1448 IS THERE A ROLE FOR ROUTINE ANTERIOR ZONE SAMPLING DURING TRANSRECTAL ULTRASOUND GUIDED SATURATION PROSTATE BIOPSY?

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening II1 Apr 20121448 IS THERE A ROLE FOR ROUTINE ANTERIOR ZONE SAMPLING DURING TRANSRECTAL ULTRASOUND GUIDED SATURATION PROSTATE BIOPSY? Eric Cole, Bobby Shayegan, Dean Daya, Michael Greenspan, Edward Matsumoto, Michael Patlas, and Jehonathan H. Pinthus Eric ColeEric Cole Hamilton, Canada More articles by this author , Bobby ShayeganBobby Shayegan Hamilton, Canada More articles by this author , Dean DayaDean Daya Hamilton, Canada More articles by this author , Michael GreenspanMichael Greenspan Hamilton, Canada More articles by this author , Edward MatsumotoEdward Matsumoto Hamilton, Canada More articles by this author , Michael PatlasMichael Patlas Hamilton, Canada More articles by this author , and Jehonathan H. PinthusJehonathan H. Pinthus Hamilton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1942AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The anterior zone (AZ) of the prostate has been recognized as a sanctuary site for prostate cancer (PC). We examined the diagnostic yield of AZ biopsies as part of a saturation template in patients with elevated PSA levels but with previous negative extended prostate biopsies (group 1), and in surveillance biopsies of PC patients (group 2). METHODS 91 patients (64 group 1 and 27 group 2) underwent TRUS- guided saturation biopsy under local (n=79) or spinal (n=12) anesthesia: 12-24 cores were taken from the peripheral zone (PZ) depending on the prostate volume, 4- 6 cores (median=4) were taken from the transitional zone (TZ) and 4-8 (median=6) cores were taken from the AZ. All suspicious ultrasonic areas were targeted as well to a total of 17-38 cores (median 26). All biopsies were completed by a single urologist and reviewed by a specialized uro-pathologist. RESULTS Mean age of the patients was 65 and 63 and mean PSA were 11.5 (95% CI 9.8-13.3) and 7.9(95% CI 5.9-9.9) in groups 1 and 2 respectively. The mean # of previous biopsies and cores in group 1 were 1.7 and 19 respectively. The overall diagnostic yield was 34% and 93% for group 1 and 2 respectively. AZ cancers were detected in 19% (group 1) and 37% (group 2) (p=0.056) but were rarely the only site involved (3% and 4% respectively). Findings in the AZ changed the risk stratification of the disease in only 4% of patients in group 1 and 7% of group 2 (P=0.579). There was an equal incidence of ≥ Gleason 7 disease in the AZ in both groups. In all but one case in both groups this was accompanied by disease of equal grade in the PZ. Similar rates of Gleason ≥ 7 disease were detected in group 1 (23%) and in group 2 (24%). There were no suspicious ultrasonic findings in the AZ in any of the patients. Isolated TZ cancers were not detected. There were no infectious complications and no need for post biopsy hospital admission. CONCLUSIONS Saturation biopsy is almost always positive in patients undergoing surveillance biopsy and commonly positive in patients with clinical suspicion for PC despite previous negative extended biopsies. However, the routine addition of TZ and AZ sampling rarely adds to the diagnostic yield, and will seldom change a patient's risk stratification. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e587 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Cole Hamilton, Canada More articles by this author Bobby Shayegan Hamilton, Canada More articles by this author Dean Daya Hamilton, Canada More articles by this author Michael Greenspan Hamilton, Canada More articles by this author Edward Matsumoto Hamilton, Canada More articles by this author Michael Patlas Hamilton, Canada More articles by this author Jehonathan H. Pinthus Hamilton, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...