Parasagittal biopsies add minimal information in repeat saturation prostate biopsy

Patel, Amit R.; Jones, J. Stephen; Rabets, John; DeOreo, Gerard A.; Zippe, Craig D.

doi:10.1016/j.urology.2003.08.040

Cited by 80 publications

(61 citation statements)

References 15 publications

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“…In some instances, failure rates may be as high as 73%. For example, the prostatic apex is difficult to access during biopsy, and lateral as well as anterior cancers are not well evaluated with standard sextant biopsies (11).…”

Section: Transrectal Us and Guided Biopsymentioning

confidence: 99%

Advancements in MR Imaging of the Prostate: From Diagnosis to Interventions

Bonekamp¹,

Jacobs²,

El-Khouli³

et al. 2011

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Prostate cancer is the most frequently diagnosed cancer in males and the second leading cause of cancer-related death in men. Assessment of prostate cancer can be divided into detection, localization, and staging; accurate assessment is a prerequisite for optimal clinical management and therapy selection. Magnetic resonance (MR) imaging has been shown to be of particular help in localization and staging of prostate cancer. Traditional prostate MR imaging has been based on morphologic imaging with standard T1-weighted and T2-weighted sequences, which has limited accuracy. Recent advances include additional functional and physiologic MR imaging techniques (diffusionweighted imaging, MR spectroscopy, and perfusion imaging), which allow extension of the obtainable information beyond anatomic assessment. Multiparametric MR imaging provides the highest accuracy in diagnosis and staging of prostate cancer. In addition, improvements in MR imaging hardware and software (3-T vs 1.5-T imaging) continue to improve spatial and temporal resolution and the signal-to-noise ratio of MR imaging examinations. Another recent advancement in the field is MR imaging guidance for targeted prostate biopsy, which is an alternative to the current standard of transrectal ultrasonographyguided systematic biopsy. Abbreviations: ADC = apparent diffusion coefficient, BPH = benign prostatic hyperplasia, DCE = dynamic contrast-enhanced, DRE = digital rectal examination, EES = extracellular-extravascular space, PSA = prostate-specific antigen, ROI = region of interest, SNR = signal-to-noise ratio, TKCM = tracer kinetic compartmental model

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Section: Transrectal Us and Guided Biopsymentioning

confidence: 99%

Advancements in MR Imaging of the Prostate: From Diagnosis to Interventions

Bonekamp¹,

Jacobs²,

El-Khouli³

et al. 2011

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216

161

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“…1 Additionally, various studies suggest that diagnostic sensitivity of prostate biopsy might not exceed B30% in most situations, even if saturation biopsy is performed. [11][12][13][14] These studies are not specific to atypia patients, but they illustrate possible limitations of prostate biopsy, particularly when combined with other studies documenting the limitations of biopsying large prostates, and may contribute to the lower cancer prevalence in this cohort. Although our cohort underwent heterogeneous core sampling, the association with cancer diagnosis was not statistically significant (Table 2).…”

Section: Radical Prostatectomymentioning

confidence: 78%

“…Sensitivity analysis determined that cancer would have to be diagnosed in 76% of the men with inflammation who did not undergo repeat biopsy for our results to be rendered statistically insignificant; this would be highly unlikely based on clinical characteristics of the patients (Table 1) and the diagnostic sensitivity of prostate biopsy. [12][13][14] Moreover, although men who did not undergo repeat biopsy had less inflammation and lower PSA, there was no association between inflammation and PSA among patients who did undergo repeat biopsy. Although there was no pathology review for this study, any variability in the prospective diagnosis of inflammation and cancer may be non-differential and thus not substantially alter the findings.…”

Section: Radical Prostatectomymentioning

confidence: 88%

Prostate atypia: clinical and pathological variables associated with cancer diagnosis on repeat biopsy

