Optimizing Prostate Cancer Detection: 8 Versus 12-Core Biopsy Protocol

Rosette, Jean J.M.C.H. de la; Wink, Margot H.; Mamoulakis, Charalampos; Wondergem, Niels E.; Kate, Fiebo J. C. ten; Zwinderman, Koos; Reijke, Theo M. de; Wijkstra, Hessel

doi:10.1016/j.juro.2009.06.037

Cited by 39 publications

(15 citation statements)

References 27 publications

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“…They refer to consecutive biopsies (patients) over a predefined period of time, where only 7 of 904 potential ‘candidates' were not included (missing PSA values); biopsies were performed by two comparably experienced urologist and data extraction was double-checked followed by blinded analysis. Under such conditions, crude detection rates of first biopsies with the two protocols (39.0 and 38.9%) were comparable to those reported for ≥12-core first biopsy-sampling schemes [11,12,13]. The fact that we did not include the transition zone even for repeated biopsies could be viewed as a shortcoming.…”

Section: Discussionsupporting

confidence: 68%

Increasing Prostate-Specific Antigen Levels Differently Influence Prostate Cancer Detection Rates of Two Different 12-Core Prostate Biopsy Schemes

Lodeta

Benkö²,

Trkulja³

2013

Urol Int

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Objective: To compare two 12-core transrectal ultrasound-guided prostate biopsy schemes in respect to cancer detection rates. Methods: Retrospective, single-center analysis of consecutive patients (n = 897) who underwent prostate biopsy (S1) with all 12 cores from far lateral areas (n = 269) or prostate biopsy (S2) with 6 cores from parasagittal and 6 from far lateral areas (n = 628). Results: Crude cancer detection rates with S1 and S2 were similar (39.0 and 38.9% for the first biopsy and 29.4 and 31.3% for repeated biopsies, respectively). Abnormal digital rectal exam, lower prostate volume and higher prostate-specific antigen (PSA) levels were independently associated with higher odds of cancer detection. Regarding first biopsies (n = 747), there was significant interaction between biopsy scheme and PSA (p < 0.001). Overall, the adjusted odds of cancer detection were higher with S1 (S1/S2 odds ratio = 2.54, 95% CI: 1.12-5.74), but the S1-S2 relationship was conditional on PSA: odds ratios progressively increased with increasing PSA from 0.64 (95% CI: 0.40-1.02) at PSA 5 ng/ml to 39.1 (95% CI: 2.71-566) at 75 ng/ml. Conclusion: Higher PSA levels increase the probability of cancer detection with 12-core prostate biopsies, but relative efficiency of different procedures appeared conditional on the PSA level. Data suggest that PSA levels should be considered in the choice of prostate biopsy sampling scheme.

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Section: Discussionsupporting

confidence: 68%

Increasing Prostate-Specific Antigen Levels Differently Influence Prostate Cancer Detection Rates of Two Different 12-Core Prostate Biopsy Schemes

Lodeta

Benkö²,

Trkulja³

2013

Urol Int

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“…This is in keeping with published figures, in spite of the fact that there was, on average, double the number of biopsies done in the TRUS group (12 cores) compared to the FG group (6 cores) [14,15]. This finding was contrary to our expectations, as we believed TRUS not only to be sampling the prostate more precisely, but also obtaining double the number of cores.…”

Section: Cancer Detectionsupporting

confidence: 77%

A review of transrectal ultrasound guided prostate biopsies: Is there still a role for finger guided prostate biopsies?

