Standard and saturation transrectal prostate biopsy techniques are equally accurate among prostate cancer active surveillance candidates

Abstract

Abbreviations & AcronymsObjectives: To examine the ability of standard and saturation transrectal prostate biopsy techniques to predict appropriate candidates for active surveillance. Methods: Between 2005 and 2007, 500 consecutive patients underwent transrectal ultrasound-guided biopsy by a standard template (12 cores) or saturation template (Ն18 cores, median 27 cores), with subsequent radical prostatectomy. Using the criteria of Gleason score Յ6, clinical stage T1 or T2a, prostate-specific antigen <10 and Յ33% of cores involved, 218 patients were potential candidates for active surveillance. Pathology results from the prostatectomy specimens were used to determine the accuracy of each biopsy technique. Biochemical failure after prostatectomy was evaluated using logistic and Cox proportional hazards regression. Results: A standard biopsy was carried out for 124 patients and saturation biopsy for 94 patients. There was no statistically significant difference between the groups in terms of median age (P = 0.14), preoperative prostate-specific antigen (P = 0.52) and clinical stage (P = 0.23). Similar rates of Gleason score Ն7 at the time of radical prostatectomy were found, with 14% for standard biopsy and 15% for saturation biopsy (P = 0.70). Upstaging was shown in two standard biopsy patients (1.6%) and no saturation biopsy patients (P = 0.62). A multivariate analysis adjusting for prior prostate biopsy, preoperative prostate-specific antigen and clinical stage showed no difference in the rate of upgrading based on biopsy technique (P = 0.26). During follow up, 5-year biochemical failure-free survival estimates were not significantly different (P = 0.11). Conclusions: In men with prostate cancer, standard and saturation transrectal prostate biopsies techniques are equally predictive of candidates for active surveillance.

Predictors of positive surgical margins and their location in Korean men undergoing radical prostatectomy

“…With each additional positive core, there is an increase in the apical extension odds ratio of 1.32 (1.15–1.50, P < 0.001) when the core number is treated as a continuous variable. Some previous studies found that a high number of positive ipsilateral cores increased the likelihood that PSM was present on that side . As for +BM, however, the present data showed no association with positive basal biopsy.…”

Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance?

“…Linder et al [19] found that 214 AS candidates undergoing extended biopsy (124 cases) versus saturation biopsy (94 cases) showed no difference in the rate of upgrading and upstaging at definitive specimen based on biopsy technique (p = 0.26); on the contrary, Abouassaly et al [20] reported a more accurate assessment of the extent and grade of disease in men enrolled in AS protocol using saturation biopsy in when compared to extended biopsy. In addition, the saturation biopsy scheme increases progression to treatment in AS on comparison with extended prostate biopsy (10 cores) [21], thus improving the detection rate of PCa located solely in the anterior zone of the gland (about 10 % of the cases) [22]; on the other hand, no significant difference was detected in upgrading or morbidity between a 24-core template or a template gland based on volume gland with an average of 1 core per cc.…”

Active surveillance for prostate cancer: current evidence and contemporary state of practice

“…20 Median times to treatment ranging from 1.2 to 2.6 years indicate similar findings at other centers, 23,26,28 and additional studies have demonstrated significantly decreased risk of progression over time. 94,95 As other studies have noted, 96 early reclassification is more likely the result of increased sampling rather than true disease progression in the vast majority of cases. Although studies of saturation biopsy prior to AS have produced mixed results, standard rebiopsy within the first year after enrollment has proven to be of high yield in identifying unfavorable disease and should be performed in most cases.…”