12-core Transrectal Ultrasound-guided Prostate Biopsy Research Articles

Standard 12-Core Transrectal Ultrasound-Guided Prostate Biopsy, a Useful Tool in Screening for Prostate Cancer: A Prospective Study in Uyo, Akwa Ibom State, Nigeria

Introduction: Guided prostate biopsy is still relevant in confirming the diagnosis of suspected prostate cancer. Objective: This study evaluated the role of Transrectal Ultrasound (TRUS) guided biopsy along with histopathological evaluation in the detection of prostate cancer on the basis of abnormal digital rectal examination (DRE) findings and elevated prostate specific antigen levels (PSA). Participants and Methods: This prospective study was undertaken among consenting men aged 40 years and above screened for prostate cancer at the University of Uyo Teaching Hospital using targeted, stepwise protocol including DRE, PSA and standard 12-core transrectal ultrasound guided biopsy technique. Biopsy samples were sent for histopathological evaluation. Findings were documented, analyzed and presented in tables and figures. Results: Among 437 participants, abnormal DRE findings, elevated PSA level above 4.0 ng/ml and abnormal TRUS findings were 17.2%, 21.1%, and 17.3% respectively. Of 44 participants who had prostate biopsies with histopathologic assessment, benign prostatic diseases were 24 cases (54.5%), slightly outnumbering malignant prostatic diseases seen in 20 (45.5%).The prostate cancer detection and prevalence rates were 45.5% and 4.6% respectively. Prostatic adenocarcinoma (45.5%), nodular hyperplasia (45.5%), basal cell hyperplasia (6.8%) and high grade prostatic intraepithelial neoplasia (2.2%) were identified histologic subtypes. Nodular hyperplasia was commonly associated with chronic prostatitis (80.0%). A significant association between DRE findings, outline of prostate, and tumour subtype was ascertained. Conclusion: Targeted screening protocol encompassing TRUS guided 12- core biopsy is a final arbiter in the diagnosis of prostate cancer and has a fairly high prostate cancer detection rate of 45.5%.

Prediction of surgical margin status and location after radical prostatectomy using positive biopsy sites on 12-core standard prostate biopsy

We evaluated the surgical margin status after radical prostatectomy according to sites positive for prostate cancer on standard 12-core transrectal ultrasound-guided prostate biopsy. Among patients who underwent radical prostatectomy at Boramae Medical Center, 520 patients with preoperative prostate-specific antigen (PSA) level < 20 ng/mL and locally confined prostate cancer on preoperative magnetic resonance imaging, treated with nerve-sparing radical prostatectomy, were included in the analysis. The surgical margin was positive for cancer in 166 (31.9% of the total) patients. The preoperative PSA level (9.3 vs. 8.0, ng/mL p = 0.001) and number of positive cores on 12-core prostate biopsy (4.1 vs. 3.4, p = 0.003) were significantly higher in patients with positive surgical margins. Moreover, the biopsy Gleason grade was higher in patients with positive surgical margins (p = 0.001). However, the pathologic Gleason grade and tumor volume were equivalent between the 2 groups. On multivariate analysis, the detection of prostate cancer on anterior lateral biopsy was associated with an increased rate of positive surgical margins (hazard ratio [HR]: 1.781, p = 0.008) after adjusting for other variables. Anterior lateral (HR: 1.919, p = 0.020), basal lateral (HR: 9.176, p < 0.001), basal medial (HR: 3.302, p = 0.031), and mid lateral (HR: 2.501, p = 0.044) biopsies were associated with positive apical, posterior, basal, and lateral surgical margins, respectively, after adjusting for other variables. The sites of prostate cancer on standard 12-core prostate biopsy could be useful for predicting surgical margin positivity after radical prostatectomy. In other words, clinicians should consider the sites of prostate cancer on prostate biopsy to reduce margin positivity after radical prostatectomy.

Lymphocyte-to-monocyte ratio is a predictor of clinically significant prostate cancer at prostate biopsy.

