The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer

Sixteen gauge needles improve specimen quality but not cancer detection rate in transrectal ultrasound-guided 10-core prostate biopsies

“…The sextant technique has been thoroughly evaluated in years and was shown to miss a relatively higher number of cancers, causing a significant sampling error. 3 The sensitivity could be improved by increasing the amount of sampled tissue, which in turn could be done either by increasing the number of cores or the amount of tissue per core, and by improving the quality of the biopsy specimens. [4][5][6][7][8][9][10] For the last few years, although sextant biopsy scheme is still used by some centres, at least 10-12 core biopsies have been recommended and are being performed by most urologists.…”

“…10,12,13 Both 16 gauge (16 g) and 18 gauge (18 g) needles work with side-notch technique. Although the core lengths of the two needles are the same (17 mm), owing to the difference in the diameters of the two needles, the core volume of an 18 g needle is 12.18 mm 3 , whereas that of a 16 g needle is 20.25 mm 3 , which means a 75% theoretical increase in core volume.…”

MR spectroscopic imaging and diffusion‐weighted imaging of prostate cancer with Gleason scores

“…To date, the suspicion of PCa is mainly based on elevated serum prostate-specific antigen (PSA) or abnormal digital rectal examination (DRE) of the prostate, both with well-known limitations (2,3). Systematic but untargeted transrectal ultrasound (TRUS)-guided biopsy is the standard method for histological diagnosis of PCa (4). However, untargeted systematic biopsies have several disadvantages: they miss cancer in up to 35% of cases (4), multiple foci of cancer are present in more than 85% of cases of PCa (5), and complications may occur because of unnecessary biopsies.…”

“…Systematic but untargeted transrectal ultrasound (TRUS)-guided biopsy is the standard method for histological diagnosis of PCa (4). However, untargeted systematic biopsies have several disadvantages: they miss cancer in up to 35% of cases (4), multiple foci of cancer are present in more than 85% of cases of PCa (5), and complications may occur because of unnecessary biopsies. Therefore, a noninvasive diagnostic method would clearly be beneficial.…”

Prostate cancer detection by TURP after repeated negative saturation biopsy in patients with persistent suspicion of cancer: a case–control study on 75 consecutive patients

“…Transrectal ultrasound-guided sextant prostate biopsy, proposed by Hodge et al 5 in 1989, was considered the gold standard in diagnosing PCa until it was shown that about 15-20% of clinical significant cancers were missed, 6 leading to the necessity of repeating several biopsy sets in a consistent number of patients. Until now, an extended transrectal ultrasound-guided biopsy scheme with an increased number of cores on the peripheral portion and on the lateral margins of the gland is the only suitable method to improve the detection rate of PCa; 7 however, the SPBx (that is, X24 cores) does not improve cancer detection rate in comparison with 12 or 18 cores biopsy as an initial prostate biopsy strategy.…”