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

Abstract

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.

The morbidity of transperineal template‐guided prostate mapping biopsy

“…The morbidity of standard TRUS biopsy has been extensively assessed; most side‐effects are self‐limited, with the most serious complication (urosepsis) rarely reported [10–22]. Biopsy‐related morbidity after TRUS‐guided saturation biopsy is also primarily self‐limited and comparable with a standard TRUS biopsy [24,25]. Recently, TTMB techniques have emerged as an alternative form of saturation biopsy.…”

“…In addition, TTMB did not affect R‐FAS (Table 1) and no patient developed significant rectal bleeding. In a TRUS‐guided biopsy series [25], three of 139 patients (2.2%) developed rectal bleeding necessitating re‐evaluation, with one patient requiring transfusion.…”

“…Erectile dysfunction (ED) has also been reported in a few patients [12,23]. TRUS‐guided saturation biopsy‐related morbidity is comparable to standard TRUS‐guided biopsy [24,25].…”

Strategies for repeat prostate biopsies

“…These biopsy sites were originally described in midlobe parasagittal plane at the apex, midgland, and base bilaterally. Despite falling out of favor as the sole approach to prostate sampling, sextant biopsies in conjunction with additional biopsies as part of an extended biopsy scheme continue to contribute significantly to the successful detection of prostate cancer [35]. Although suffi cient for histologic confi rmation of the presence of cancer in patients with very abnormal digital rectal examinations and elevated PSA levels, use of sextant biopsies alone is generally considered inadequate for routine initial or repeat biopsies [2,3,16•].…”

Strategies for repeat prostate biopsies

“…"Extended" biopsy is the terminology typically used to refer to greater than six biopsy cores taken in the sextant fashion. Despite falling out of favor as the sole approach to prostate sampling, sextant biopsies in conjunction with additional biopsies as part of an extended biopsy scheme continue to contribute significantly to the successful detection of prostate cancer [35].…”