Abstract
Despite decades of use as the “gold standard” in the detection of prostate cancer, the optimal biopsy regimen is still not universally agreed upon. While important aspects such as the need for laterally placed biopsies and the importance of apical cancer are known, repeated studies have shown significant patients with cancer on subsequent biopsy when the original biopsy was negative and an ongoing suspicion of cancer remained. Attempts to maximise the effectiveness of repeat biopsies have given rise to the alternate approaches of saturation biopsy and the transperineal approach. Recent interest in focal treatment of prostate cancer has further highlighted the need for accurate detection of prostate cancer, and in response, the introduction of transperineal template-guided biopsy. While the saturation biopsy approach and the transperineal template approach increase the detection rate of cancer in men with a previous negative biopsy and appear to have acceptable morbidity, there is a lack of clinical trials evaluating the different biopsy strategies. This paper reviews the evolution of prostatic biopsy and current controversies.
Highlights
Prostate cancer is recognized as one of the major medical problems facing the male population
We have attempted to summarise the interesting evolution of the refinements to prostate biopsy since Hodges and colleagues, in 1989, first demonstrated the superiority of systematic TRUS biopsies, compared to digitally directed biopsy
A 10–12 core systematic biopsy, targeting the far lateral aspect of the peripheral zone, has become standard practice for initial biopsy. These extended schemes have been demonstrated to be insufficient in the repeat biopsy setting
Summary
Prostate cancer is recognized as one of the major medical problems facing the male population. In Europe, with an annual incidence of 214 cases per 1000 men, prostate cancer represents the most common solid tumour affecting men, having surpassed lung and colorectal cancers [1], and it is the second most common cause of cancer death in men [2]. In 2008, an estimated 186,320 men were diagnosed with prostate cancer and 28,600 were expected to die from the disease in the USA [2]. Despite the rapid development of imaging and extensive clinical evaluation of PSA and its derivates, as well as novel prostate cancer biomarkers, prostate biopsy remains up to this day the only diagnostic test for the detection of cancer. Far from a standardized practice, prostate biopsy is still evolving. The ideal technique, the so-called biopsy “gold standard”, is still to be fully defined
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have