Inflammation plays critical roles at different stages of carcinogenesis and cancer progression. Several previous studies showed conflicting results for the predictive role of systemic inflammation markers in the detection of clinically significant prostate cancers (CSPCs). We aimed to determine the predictive roles of lymphocyte-to-monocyte (LMR) and eosinophil-to-lymphocyte ratios (ELR) in the detection of CSPC at standard 12-core transrectal ultrasound-guided prostate biopsy (12-core-TRUS-Bx) using our large-cohort database. Clinical and pathological data of a total of 1740 men, who underwent initial standard 12-core TRUS-Bx, were analyzed. LMR and ELR were calculated from the prebiopsy complete blood count. Definitions of CSPC, LMR, and ELR were "Gleason grade group ≥2," "the lymphocyte counts/the monocyte counts," and "the eosinophil counts/the lymphocyte counts," respectively. Median (interquartile range) of serum prostate-specific antigen(PSA) level and prostatic volume before TRUS-Bx were 7.59 (5.02-13.12) ng/ml and 38.2 (29.0-52.9) ml, respectively. Benign prostatic lesions, clinically insignificant prostate cancers (CIPCs), and CSPCs were detected in 1179 (67.8%), 180 (10.3%), and 381 (21.9%) patients, respectively. The patients with CSPCs had older age, a higher prevalence of diabetes mellitus or hypertension, a higher rate of digital rectal examination abnormality, higher serum PSA level, lower serum testosterone level, and lower LMR than those with benign lesions or CIPCs. However, there was no difference in ELR among the three (benign lesions, CIPCs and CSPCs). In all the patients, multivariate regression analysis showed that lower LMR was an independent predictor of CSPCs compared with ELR. In the subset of men with prostate volume ≥39.3 ml, lower LMR was an independent predictor of CSPCs compared with ELR. In the subset of men with prostate volume <39.3 ml, men with lower LMR showed the tendency of having a higher probability of CSPCs without any statistical significance on the contrary to ELR. Our data indicate that LMR can play an independent predictive role in the detection of CSPCs at initial 12-core-TRUS-Bx compared with ELR. The predictive role of the LMR appears to be significant for men with larger prostate volume rather than those with smaller prostate volume.

Platelet-to-lymphocyte ratio and systemic immune-inflammation index versus circulating prostate cells to predict significant prostate cancer at first biopsy.

It has been reported that the systemic immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) are higher in men with prostate cancer. We compare their use with the percentage of free prostate-specific antigen (PSA), PSA density, and primary circulating prostate cells (CPCs) to predict clinically significant prostate cancer at first biopsy in men with a PSA of 4-10 ng/mL. Consecutive men with suspicion of prostate cancer underwent a 12-core transrectal ultrasound-guided prostate biopsy; total serum PSA, the percentage of free PSA, prostate ultrasound to calculate PSA density, and absolute neutrophil, lymphocyte, and platelet counts were used for risk assessment. CPCs were detected using differential gel centrifugation and immunocytochemistry with anti-PSA and anti-P504S. A malignant CPC was defined as a cell-expressing PSA and P504S and defined as positive or negative. Biopsies were classified as indicating cancer or no cancer. Areas under the curve for each parameter were calculated and compared, and diagnostic yields were calculated. A total of 1223 men participated, and 467 (38%) had a biopsy positive for cancer, whereas 353/467 (76%) had clinically significant prostate cancer. The PLR was significantly higher in men with prostate cancer; there was no significant difference for the SII. The areas under the curves were CPC 0.84, the percentage of free PSA was 0.79, PLR 0.65, PSA density 0.62, and SII 0.46. Neither the PLR nor the SII discriminated between patients with clinically significant prostate cancer, indolent cancer, and benign prostatic disease. Based on the results of this study, neither the SII nor PLR could differentiate between clinically significant prostate cancer and indolent cancer/benign disease at initial biopsy.

Outcomes of standard 12-core transrectal ultrasound-guided prostate biopsy in biopsy naive Indian men -single center experience.

