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Abstract

The exact role of transition zone (TZ) biopsy in predicting the extent of local pathological stage is yet to be determined. In the present study, two cores of TZ biopsies were added to the systematic sextant biopsy technique and the results were compared with the histopathological data from the radical retropubic prostatectomy (RRP) specimens. The analysis of clinical and biopsy (peripheral zone [PZ] and TZ) features revealed that although TZ biopsy provided some valuable information (e.g. very good agreement between the positive TZ biopsy side and extraprostatic extension [EPE] side) it was not superior to the percentage of positive PZ cores for the prediction of EPE. This result does not necessarily mean that TZ biopsy is useless for the prediction of EPE. An increased number of cores from the TZ can certainly provide better information. However, there is no agreement on the optimum number of TZ cores that should be taken for this purpose. Kojima et al. took four TZ cores and compared their results with RRP specimens in only 14 of their patients.1 Chang et al. performed systematic sextant biopsy of the TZ. However, this study did not provide information on prostatectomy results.2 Liu et al. took four to 10 TZ cores, depending on the size of the prostate.3 They also did not provide information on pathological stage. It should also be noted that patient tolerance considerably drops when the number of TZ biopsies is increased. Both Kojima et al. and Chang et al. used some form of regional anesthesia to perform prostate biopsies.1,2 Thus, we suggest that the relationship between TZ involvement and prediction of EPE should be further investigated in prostatectomy specimens. In addition, increased number of TZ cores should be taken using regional anesthesia. The technique used by Kojima et al., which utilized intracavitary radiotherapy templates for transperineal prostate biopsy,1 is an interesting approach, but whether it is superior to the standard transrectal technique should be well documented before such an invasive approach can be recommended for routine use.