Prospective Evaluation of Lateral Biopsies of the Peripheral Zone for Prostate Cancer Detection

Chang, James J.; Shinohara, Katsuto; Bhargava, Vivek; Presti, Joseph C.

doi:10.1097/00005392-199812010-00044

Cited by 69 publications

(95 citation statements)

References 8 publications

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“…Initially we were surprised at the relatively few additional tumours detected by lateral PZ biopsies, as many groups have reported a signi®cant improvement in cancer detection rates with this technique [7,8,21]. However, the present detection rate of an additional 6% of tumours con®ned exclusively to the lateral PZ compares favourably with Ravery et al [23], who noted a 6.6% overall improvement in prostate cancer detection with the addition of 4 ±6 lateral PZ biopsies, depending on prostate volume.…”

Section: Discussioncontrasting

confidence: 53%

“…The TZ biopsies were taken at the level of the mid-gland where the TZ was most prominent. The lateral PZ biopsies were taken by positioning the probe just medial to the lateral edge of the prostate at the base and mid-gland regions bilaterally, as described by Chang et al [8]. This method generally allowed any area of DRE abnormality or suspicious hypoechoic lesion noted on TRUS to be incorporated into the biopsy protocol.…”

Section: Methodsmentioning

confidence: 99%

“…To improve PZ sampling it has been proposed that needle placement for systematic biopsies be directed more laterally [6], so that the biopsy tract traverses more of the PZ and encompasses the lateral PZ. In prospective studies, the addition of lateral PZ biopsies to the standard sextant protocol detected an additional 14 ±31% of cancers that would have remained undetected by the sextant method alone [7,8]. The combination of sextant and lateral PZ biopsies signi®cantly increased cancer detection while almost eliminating the need for lesion-directed biopsies [8].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Improving prostate cancer detection with an extended-core transrectal ultrasonography-guided prostate biopsy protocol

Durkan¹,

Sheikh²,

Johnson³

et al. 2002

BJU Int

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Objective To investigate whether taking two transition zone (TZ) and four lateral peripheral zone (PZ) biopsies in addition to routine parasaggital sextant biopsies would improve detection rates in men with suspected prostate cancer. Patients and methods The study included 493 consecutive men (mean age 68.7 years, SD 8.2) with elevated serum prostate-speci®c antigen (PSA) levels and/or abnormal ®ndings on a digital rectal examination who underwent transrectal ultrasonography-guided prostate biopsy. In addition to sextant biopsies, six further biopsies were obtained, two from the TZ (mid-gland) and four from the lateral PZ (base and mid-gland).Pathological ®ndings for the additional biopsies were compared with those of the sextant regions. Results Prostatic adenocarcinoma was diagnosed in 164 of the 493 (33%) men biopsied. Men with cancer were older, had smaller prostates and higher median PSA levels than men with negative biopsies. Sextant biopsies were positive for cancer in 133 of 164 (81%) men. All three sets of biopsies were positive in 53 (32%) cases. In 50 (30%) men both the sextant and lateral PZ biopsies were positive, while in six (4%) men, both sextant and TZ biopsies were positive. Thirty-one (19%) tumours were not detected by sextant biopsies, 10 (6%) where the lateral PZ biopsies alone were positive, 17 (10%) where the TZ biopsies alone were positive and four (3%) where both the TZ and lateral PZ together were positive. There were no differences in median PSA concentration, total prostate volume or TZ volume between men with an isolated TZ cancer and men with cancer elsewhere in the prostate. However, 77% of men with TZ cancer had a PSA of >10 ng/mL, compared with 60% of men with cancer at other sites within the prostate (P=0.015). Conclusion An extended-core biopsy protocol signi®cantly improves the detection rate for prostate cancer when compared with the standard sextant biopsy protocol alone. Routine TZ biopsies should be considered for men with serum PSA levels of >10 ng/mL.

