Editorial Comment

Abstract

The search for the optimal biopsy strategy continues. An increasing number of lateral biopsies in addition to traditional sextant biopsy, saturation biopsy, the selection of computer-based sampling sites,1, 2 image-guided directed biopsy (using emerging imaging technology with magnetic resonance imaging and/or transrectal ultrasonography), the indication of repeat biopsy and so on are all under investigation. To identify the biopsy strategy without missing clinically significant cancer with a minimum number of biopsies taken is a true challenge. Orikasa et al. should be congratulated on their pioneering work in proving a clinically significant sampling site. This article addresses the clinical utility of an apical anterior peripheral zone biopsy in men with normal digital rectal examination (DRE), and particularly in men with a prior negative biopsy.3 As reinforced by this article, repeat biopsy, indicated by continuously elevated prostate-specific antigen with normal DRE, needs site-directed biopsies from the areas where the previous biopsies have not been taken. After the landmark work of computer-based sampling analysis by Chen et al.1 to target the anterior horn peripheral zone, the apical anterior peripheral zone could become another significant sampling site, as this article and Matsumoto et al. point out.2 The importance is not only in an improved detection rate. Since the positive surgical margin most likely occurs in an apical dissection,4 pre-operative cancer mapping provided by a positive biopsy outcome in this site will contribute to better oncologic therapeutic outcomes.