Kopp

Parsons

Shiau

et al. 2011

Prostate Cancer Prostatic Dis

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The clinical significance of atypical glands suspicious for malignancy (atypia) on prostate biopsy is unclear. We studied a cohort of 139 patients with atypia who underwent repeat prostate biopsy. We analyzed clinical and pathological variables that may be associated with cancer on repeat biopsy. Cancer was diagnosed in 41 (29%) of patients with atypia: 26 of 41 (66%) were Gleason 6, 20% were Gleason 7 and 7% were Gleason 8 (Gleason o6 not reported). There were no significant associations of age, race, family history, PSA, PSA density (PSAd), number of previous biopsies or time to repeat biopsy with cancer diagnosis. In multivariate regression, histological inflammation was associated with an 85% decreased probability of cancer on repeat biopsy (odds ratio; OR 0.15; 95% confidence interval; CI 0.04-0.57; P ¼ 0.04). Radical prostatectomy was performed in 14 of 41 (34%) patients with cancer; 6 (43%) were Gleason sum X7, 3 (21%) were pT3a and 1 (7%) had lymph node metastases. In conclusion, inflammation was independently associated with a significantly decreased risk of cancer on repeat biopsy. However, some patients with initial atypia have higher-risk prostate cancer. Additional studies are needed to elucidate these associations.

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“…We found that no cancers identified during that study were located exclusively in the parasagittal regions of the prostate and determined that focused sampling of the lateral regions of the prostate could optimize the sensitivity of repeat prostate biopsy. 7 Although we determined that further investigation into initial biopsy strategies involving more than 12 cores was not appropriate, a subanalysis of the previously published population provides a unique group of patients who underwent exhaustive biopsy and allows us to compare the location of cancer-positive biopsy cores within the initial and repeat biopsy patient populations.…”

Section: Introductionmentioning

confidence: 99%

Parasagittal biopsies are more important as part of an initial biopsy strategy than as part of a repeat biopsy strategy: observations from a unique population

Patel

Jones

Zhou

et al. 2007

Prostate Cancer Prostatic Dis

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Comparing the yield of parasagittal biopsies during initial saturation biopsy to the yield during repeat saturation biopsy for detection of prostate cancer. Office-based saturation biopsy (24 cores) with periprostatic lidocaine block was performed in 139 consecutive men who had never previously undergone prostate biopsy. Indication for biopsy was elevated prostate-specific antigen 42.5 ng/dl. Biopsy specimens were obtained and marked by location for histological examination. Subanalysis of patients from this unique study was performed to compare the location of saturation biopsy cancer detection in these patients to a cohort of 100 patients who had previously undergone biopsy with nonmalignant findings. In the initial biopsy group, cancer was detected in 62/139 patients (44.6%). Breakdown of cancer location demonstrated unique parasagittal cancers in 9/62 patients (14.5%). Laterally base cancer was found exclusively in 22/62 patients (35.5%). For the repeat biopsy population, cancer was found in 25 patients (25%); no patients (0%) had exclusive parasagittal cancer. To our knowledge, this is the first study to demonstrate a difference in the location of positive cores between initial and repeat biopsy status. The exclusive parasagittal cancer detection rate decreases significantly in the repeat biopsy population when using the same biopsy method. Our findings support including traditional template parasagittal sampling of the prostate on firsttime biopsy in addition to lateral cores typical of extended field biopsies for a total of 10-12 cores. However, parasagittal sampling adds negligible additional information in repeat biopsy; thus we recommend obtaining primarily laterally based cores for repeat biopsy.

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Parasagittal biopsies add minimal information in repeat saturation prostate biopsy

Cited by 80 publications

References 15 publications

Advancements in MR Imaging of the Prostate: From Diagnosis to Interventions

Advancements in MR Imaging of the Prostate: From Diagnosis to Interventions

Prostate atypia: clinical and pathological variables associated with cancer diagnosis on repeat biopsy

Parasagittal biopsies are more important as part of an initial biopsy strategy than as part of a repeat biopsy strategy: observations from a unique population

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