Introduction:Prostate cancer is now the second-most common cancer in many parts of India. Despite being the second-largest population in the world, data regarding outcomes of biopsy in Indian men are limited. We report the correlation of biopsy finding with prostate-specific antigen (PSA) level in Indian men undergoing biopsy for either elevated PSA and/or abnormal digital rectal examination (DRE) findings.Materials and Methods:We retrospectively analyzed data of 853 men who underwent TRUS-guided prostate biopsy in a single institution from January 2014 to October 2019. The biopsy was performed when serum PSA was more than 4.00 ng/mL and/or DRE findings were suspicious for malignancy.Results:Overall cancer detection rate was 38.8%. Patients were classified in five groups based on PSA levels, irrespective of DRE findings (0–3.99 ng/mL, 4.00–9.99 ng/mL, 10.00–19.99 ng/mL, 20.00–39.99 ng/mL, and ≥40 ng/mL). Overall prostate cancer detection rates at corresponding at PSA levels were 3/23 (13%), 62/282 (21.9%), 86/226 (38.05%), 66/126 (52.3%), and 165/196 (84.18%), respectively. 331 (38.8%) patients of the total 853 had suspicious DRE, the cancer detection rate in corresponding PSA groups, based on DRE alone was 3/23 (13.04%), 23/42 (54.76%), 39/56 (69.64%), 43/52 (82.69%), and 157/160 (98.13%), respectively.Conclusion:The overall prostate cancer detection rate at our center was 38.8%, which is much higher as compared to other Indian data. Our study also emphasizes the role of DRE in Indian men presenting with elevated PSA.

Prostate Health Index outperforms other PSA derivatives in predicting a positive biopsy in men with tPSA &lt;10 ng/mL

Few prospective studies have focused on the performance of the Prostate Health Index (PHI) in Asian populations. Therefore, we aimed to evaluate the performance of the PHI in predicting prostate cancer (PCa) compared with standard prostate-specific antigen (PSA) tests. We prospectively enrolled patients with suspected PCa with a total PSA (tPSA) level 4 to 10 ng/mL or tPSA <4 ng/mL and a suspicious digital rectal examination between February 2017 and September 2018. All of the patients underwent a 12-core transrectal ultrasound-guided prostate biopsy. Prebiopsy blood samples were analyzed for tPSA, free PSA (fPSA), percentage of fPSA (%fPSA), [-2]proPSA (p2PSA), and percentage of p2PSA (%p2PSA). The PHI was calculated as (p2PSA/fPSA) × √tPSA. The areas under the receiver operating characteristic curve (AUCs) were estimated for the PSA derivatives in addition to their specificities at a prespecified sensitivity of 90%. Of the 307 enrolled patients, 95 (30.9%) had PCa on biopsy. Excluding fPSA, all of the PSA derivatives were significantly different between the positive and negative biopsy groups. Of the various derivatives, the PHI (AUC: 0.783) showed the best performance in predicting the results of the initial biopsy compared with tPSA (AUC: 0.611). At a sensitivity of 90%, the PHI had the best specificity of 46.7% compared with 23.2% for tPSA. Using a PHI cutoff value of 35.15 for biopsy, 108 (35.2%) patients could have avoided undergoing a biopsy. To detect Gleason score ≥ 7 disease at 90% sensitivity, the threshold for PHI was 36.96 with a specificity of 52.1%. PHI was the best biomarker among the PSA derivatives in predicting PCa at biopsy in men with tPSA < 10 ng/mL. The risk of a Gleason score ≥ 7 increased with increasing PHI.

The Incidence of Hematospermia After 12-Core Transrectal Ultrasound-Guided Prostate Biopsy: A Single-Center Study with 1,210 Patients

The Incidence of Hematospermia After 12-Core Transrectal Ultrasound-Guided Prostate Biopsy: A Single-Center Study with 1,210 Patients

Assessment of Needle Tip Deflection During Transrectal Guided Prostate Biopsy: Implications for Targeted Biopsies.

To measure needle tip deflection during transrectal ultrasound (TRUS) prostate biopsy and evaluate predictors for needle tip deflection. Analysis of 568 prostate biopsies obtained from 51 consecutive patients who underwent a standard 12-core TRUS guided prostate biopsy. TRUS guided prostate biopsies were performed using BK flex500, with a side-fire biplane probe. Each biopsy core image was captured and clinical data were recorded prospectively. The angle between the expected trajectory of the needle and actual needle course was measured using the longitudinal view of the captured image. The distance between expected and actual needle tip was calculated. We measured median and interquartile needle tip deflection rate stratified by side and location (apex, midgland, base). Univariable and multivariable linear regressions analysis were performed. The overall median needle tip deflection was 1.77 mm (IQR 1.35-2.47). Location did not significantly alter needle deflection measurements. On multivariable linear regression analysis, higher prostate volume (B = 0.007 95%, CI 0.004, 0.011; p < 0.001) and the right sided biopsy (B = 0.191 95%, CI 0.047, 0.336; p = 0.010) emerged as predictors of higher needle tip deflection. To the best of our knowledge this is the first study to measure needle tip deflection during TRUS guided prostate biopsies. We demonstrated that larger prostate size and biopsy side may affect the accuracy of biopsies. These results may have clinical implication to those performing targeted biopsies.

