Optimization of Prostatic Biopsy: A Prospective Randomized Trial Comparing the Sextant Biopsy with a 10-Core Biopsy

Abstract

Objective: New prostatic biopsy protocols suggest to increase the core numbers to enhance detection. Additional cores are usually sampled from the lateral part of the p-zone. We direct the sextant biopsy to the most lateral part of the p-zone, therefore we investigated if there is a gain by adding 4 median biopsy cores. Material and Methods: The prospective randomized trial (n = 200) compared our modified sextant biopsy to a 10-core strategy with 2 additional median cores on both sides. Directed biopsies to suspicious areas were allowed in both groups. Morbidity was assessed by a self-administered questionnaire. Results: PC detection was 32% for 6 cores and 40% for 10 cores. Four patients were detected only by median biopsies. Using the binomial distribution table the gain of 4% is statistically significant. There was no statistical difference in morbidity, but a trend towards a higher rate of side effects in the 10-core group. Conclusions: The gain in prostate cancer detection rate by additional median biopsies is low, but statistically significant. There is no difference in morbidity and patient acceptance is high, therefore we favor the 10-core biopsy in our patients.

Side-effects of post-treatment biopsies in prostate cancer patients treated with endocrine therapy alone or combined with radical radiotherapy in the Scandinavian Prostate Cancer Group-7 randomized trial

“…In accordance with reports on prostate biopsy side-effects in previously untreated patients, the incidence of severe sideeffects was low, and not increased if more than eight biopsy cores were taken [8][9][10]23].…”

A randomised controlled trial comparing use of lignocaine periprostatic nerve block alone and combined with diclofenac suppository for patients undergoing transrectal ultrasound (TRUS)‐guided prostate biopsy

“…Although there is no consensus on the ideal number of biopsy cores that should be taken, current practice recommends at least eight core biopsies. The traditional sextant biopsies yielded high false‐negative error rates of 20–30% . Increased numbers of core biopsies up to 14 cores may subject a patient to more discomfort or pain during the procedure.…”

Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound‐guided prostate biopsy: A prospective randomized study

“…were the first to report on TRUS‐guided prostate biopsy in 1989 1 . Initially, the systematic sextant biopsy was the standard procedure but has been reported to have false negative error rates of 20–30%, leading to the adoption of 8‐ or 12‐core methods 13 …”