Jehle

Lazarus

Barnes

2015

African Journal of Urology

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Objective: We compared our institution's initial experience with transrectal ultrasound-guided (TRUS) prostate biopsies in a single arm prospective study to a historical cohort of finger guided (FG) biopsies. The primary outcome measure was prostate cancer detection. We documented our findings on TRUS including the findings of peripheral calcifications, hypoechoic lesions and capsular distortion and evaluated whether these had any significance in prostate cancer detection. Patients and methods: All patients presenting to our institution for prostate biopsy were included. Indications included raised PSA and/or abnormal DRE or other suspicion of prostate cancer. Data on 12-core TRUS guided biopsies were prospectively collected and compared to a historical cohort of 6-core FG biopsies obtained from the pathology database of all prostate biopsies performed at Groote Schuur Hospital within the study period. Results: One hundred and ninety-two patients were included in the TRUS group over a 25-month period (2008)(2009)(2010) and 262 FG biopsies were reviewed between 2006 and 2008. Abnormal DRE findings were present in 56.2% of FG and 43.3% of TRUS biopsies. Histology was available in 97.8% of cases. The incidence of prostate cancer was 42%. Malignant or suspicious histology was found in 45.6% of the FG group compared to 48.6% in the TRUS group (p = 0.27). In patients with a normal DRE there was a trend that favoured TRUS for improved cancer detection, which is significant if the PSA was below 10 ng/mL. Conclusion: Our study did not show superiority of TRUS over FG biopsies except when the patient had a low PSA (below 10 ng/mL) and a normal DRE. Systematic FG biopsies may be underutilised in the TRUS era, and may be of benefit in patients presenting with a PSA over 10 ng/mL or an abnormal DRE. This may be of value in a limited resource setting where access to TRUS is restricted.

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“…The process of repeated biopsy addresses this to some degree. 15 Many agree that TRUS biopsy is still too inaccurate for this purpose, however. To this burden of accurate risk stratification, the clinician who is advising the patient of his suitability for focal therapy has the additional task of defining the topography of the disease-in other words, its location and extent.…”

Section: Assessment Of Patients Who May Be Candidates For Focal Therapymentioning

confidence: 99%

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

Rosette

Ahmed

Barentsz³

et al. 2010

Journal of Endourology

172

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Purpose: To establish a consensus in relation to case selection, conduct of therapy, and outcomes that are associated with focal therapy for men with localized prostate cancer. Material and Methods: Urologic surgeons, radiation oncologists, radiologists, and histopathologists from North America and Europe participated in a consensus workshop on focal therapy for prostate cancer. The consensus process was face to face within a structured meeting, in which pertinent clinical issues were raised, discussed, and agreement sought. Where no agreement was possible, this was acknowledged, and the nature of the disagreement noted. Results: Candidates for focal treatment should have unilateral low-to intermediate-risk disease with clinical stage cT 2a . Prostate size and both tumor volume and tumor topography are important case selection criteria that depend on the ablative technology used. Currently, the best method to ascertain the key characteristics for men who are considering focal therapy is exposure to transperineal template mapping biopsies. MRI of the prostate using novel techniques such as dynamic contrast enhancement and diffusion weighed imaging are increasingly being used to diagnose and stage primary prostate cancer with excellent results. For general use, however, these new techniques require validation in prospective clinical trials. Until such are performed, MRI will, in most centers, continue to be an investigative tool in assessing eligibility of patients for focal therapy. Conclusions: Consensus was derived for most of the key aspects of case selection, conduct of treatment, and outcome measures for men who are undergoing focal therapy for localized prostate cancer. The level of agreement achieved will pave the way for future collaborative trials.

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Optimizing Prostate Cancer Detection: 8 Versus 12-Core Biopsy Protocol

Abstract: There are no statistically significant differences in the prostate cancer detection rate between 8 and 12-core prostate biopsy protocols. Transition zone biopsies contribute to prostate cancer detection in a repeat biopsy protocol.

Cited by 39 publications

References 27 publications

Increasing Prostate-Specific Antigen Levels Differently Influence Prostate Cancer Detection Rates of Two Different 12-Core Prostate Biopsy Schemes

Increasing Prostate-Specific Antigen Levels Differently Influence Prostate Cancer Detection Rates of Two Different 12-Core Prostate Biopsy Schemes

A review of transrectal ultrasound guided prostate biopsies: Is there still a role for finger guided prostate biopsies?

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

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