P006 - Predicting tumor volume using a novel biopsy-related parameter derived from location and relationship of positive cores on standard 12-core trans-rectal ultrasound-guided prostate biopsy

P006 - Predicting tumor volume using a novel biopsy-related parameter derived from location and relationship of positive cores on standard 12-core trans-rectal ultrasound-guided prostate biopsy

A novel biopsy-related parameter derived from location and relationship of positive cores on standard 12-core trans-rectal ultrasound-guided prostate biopsy: a useful parameter for predicting tumor volume compared to number of positive cores

To develop a novel biopsy-related parameter, named overlapping line, defined as the line between the adjacent positive cores on 12-core trans-rectal ultrasound-guided prostate biopsy, and evaluated the value of overlapping line for predicting tumor volume in the final pathologic examination. Among patients with prostate cancer who underwent radical prostatectomy at Boramae Medical Center, 470 patients who underwent standard 12-core trans-rectal ultrasound-guided prostate biopsy were selected for the analysis. The number of overlapping line was determined in each patient, and its effects on tumor volume were evaluated after adjusting for other variables. Median prostate specific antigen level was 9.1ng/mL, and the maximum % cancer in positive cores was 42.8%. Median numbers of positive cores and overlapping lines were three and two, respectively. The pathologic stage was T2 or less, T3a, and T3b or greater in 297 (63.5%), 104 (22.2%), and 67 patients (14.3%), respectively. Median tumor volume in prostatectomy specimen was 3.4mL. In multivariable analysis, the number of overlapping lines (B 0.750, p<0.001) was a significant predictor for tumor volume, in addition to prostate specific antigen level and maximum % cancer in positive cores. In addition, the model with overlapping line showed superior accuracy compared to the model with positive core based adjusted r 2 (0.467 vs. 0.456). The number of overlapping lines, a novel prostate biopsy-related variable, is thought to be a more reliable predictor for tumor volume compared to the number of positive cores and could be easily applied to routine daily practice.

Effect of heparin bridged transrectal prostate biopsy on the risk of hemorrhage in patients requiring temporary discontinuation of warfarin.

125 Background: Safety of heparin bridging therapy for transrectal ultrasound-guided prostate (TRUS) biopsy in patients requiring temporary discontinuation of antithrombotic therapy is unknown. This study aimed to assess the relationship between heparin bridging therapy and the incidence of complications after TRUS biopsy. Methods: From January 2005 to November 2015, we performed 1307 consecutive TRUS biopsies on 1134 patients in our hospital. The patients were assigned to two groups: those without heparin bridging (the control group) and those with temporary discontinuation of antithrombotic agents with heparin bridging therapy (the bridging group). A 10–12-core TRUS biopsy was performed; the patients were evaluated for bleeding-related complications. Results: Of 1134 patients, 1109 (1281 biopsies) and 25 (26 biopsies) were assigned to the control and bridging group, respectively. Patient background did not significantly differ between the control and bridging groups, except for age, history of diabetes, cardiovascular diseases, and CHADS2 scores. Compared with the control group, the bridging group showed a significantly higher rate of complication for any complication (35% vs. 8.3%, P &lt; 0.001), bleeding-related complications (27% vs. 4.4%), and urinary tract infection (7.7% vs. 1.2%). No thromboembolic event was observed in the present study. Multivariate logistic analysis showed that heparin bridging therapy was a significant risk factor for the incidence of any complication and bleeding-related complications. Conclusions: Heparin bridging therapy with temporal discontinuation of antithrombotic agents may increase the risk of complications after TRUS biopsy. Further, large-scale studies are required to clarify the safety of heparin bridging therapy.

