Systematic 5 Region Prostate Biopsy is Superior to Sextant Method for Diagnosing Carcinoma of the Prostate

Eskew, L. Andrew; Bare, Ricky L.; McCullough, David L.

doi:10.1097/00005392-199701000-00059

Cited by 165 publications

(216 citation statements)

References 9 publications

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“…For the 493 men who underwent biopsy, this equates to a 6% increase in the rate of cancer detection from 27% (sextant only, 133/493) to 33% (extended biopsies, 164/493). This ®nding is in general agreement with other published extended biopsy protocols [7,21,22]. Although the present sampling technique may have differed from those in other reports, it is clear that prostate cancer detection can be signi®cantly improved by taking more biopsies (within reason) and sampling regions of the prostate not incorporated in the routine sextant protocol.…”

Section: Discussionsupporting

confidence: 90%

“…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: 55%

“…We have not prospectively compared complication rates for six vs 12 biopsies but others have reported no signi®cant increase in pain or serious morbidity when men undergoing 12 biopsies were compared with men undergoing routine sextant biopsies [27]. In another study of 119 men undergoing a ®ve-region extended-core biopsy protocol, no serious complications were reported, although 80% of patients reported self-limiting haematuria [7]. Extensive sampling of the prostate may result in acute urinary retention caused by transient prostatic oedema precipitating BOO.…”

Section: Discussionmentioning

confidence: 95%

“…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%

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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: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 95%

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

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%

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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Prospective study of correlations between biopsy-detected high grade prostatic intraepithelial neoplasia, serum prostate specific antigen concentration, and race

Fowler

Bigler

Lynch

et al. 2001

Cancer

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Systematic 5 Region Prostate Biopsy is Superior to Sextant Method for Diagnosing Carcinoma of the Prostate

Cited by 165 publications

References 9 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

Prospective study of correlations between biopsy-detected high grade prostatic intraepithelial neoplasia, serum prostate specific antigen concentration, and race

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