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Section: Discussioncontrasting

confidence: 53%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improving prostate cancer detection with an extended-core transrectal ultrasonography-guided prostate biopsy protocol

Durkan¹,

Sheikh²,

Johnson³

et al. 2002

BJU Int

View full text Add to dashboard Cite

show abstract

“…6 Several groups have since demonstrated that complementing the sextant format with further biopsies will optimize cancer detection rates without increasing morbidity. [7][8][9][10] Regardless of the increased number of biopsies that are obtained, detection rates are still typically only 30-44%. 7,9 In the remaining patients the question is whether the elevated PSA is due to other causes vs cancer that went undetected.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] Regardless of the increased number of biopsies that are obtained, detection rates are still typically only 30-44%. 7,9 In the remaining patients the question is whether the elevated PSA is due to other causes vs cancer that went undetected. It is in these patients that a quandary exists as to how and when to perform further evaluations.…”

Section: Introductionmentioning

confidence: 99%

Determining variables for repeat prostate biopsy

Busby

Evans

2004

Prostate Cancer Prostatic Dis

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During the evaluation of prostate cancer, men who have undergone transrectal ultrasound-guided biopsy with negative results present a dilemma as to what further follow-up is required. Multiple variables have been proposed throughout the literature to improve cancer detection rates not only in initial biopsy results, but also on repeat evaluation. These variables include prostate-specific antigen (PSA) velocity, PSA density, free-percent PSA, and histological findings, each of which may singly or collectively dictate the need for further biopsy. After performing a Medline literature search using specific Medical Subject Headings (prostate biopsy, repeat prostate biopsy, PSA velocity, PSA density, free-percent PSA, prostate inflammation), we critically evaluated pertinent articles. Using this accumulated data and information, we composed an algorithm to assist in the decision process for repeat biopsy.

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A new stretch for Gor‐Tex™

Mullins

2010

Cathet Cardio Intervent

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This study demonstrates the capability of over expanding the nominal diameter of stretch Gor-Tex TM (PTFE) tubular vascular grafts used for systemic to pulmonary shunts in infants. Until this article, most interest and published work on re-expansion of thin walled GorTex TM in the congenital population concerned large stents covered with Gor-Tex TM in the setting of larger vessels (aorta or ''Fontan'' channels) and the ability to expand these covered stents to an even larger diameter after several or more years to accommodate the growth of a patient. Likewise, previous information on the dilation of shunts was concerned with the relief of acquired stenosis within those shunts.The in vitro bench testing in this study documented that by implanting an intravascular stent mounted on a balloon, which is larger in diameter than the graft, the native Gor-Tex TM tubular grafts could be stretched in diameter up to 40 to 45% larger than the nominal diameter of the graft.The investigators also documented, the safety of the ''over dilation'' by demonstrating that even when high pressure (up to 18 Atms), larger balloons (balloons larger than the nominal diameter plus the 40-45% expected stretched diameter) were used, the grafts still only reached the maximum increase of 40-45% over their nominal diameter. Of even greater importance, while the oversized balloons did not increase the diameter of the grafts any more than the 40-45%, the significant over dilation of tubular grafts did not tear or split the grafts.Clinically, the over-dilation of the graft technique was used in 10 young patients. A total of 14 stents were placed in 11 Gor-Tex TM grafts. All stent dilation/ implants increased the diameter to 1 mm greater than the nominal diameter of the graft and produced an increased flow to the pulmonary bed with a concomitant increase in systemic saturations in all patients. Five of ten patients maintained enough clinical improvement to survive for as long as 6 months and up to 5 years after the tube graft over expansion, which in turn allowed them to undergo more definitive surgery without any other intervening intervention. Within 10.2 months after the initial over expansion of their grafts, four patients did deteriorate clinically with three of four grafts requiring re-stenting and one, an angioplasty of the previously stented tubular graft.In addition to the encouraging new information from the study, the authors supplied a plethora of valuable technical advice, not the least of which was that the procedure really required two pairs of knowledgeable hands to accomplish the complex manipulations in traversing the circuitous anatomy to the orifice of a shunt and safely dilating and implanting the stent accurately into the graft.The results from the in vitro study, along with the small clinical series of patients suggest that the use of a Gor-Tex TM tubular grafts are preferable to a classic native subclavian to pulmonary artery shunt in small infants as the ability to safely over dilate the GorTex TM tubular grafts allows a re...

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Prospective Evaluation of Lateral Biopsies of the Peripheral Zone for Prostate Cancer Detection

Abstract: The addition of lateral peripheral zone biopsies increases the sensitivity for cancer detection while nearly eliminating the need for lesion directed biopsies.

Cited by 69 publications

References 8 publications

Improving prostate cancer detection with an extended-core transrectal ultrasonography-guided prostate biopsy protocol

Improving prostate cancer detection with an extended-core transrectal ultrasonography-guided prostate biopsy protocol

Determining variables for repeat prostate biopsy

A new stretch for Gor‐Tex™

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