Contemporary outcomes in the detection of prostate cancer using transrectal ultrasound-guided 12-core biopsy in Singaporean men with elevated prostate specific antigen and/or abnormal digital rectal examination

Abstract

ObjectiveDespite being the third commonest cancer in Singaporean men, there is a dearth of basic data on the detection rate of prostate cancer and post-procedure complication rates locally using systematic 12-core biopsy. Our objective is to evaluate prostate cancer detection rates using 12-core prostate biopsy based on serum prostate specific antigen (PSA) levels and digital rectal examination (DRE) findings in Singaporean men presenting to a single tertiary centre. The secondary objective is to evaluate the complication rates of transrectal prostate biopsies.MethodsWe retrospectively examined 804 men who underwent first transrectal-ultrasound (TRUS) guided 12-core prostate biopsies from January 2012 to April 2014. Prostate biopsies were performed on men presenting to a tertiary institution when their PSA levels were ≥4.0 ng/mL and/or when they had suspicious DRE findings.ResultsOverall prostate cancer detection rate was 35.1%. Regardless of DRE findings, patients were divided into four subgroups based on their serum PSA levels: 0–3.99 ng/mL, 4.00–9.99 ng/mL, 10.00–19.99 ng/mL and ≥20.00 ng/mL and their detection rates were 9.5%, 20.9%, 38.4% and 72.3%, respectively. The detection rate of cancer based on suspicious DRE findings alone was 59.2% compared to 36.5% based on serum PSA cut-off of 4.0 ng/mL alone. The post-biopsy admission rate for sepsis was 1.5%.ConclusionIn conclusion, using contemporary 12-core biopsy methods, the local prostate cancer detection rate based on serum PSA and DRE findings has increased over the past decade presumably due to multiple genetic and environmental factors. Post-biopsy sepsis remains an important complication worldwide.

Development and external multicenter validation of Chinese Prostate Cancer Consortium prostate cancer risk calculator for initial prostate biopsy

“…According to Prostate Biopsy Collaborative Group, the PCa detection rates of men with PSA of 4 to10 ng/ml in Cleveland Clinic and Durham VA Hospital, were reported to be 40.3% and 43.4%, respectively [5]. Nevertheless, the PCa detection rate of the same group of patients (PSA ¼ 4-10 ng/ml) was lower in Singapore (20.9%) [6] and Japanese [7] (19.7%) men, who underwent mainly extended biopsy in large clinical cohorts. The PCa detection rate of Korean men (19.6%) receiving mainly extended biopsy (75.3% patients underwent extended biopsy) [8] and Chinese men (25.3%) receiving mainly extended biopsy (mean number of cores: 10.4-10.7) [9] was 19.6% and 25.3%, respectively.…”

Detection of clinically significant cancer in the anterior prostate by transperineal biopsy

“…For men with a PSA level of <3 ng/mL, detection of prostate cancer on transrectal biopsy has been described in 9.5-27% [12][13][14][15], and in one study, high-grade cancer was only detected in 2% of patients with a PSA level of <4 ng/mL [16]. For men with a PSA level of 4-10 ng/mL, detection of prostate cancer has been described in 20-27% using transrectal biopsy [15,17,18]. Possible reasons for higher detection rates of cancer in our present TP biopsy study compared to published TRUS biopsy data include a higher number of cores taken and inclusion of other biopsy indications such as abnormal DRE.…”

Outcomes of standard 12-core transrectal ultrasound-guided prostate biopsy in biopsy naive Indian men -single center experience

“…Cancer detection rate was 9.5% (4/42), 20.9% (87/417), 38.4% (66/172), 72.3% (125/173) for PSA levels of <4 ng/mL, 4–9.99 ng/mL, 10–19.99 ng/mL, and >20 ng/mL, respectively. [ 10 ] Yong et al in 2016 presented outcomes of TRUS biopsy in 1022 northern Han Chinese population with an overall cancer detection rate of 42.8% (438/1022). They found cancer detection rate of 30% (21/70), 22.6% (61/270), 36.0% (123/342), 59.1% (146/247), and 93.5% (87/93) for PSA range <4.0, 4.0–10.0, 10.0–20.0, 20.0–100.0, and ≥100.0 ng/mL, respectively.…”