Incidence and Clinical Significance of False-Negative Sextant Prostate Biopsies

Abstract

Our findings suggest that this 23% incidence of false-negative biopsies represents significant cancer. This relatively high incidence is important to consider in treatment modalities in which prostate biopsy may be performed to determine response to therapy.

What kind of prostate cancers do we miss on multiparametric magnetic resonance imaging?

“…In our study group 332 patients (40.0 %) treated with radiation therapy were included although the diagnosis in these patients relies solely on prostate biopsy. About 20 % of these patients treated for a LG or IG PrCa might have harboured HG PrCa that remained undetected [34]. Third, the mpMRI techniques used in our study (T2-WI, DWI and MRSI, without DCE) are a reflection of the technical evolution during the inclusion period (2002−2014) and differ slightly from the mpMRI protocol that we currently use.…”

Image-based clinical decision support for transrectal ultrasound in the diagnosis of prostate cancer: comparison of multiple logistic regression, artificial neural network, and support vector machine

“…Although the TRUS-guided prostate needle biopsy remains the gold standard for diagnosis of prostate cancer, the accuracy of the biopsy is limited. According to Rabbani et al, in the case of a sextant biopsy, 23% of all tumors are not diagnosed [52].…”

Clinical outcome of transrectal ultrasound-guided prostate biopsy, targeting eight cores, for detecting prostate cancer in Japanese men

“…However, most recent studies have suggested that biopsy of alternative areas of the prostate, such as the TZ and the ALH, may increase the rate of prostate cancer detection. [4][5][6]8,14 For example, Eskew et al 14 15 reported, in their prospective study, that the cancer detection rates with 6-core and 12-core biopsy regimens were almost identical (26% and 27%). Moreover, to our knowledge, there seem to be few studies evaluating the significance of sampling in addition to the standard sextant biopsy in a large series of Japanese men.…”

“…10,17 However, of the 101 patients diagnosed as having prostate cancer, 11 had a positive core only in the ALH; that is, the increase in the cancer detection rate yielded by obtaining two extra cores from the ALHs was 10.9%, showing less impact of additional sampling on the cancer detection rate than that described in recently reported studies. [4][5][6]8,14 Possible explanations for this discrepancy are as follows. (1) Two additional cores may not be enough to affect the cancer detection rate, due to the small size of the tumors currently detected in the PSA screening era.…”

“…3 However, several investigators have reported that a standard sextant biopsy result may underestimate the presence of malignant lesions, based on the false-negative rates of standard sextant biopsy ranging as high as 10% to 34%. [4][5][6] To further increase the accuracy of prostate cancer detection, several groups have evaluated more extensive systematic sampling of the lateral lesions of the PZ. [7][8][9] Recently, Chen et al 10 performed a computer simulation analysis of systematic biopsy based on the reconstruction of 180 radical prostatectomy specimens, and they recommended obtaining a new series of 11 cores, including the conventional sextant, two transition zone (TZ), one midline, and two anterior lateral horn (ALH) biopsies.…”