Saturation Technique Does Not Improve Cancer Detection as an Initial Prostate Biopsy Strategy

Jones, J. Stephen; Patel, Amit R.; Schoenfield, Lynn; Rabets, John; Zippe, Craig D.; Magi‐Galluzzi, Cristina

doi:10.1016/s0022-5347(05)00211-9

Cited by 177 publications

(107 citation statements)

References 20 publications

Supporting

Mentioning

102

Contrasting

Order By: Relevance

“…8,9 Increasing the number of transrectal cores at initial biopsy does not appear to significantly improve yield. 10,11 Eichler et al 8 pooled data from 68 studies and found a significant improvement in cancer detection moving from the standard sextant scheme to a 12-core approach. However, there was no benefit to further increasing the number of cores taken.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

Taira

Merrick

Galbreath

et al. 2009

Prostate Cancer Prostatic Dis

262

171

View full text Add to dashboard Cite

Transrectal ultrasound (TRUS) biopsy can miss 20-30% of clinically significant cancers. We evaluate an alternative approach-transperineal template-guided mapping biopsy (TTMB) in the initial and repeat biopsy setting. From January 2005 through September 2008, 373 consecutive men underwent TTMB (294 men with X1 prior negative biopsy and 79 men as the initial biopsy). The location of each positive biopsy core, number of positive cores, and percent involvement of each core was recorded. Cancer detection rate for the initial biopsy was 75.9%. For men with 1, 2, and X3 prior negative biopsies detection rates were 55.5%, 41.7%, and 34.4%, respectively. In all, 55.5% of the cancers identified were Gleason X7. The majority of the cancers were multifocal. There was no significant change in the number of positive cores or Gleason score as the number of prior biopsies increased. The anterior and apical aspects of the prostate were among the most common cancer locations. TTMB provides a high rate of cancer detection as initial and repeat biopsy. TTMB was particularly effective at diagnosing anterior and apical cancer. TTMB may have particular application for men considering active surveillance, with prior negative TRUS biopsies, and those considering subtotal gland or other minimally invasive treatments.

show abstract

Section: Discussionmentioning

confidence: 99%

“…For each biopsy core, the template coordinate and the offset from base were recorded. Biopsy regions included posterior prostate (3,4,12,13,21,22), posterior lateral (2,5,11,14,20,23), anterior lateral (1,6,9,10,15,16), anterior apex (19,24), and TZ (7,8,17,18) After completion of all sampling, patients underwent cystoscopic evaluation.…”

Section: Methodsmentioning

confidence: 99%

Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

Taira

Merrick

Galbreath

et al. 2009

Prostate Cancer Prostatic Dis

262

171

View full text Add to dashboard Cite

show abstract

“…1 This approach has its limits because in 25% to 30% of patients with PCa the neoplastic tissue is not included in the samples. 2 Moreover in patients with persistently increased PSA and negative PB, the repetition of biopsies does not increase the detection rate of PCa, which indeed decreases progressively. 3 Because of the additional number of samples there is a significant risk of complications (infection, bleeding, acute urinary retention), anxiety and social-sanitary costs.…”

mentioning

confidence: 95%

The Roles of Multiparametric Magnetic Resonance Imaging, PCA3 and Prostate Health Index—Which is the Best Predictor of Prostate Cancer after a Negative Biopsy?

et al. 2014

View full text Add to dashboard Cite

Purpose: In patients with a negative prostate biopsy and persistent suspicion of prostate cancer, additional analyses such as the PCA3 score, PHI and multiparametric magnetic resonance imaging have been proposed to reduce the number of unnecessary repeat biopsies. In this study we evaluate the diagnostic accuracy of PCA3, PHI, multiparametric magnetic resonance imaging and various combinations of these tests in the repeat biopsy setting. Materials and Methods: A total of 170 patients with an initial negative prostate biopsy and persistent suspicion of prostate cancer were enrolled in this prospective study. The patients underwent measurements of the total prostate specific antigen and free prostate specific antigen rate, along with PHI, PCA3 tests and multiparametric magnetic resonance imaging before standard repeat biopsy that was performed by urologists blinded to the multiparametric magnetic resonance imaging results. Multivariate logistic regression models with various combinations of PCA3, PHI and multiparametric magnetic resonance imaging were used to identify the predictors of prostate cancer with repeat biopsy, and the performance of these models was compared using ROC curves, AUC analysis and decision curve analysis. Results: In the ROC analysis the most significant contribution was provided by multiparametric magnetic resonance imaging (AUC 0.936), which was greater than the contribution of the PHIþPCA3 model (p <0.001). In the multivariate logistic regression analysis only multiparametric magnetic resonance imaging was a significant independent predictor of prostate cancer diagnosis with repeat biopsy (p <0.001). The results of the decision curve analysis confirmed that the most significant improvement in the net benefit was provided by multiparametric magnetic resonance imaging.

show abstract

“…5 We concluded that saturation biopsy improves the diagnostic yield for repeat biopsy, but does not improve results of initial biopsy, so we recommended its use only for the repeat-biopsy population. 6 We previously reported that parasagittal biopsies in the repeat biopsy population had low yield with respect to cancer detection, and that unique parasagittal cancers were rarely (not a single case in our series of 100 patients) found during repeat biopsy. 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.…”

Section: Introductionmentioning

confidence: 52%

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

View full text Add to dashboard Cite

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.

show abstract

Saturation Technique Does Not Improve Cancer Detection as an Initial Prostate Biopsy Strategy

Cited by 177 publications

References 20 publications

Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

The Roles of Multiparametric Magnetic Resonance Imaging, PCA3 and Prostate Health Index—Which is the Best Predictor of Prostate Cancer after a Negative 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

Contact Info

Product

Resources

About