among men who underwent RP.METHODSA retrospective survey of 535 patients from the Shared Equal Access Regional Cancer Hospital database who underwent RP at 4 different equal‐access medical centers between 1988 and 2002 was undertaken. The total percentage of cores positive was compared with the percentage of cores positive from the dominant and nondominant sides for their ability to predict biochemical recurrence after RP. The best predictor then was compared with the standard clinical variables PSA, biopsy Gleason score, and clinical stage in terms of ability to predict time to PSA recurrence after RP using multivariate analysis.RESULTSThe adverse pathologic features of positive surgical margins and extracapsular extension were significantly more likely to be ipsilateral to the dominant side on the prostate biopsy. The percentage of cores positive from the dominant side provided slightly better prediction (concordance index [C] = 0.636) for PSA failure than the total percentage of cores positive (C = 0.596) and markedly better than the percentage of cores from the nondominant side (C = 0.509). Cutoff points for percentage of cores positive from the dominant side were identified (< 34%, 34–67%, and > 67%) that provided significant risk stratification for PSA failure (P < 0.001). On multivariate analysis, the percentage of cores positive from the dominant side was the strongest independent predictor of PSA recurrence (P < 0.001). Biopsy Gleason score (P = 0.017) also was a significant, independent predictor of recurrence. There was a trend, which did not reach statistical significance, toward an association between greater PSA values and biochemical failure (P = 0.052). Combining the PSA level, biopsy Gleason score, and percentage of cores positive from the dominant side of the prostate resulted in a model that provided a high degree of prediction for PSA failure (C = 0.671).CONCLUSIONSThe percentage of cores positive from the dominant side of the prostate was a slightly better predictor of PSA recurrence than was the total percentage of cores positive. Using the percentage of cores from the dominant side along with the PSA level and the biopsy Gleason score provided significant risk stratification for PSA failure. Cancer 2003. Published 2003 by the American Cancer Society.

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Optimal Combinations of Systematic Sextant and Laterally Directed Biopsies for the Detection of Prostate Cancer

Cited by 43 publications

References 16 publications

Sixteen gauge needles improve specimen quality but not cancer detection rate in transrectal ultrasound-guided 10-core prostate biopsies

Sixteen gauge needles improve specimen quality but not cancer detection rate in transrectal ultrasound-guided 10-core prostate biopsies

Intraluminal crystalloids are highly associated with prostatic adenocarcinoma on concurrent biopsy specimens

The percentage of prostate needle biopsy cores with carcinoma from the more involved side of the biopsy as a predictor of prostate specific antigen recurrence after radical prostatectomy

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