Additional Mid-Peripheral Biopsies to the Systematic Lateral-Peripheral Sextant Biopsy Provides an Improvement in Prostate Cancer Detection in Japanese Men

Abstract

The aims of this study were to evaluate 1) in transrectal biopsy, whether additional 4-core biopsies of the mid-peripheral region after lateral-peripheral sextant biopsy in the peripheral zone can improve the prostate cancer detection rate, and 2) the preventive role of flomoxef sodium and levofloxacin against infectious complications. Material and Methods: We retrospectively analyzed the records of 1541 patients who underwent initial transrectal ultrasound guided prostate biopsies at our hospital between January 2003 and November 2016. Two hundred and fifty-one patients underwent sextant prostate biopsy and 1290 underwent 10-core biopsy. The cancer detection rates of these two methods were analyzed. Since April 2009, a single-dose of flomoxef sodium (500 mg) has been injected immediately before the 10-core biopsy in addition to levofloxacin for antimicrobial prophylaxis. The infectious complication rate among biopsied patients with or without flomoxef sodium was also evaluated. Results:The additional 4-cores biopsies significantly increased the cancer detection rate compared with sextant biopsy, especially in a subgroup of patients with a serum prostate specific antigen level of 4.0-10.0 ng/ml (38.5% vs 28.7%, p=0.032) without increasing the rate of clinically insignificant cancer (5.2% vs 7.5%, p=0.367). Moreover, the incidence rate of acute prostatitis in 10-core-biopsied patients who were administered flomoxef sodium in addition to levofloxacin was significantly lower than in those administered levofloxacin alone (0.4% vs 4.6%, p<0.0001). Conclusions:The additional 4-core biopsies significantly increased the cancer detection rate compared with sextant biopsy without increasing the rate of clinically insignificant cancer. Moreover, flomoxef sodium together with levofloxacin may have preventive effects against infectious complications.