Extended 21-Sample Needle Biopsy Protocol for Diagnosis of Prostate Cancer in 1000 Consecutive Patients

The purpose of this study is to report our method in detecting prostate cancer (PCa) using an 18-core transrectal ultrasound (TRUS) prostate biopsy (PB) schema, in combination with additional targeted cores from suspicious images in conventional (e-cMRI) and functional (e-fMRI) endorectal magnetic resonance imaging (e-MRI) of the prostate. From 2004 to 2008, 260 consecutive patients with a clinical suspicion of PCa underwent PB and were prospectively studied. e-cMRI and e-fMRI was performed in all patients before PB. The patients were divided into two groups (A and B) according to the results of their radiological findings (group A ¼ suspicious findings, group B ¼ non-suspicious findings). After the images were processed, an 18-core TRUS-guided PB was performed. When a patient exhibited a suspicious site on e-cMRI and e-fMRI images, three additional targeted PBs were obtained from that site. In group A, 17.5% of PCa was detected by the 18-core PB and 56.5% of PCa was detected by the targeted cores. The overall PCa detection rate (18 þ targeted cores) was 73.9%. The overall specificity was 73.9%. In group B, overall false-positive detection rate reached 19.2%, with the overall sensitivity being 80.8%. The method described above is not only practical but also a promising modality in PCa detection. As seen, PCa was optimally detected when combining the 18-core and targeted-core PB schema together. Non-suspicious images do not rule out the probability of PCa, thus justifying a PB in these patients as well.

Section: Discussionmentioning

confidence: 99%

Prostate cancer detection using an extended prostate biopsy schema in combination with additional targeted cores from suspicious images in conventional and functional endorectal magnetic resonance imaging of the prostate

Engelhard

Zugor

et al. 2009

“…Likewise, sextant prostate biopsy scheme under TRUS guidance has been used as the standard biopsy procedure at most centres after it was described by Hodge et al, 2 Sixteen gauge needles in prostate biopsies GH Inal et al sensitivity issues have been reported. [3][4][5][6][7][16][17][18] The debate has been going on since then, and various well designed studies have been constructed in an effort to increase the sensitivity of TRUS-guided biopsies without increasing the morbidity and patient discomfort. At present, it is well known that standard six-core biopsy technique involving six para-sagittal mid-lobar biopsy cores is not sufficient in terms of sensitivity and specificity and that it misses up to 35% of the present cancers.…”

Section: Discussionmentioning

confidence: 99%

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

Inal

Öztekin

Uğurlu

et al. 2008

Performance of 16 (16 g) (n ¼ 103) and 18 gauge (18 g) (n ¼ 101) biopsy needles in transrectal ultrasound (TRUS)-guided 10-core prostate biopsies were compared in terms of cancer detection and pre-defined specimen quality criteria in this prospective randomized study. Cancer detection rates of the two groups were similar, although the mean core volume of 16 g needles was almost twice that of 18 g needles. On the other hand, using 16 g needles significantly improved specimen quality by acquiring less empty cores, small cores and fragmented cores. There were no significant differences among the complication rates and VAS pain scores of the two groups. Sixteen gauge needles can safely be used in TRUS-guided prostate biopsies, as they improve specimen quality without increasing morbidity and patient discomfort.

“…Recent studies also validated the 10-12-core biopsy method. 21,22 Eichler et al 22 performed a meta-analysis to study the diagnostic accuracy of extended biopsy, and found that 12 cores with additional cores lateral to the standard sextant cores detected 31% more cancers. The authors did not find an additive effect of 18-24-core biopsy for cancer detection.…”

Section: Discussionmentioning

confidence: 99%

Development and external validation of a nomogram for predicting cancer probability at initial prostate biopsy using the life expectancy- and prostate volume-adjusted biopsy scheme

Nomura

Ito

Miyakubo

et al. 2011

BACKGROUND:We previously reported the diagnostic efficacy of the age-and prostate volume-adjusted prostate biopsy method (the adjusted biopsy method). Here, we developed a new nomogram for predicting cancer probability at initial biopsy using the adjusted method. METHODS:Between 2002 and 2010, 1059 Japanese men with PSA levels between 1.1 and 40 ng ml À1 and biopsied for the first time using the adjusted method at Gunma University Hospital were enrolled. All subjects underwent digital rectal examination (DRE) and transrectal ultrasonography (TRUS). Data from the initial 849 subjects were used for development of the nomogram and those from the final 210 subjects were used for internal validation. External validation was conducted using data from two affiliated hospitals where the same adjusted biopsy method was used. The nomogram was developed through logistic regression analysis, and predictive accuracy and performance characteristics were assessed using the area under the curve (AUC) of the receiver operating characteristics and calibration plots. Furthermore, we compared the predictive accuracy of the newly developed nomogram with the 'Prostate Risk Indicator' using the development data set, as well as the two external data sets. RESULTS:The AUC of the logistic regression-based nomogram was significantly higher than those of any single clinical parameter. External validation showed significant correlations with the present model. The AUC-receiver operating characteristic of the 'Prostate Risk Indicator' was the second largest following the new nomogram using the development data set and one external data set and almost equal to the new nomogram using the other external data set.CONCLUSIONS: Nevertheless the present model does not include somewhat subjective findings on TRUS abnormality, which is necessary for the estimation by 'Prostate Risk Indicator', the predictive accuracy of the present simple nomogram could be excellent enough to contribute to accurate shared decision-making between doctors and men who are candidates for the adjusted biopsy scheme.