MP63-16 IMPORTANCE OF EXTREME APICAL SAMPLING FOR PROSTATE CANCER DIAGNOSIS

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2014MP63-16 IMPORTANCE OF EXTREME APICAL SAMPLING FOR PROSTATE CANCER DIAGNOSIS Ahmed Elshafei, Ganesh Kartha, Yonghong Li, Ayman S. Moussa, Tianming Gao, and J.Stephen Jones Ahmed ElshafeiAhmed Elshafei More articles by this author , Ganesh KarthaGanesh Kartha More articles by this author , Yonghong LiYonghong Li More articles by this author , Ayman S. MoussaAyman S. Moussa More articles by this author , Tianming GaoTianming Gao More articles by this author , and J.Stephen JonesJ.Stephen Jones More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1953AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess extreme apical sampling on prostate cancer (PCa) detection, plus determination of aggression and disease burden. Outcomes were compared in patients with standard risk vs. predicted high risk of a positive biopsy. METHODS 3053 patients who underwent initial prostate biopsy from 2000 to 2011 were reviewed. 2521 underwent 12 core while 532 underwent 14 core sampling (2 extra cores from the extreme anterior apex). Patients with additional cores from other areas or additional cores obtained in response to DRE or hypoechoic findings were excluded. Patients were stratified into 2 groups; those with standard suspicion of PCa (elevated prostate specific antigen (PSA) ≤ 10ng/ml, normal digital rectal exam (DRE), and no suspicious lesion on transrectal ultrasound (TRUS)) and those with higher suspicion PCa (PSA > 10ng/ml and/or abnormal DRE and/or lesion on TRUS). RESULTS Univariate analysis, as detailed in Table 1, shows the 14 core apical-focus scheme detected more cancer compared to the 12 core scheme in patients with a standard risk of cancer on biopsy (43.09% vs. 36.18%; P=0.02). On multivariate analysis, PCa detection with 14 core sampling was more likely in all patients (OR 1.339, 95% CI 1.070-1.676) and in men with standard risk (OR 1.334, 95% CI 1.007-1.769). Table 2. A greater median number of positive cores (3 vs. 2, p= 0.04) and a higher maximum cancer % per core (40% vs. 25% p=0.002) was seen in the 14 core cohort when stratified to standard risk. Gleason≥7 was more likely to be detected with 14 cores in the standard risk group (55.6% vs. 45.2% p=0.03). Differences in PCa detection (p= 0.53) and Gleason≥7 (p=0.10) between 12 and 14 core sampling was not noted in the higher risk group. CONCLUSIONS Extreme apical sampling increases aggressive cancer detection on initial biopsy, especially in patients with standard suspicion of PCa. This area should be intentionally sampled during prostate biopsy, although it may not be as important in those with high suspicion of PCa, where standard 12 core sampling may be sufficient. Table 1. Prostate cancer detection between different schemes stratified by the risk groups Prostate cancer detection 12 core scheme 14 core scheme P-value Overall patients 1055/2521 (41.85%) 246/532 (46.24%) 0.063 Patients with suspicion of having cancer 606/1675 (36.18%) 134/311 (43.09%) 0.02 Patients with higher suspicion of having cancer 449/846 (53.07%) 112/221 (50.68%) 0.53 Table 2. Multivariate analysis of clinico-demographic variables associated with prostate cancer detection on initial biopsy All patients baseline comparison between 12 and 14 core groups (n=3053) Variables Odds Ratio 95% Confidence Limits P-value Number of Cores 1.339 1.070-1.676 0.0108 Age 1.048 1.036-1.060 <0.0001 African American race 1.464 1.137-1.885 0.0031 FH∗ 1.568 1.258-1.954 <0.0001 PSA∗ 1.140 1.107-1.174 <0.0001 Abnormal DRE∗ 1.408 1.121-1.768 0.0033 TPV∗ 0.974 0.969-0.979 <0.0001 Patients with suspicion of having cancer (n=1986) Variables Odds Ratio 95% Confidence Limits P-value Number of Cores 1.334 1.007-1.769 0.04 Age 1.048 1.032-1.064 <0.0001 African American race 1.258 0.924-1.713 0.15 FH∗ 1.576 1.209-2.054 0.0008 PSA∗ 1.144 1.067-1.226 0.0002 TPV∗ 0.973 0.967-0.980 <0.0001 Patients with higher suspicion of having cancer (n=1067) Variables Odds Ratio 95% Confidence Limits P-value Number of Cores 1.383 0.948-2.017 0.09 Age 1.052 1.032-1.073 <0.0001 African American race 1.962 1.246-3.089 0.004 FH∗ 1.571 1.055-2.340 0.03 PSA∗ 1.166 1.118-1.215 <0.0001 Abnormal DRE∗ 2.195 1.416-3.402 0.0004 TPV∗ 0.975 0.968-0.983 <0.0001 ∗ FH: family history, PSA: prostate specific antigen, DRE: digital rectal examination, TPV: total prostate volume. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e714-e715 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ahmed Elshafei More articles by this author Ganesh Kartha More articles by this author Yonghong Li More articles by this author Ayman S. Moussa More articles by this author Tianming Gao More articles by this author J.Stephen Jones More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...