The Optimal Systematic Prostate Biopsy Scheme Should Include 8 Rather Than 6 Biopsies: Results of a Prospective Clinical Trial

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

doi:10.1016/s0022-5347(05)67995-5

Cited by 430 publications

(248 citation statements)

References 10 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%

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%

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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“…2,15 In contrast, minor complications are frequent, with 60-79%. 5,16 Most of these complications do not require any intervention and are selflimiting. However, it is essential to have a clear understanding of the true morbidity of this procedure to counsel the patient accordingly.…”

Section: Discussionmentioning

confidence: 99%

“…In the face of low morbidity, the TRUS-PB is performed as an outpatient procedure. 2,[5][6][7] Although the incidence of major complications associated with TRUS-BP is low, minor complications such as urinary tract infection, dysuria, hematuria and hemospermia are frequent. 2,6 Although many studies have reported the incidence of complications, they were not specifically designed to evaluate the true complication rate and its implications.…”

Section: Introductionmentioning

confidence: 99%

Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study

Manoharan

Ayyathurai

Nieder

et al. 2007

Prostate Cancer Prostatic Dis

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Hemospermia is known to be associated with transrectal ultrasound-guided prostate biopsy (TRUS-PB). The true incidence of hemospermia, its duration and implications are not well established. We performed a prospective observational study involving patients undergoing TRUS-PB for suspected prostate cancer at our institution. Sixty-three eligible men were included in the study. Most men (84%) undergoing TRUS-PB, who were able to ejaculate, experienced hemospermia, which was associated with some degree of anxiety. The mean duration of hemospermia was 3.5 (71.7) weeks. The number of ejaculations before the complete resolution of hemospermia was 8 (76.7). None of the clinical and pathological factors was a significant predictor of the duration of hemospermia. Patients should be adequately counseled before TRUS-PB to avoid undue anxiety and alterations in sexual activity.

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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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The Optimal Systematic Prostate Biopsy Scheme Should Include 8 Rather Than 6 Biopsies: Results of a Prospective Clinical Trial

Abstract: The 6 systematic biopsies of the peripheral zone are inadequate and a minimum of 8, including the apex, mid lobar mid gland, lateral mid gland and lateral base, should routinely be performed.

Cited by 430 publications

References 10 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

Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study

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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