MP53-17 TRANSPERINEAL TEMPLATE PROSTATE BIOPSIES: THE NEW GOLD STANDARD FOR PROSTATE CANCER DIAGNOSIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2014MP53-17 TRANSPERINEAL TEMPLATE PROSTATE BIOPSIES: THE NEW GOLD STANDARD FOR PROSTATE CANCER DIAGNOSIS Shady Nafie, John Dormer, John Kilian Mellon, and Masood Ahmed Khan Shady NafieShady Nafie More articles by this author , John DormerJohn Dormer More articles by this author , John Kilian MellonJohn Kilian Mellon More articles by this author , and Masood Ahmed KhanMasood Ahmed Khan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1648AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Transrectal Ultrasound (TRUS) guided prostate biopsy is regarded as the gold standard for prostate cancer diagnosis. Transperineal template prostate biopsy (TPTPB) has been shown to improve prostate cancer detection in men with a rising PSA and previous negative TRUS guided prostate biopsies. We performed a prospective study directly comparing the prostate cancer detection rate between TRUS guided biopsy and TPTPB in 50 men with a benign feeling DRE, PSA < 20 ng/mL and no previous prostate biopsies. Methods 50 patients with a mean age of 67 years (range: 54-84), mean prostate volume of 58 cc (range:19-165) and mean PSA of 8 ng/L (range: 4-18) underwent standard 12-core TRUS guided prostate biopsy followed immediately by 36-core TPTPB under general anesthetic. We determined the prostate cancer detection rate between the two diagnostic modalities. Results A total of 20/50 (40%) men had benign pathology. Of the 30/50 (60%) diagnosed with prostate cancer 16 (32%) had positive results in both TRUS and TPTPB, while 14 (28%) had negative TRUS but positive TPTPB. Hence, TRUS guided prostate biopsy detected cancer in 32% whereas it was 60% with TPTPB. Furthermore, no cancers were detected solely by TRUS biopsy. In 19/30 (63%) the cancers detected by TPTPB had Gleason score ≥ 7. In total, 2 (4%) patients experienced urosepsis, 7 (14%) temporary urinary retention, 16 (32%) had mild haematuria and 19 (38%) haematospermia. Conclusions TPTPB is associated with a significantly higher prostate cancer detection rate compared to TRUS biopsies (60% vs. 32%, p<0.0001) in men with an elevated PSA < 20 ng/mL and a benign feeling prostate. We propose that TPTPB should be regarded as the biopsy technique of choice in this group of men. In addition, PSA appears to be a better biomarker for prostate cancer than previously thought. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e595 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Shady Nafie More articles by this author John Dormer More articles by this author John Kilian Mellon More articles by this author Masood Ahmed Khan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Magnetic resonance imaging-directed biopsy improves the prediction of prostate cancer aggressiveness compared with a 12-core transrectal ultrasound-guided prostate biopsy

The Gleason grading system is a fundamental indicator of the aggressive nature of prostate cancer (PCa). Diffusion-weighted imaging (DWI) and magnetic resonance (MR) spectroscopy (MRS) are methods for the assessment of PCa aggressiveness. The present study was designed to prospectively investigate whether transrectal ultrasound (TRUS)-guided MR imaging (MRI)-directed biopsies (TRUS‑MR‑Dbs) improve the prediction of PCa aggressiveness in comparison with 12-core TRUS-guided biopsies (TRUS‑Gbs). A total of 518 patients underwent pre-biopsy multi-parametric MRI to identify the clinically suspicious PCa regions. TRUS‑MR‑Dbs were performed on patients with suspected PCa by MRI in addition to TRUS‑Gbs. Only patients who underwent radical prostatectomy (RP) were included in the comparative analysis. TRUS‑biopsy was directed to those areas within suspicious regions with a minimum apparent diffusion coefficient obtained by DWI or with a maximum (choline + creatine)/citrate ratio obtained by MRS. The highest Gleason grades (HGGs) and the Gleason scores (GSs) of specimens were identified. The biopsies and RP results were evaluated using a McNemar test or χ2 analyses using Fisher' exact tests. MRI results were positive in 254 (49.0%) of the 518 patients. TRUS‑MR‑Db detected 165/254 (65.0%) cancer cases and TRUS‑Gb detected 190/518 (36.7%) cancer cases. Forty patients underwent RP. The TRUS‑MR‑Dbs method demonstrated a higher concordance rate (CR) with RP (89.6%) than TRUS‑Gbs (72.9%, P=0.008) for the overall HGG. The CRs with RP for TRUS‑MR‑Dbs vs. those for TRUS‑Gbs were 100 vs. 85.7% (P=0.5), 87.5 vs. 68.8% (P=0.031) and 50 vs. 50% (P=1) for HGG3, HGG4 and HGG5, respectively. The HGG CRs with RP for DWI‑directed biopsies (DWI-Dbs) vs. MRS-directed biopsies (MRS-Dbs) were 77.1 vs. 50.0% (P=0.015) for the overall tumors, 80.0 vs. 40.0% (P=0.003) for peripheral zone tumors and 69.2 vs. 76.9% (P=1) for transition zone tumors. A total of 37 (77.1%) and 25 (52.1%; P=0.007) tumors were assigned accurate GS for TRUS‑MR‑Dbs and TRUS‑Gbs, respectively. The results revealed that TRUS‑MR‑Dbs improved the prediction of PCa aggressiveness and that DWI-Dbs had a superior performance when compared with MRS‑Dbs in the peripheral zone.

Increasing Prostate-Specific Antigen Levels Differently Influence Prostate Cancer Detection Rates of Two Different 12-Core Prostate Biopsy Schemes

Objective: To compare two 12-core transrectal ultrasound-guided prostate biopsy schemes in respect to cancer detection rates. Methods: Retrospective, single-center analysis of consecutive patients (n = 897) who underwent prostate biopsy (S1) with all 12 cores from far lateral areas (n = 269) or prostate biopsy (S2) with 6 cores from parasagittal and 6 from far lateral areas (n = 628). Results: Crude cancer detection rates with S1 and S2 were similar (39.0 and 38.9% for the first biopsy and 29.4 and 31.3% for repeated biopsies, respectively). Abnormal digital rectal exam, lower prostate volume and higher prostate-specific antigen (PSA) levels were independently associated with higher odds of cancer detection. Regarding first biopsies (n = 747), there was significant interaction between biopsy scheme and PSA (p < 0.001). Overall, the adjusted odds of cancer detection were higher with S1 (S1/S2 odds ratio = 2.54, 95% CI: 1.12-5.74), but the S1-S2 relationship was conditional on PSA: odds ratios progressively increased with increasing PSA from 0.64 (95% CI: 0.40-1.02) at PSA 5 ng/ml to 39.1 (95% CI: 2.71-566) at 75 ng/ml. Conclusion: Higher PSA levels increase the probability of cancer detection with 12-core prostate biopsies, but relative efficiency of different procedures appeared conditional on the PSA level. Data suggest that PSA levels should be considered in the choice of prostate biopsy sampling scheme.

Two Procedures at the Same Robotic Session

A 66-year old male patient with right upper abdominal pain was diagnosed with cholelithiasis on abdominal ultrasound and elective laparoscopic cholecystectomy was recommended. His serum prostate-specific antigen was 21.3 ng/mL and underwent a 12-core transrectal ultrasound-guided prostate biopsy, which showed prostatic adenocarcinoma (Gleason score 4+4). Owing to the presence of concomitant cholelithiasis, we performed robot-assisted laparoscopic radical prostatectomy and robot-assisted laparoscopic cholecystectomy at the same session. Console time was 257 minutes. Intraoperative blood loss was 50 mL. Patient was fit to be discharged on postoperative day 2. Surgical specimen pathology showed a bilateral prostatic adenocarcinoma of Gleason score 4+3, with unilateral extracapsular extension and negative surgical margins. Currently, he is full continent with a serum prostate-specific antigen of 0.04 ng/mL on his first-month follow-up evaluation. Combined robotic approach seems to have many benefits including shorter hospital stay, decreased cost, decreased anesthesia risk, and better cosmetic results.

Prostate cancer diagnosis: should patients with prostate specific antigen >10 ng/mL have stratified prostate biopsy protocols?

Background: Trans-rectal ultrasound (TRUS) guided systematic prostate biopsy is a standard tool in prostate cancer (CaP) diagnosis. Extended biopsy techniques using 10–12 cores are the norm. Controversy exists on extended TRUS biopsy in men with PSA >10 ng/mL. We evaluated cancer detection rates on an individual core basis, to stratify prostate biopsy protocols based on PSA levels. Patients and methods: Over a five-year period, 1036 patients underwent TRUS guided prostate biopsy for raised serum PSA (>2.5 ng/mL). 436 patients had PSA >10 ng/mL. Patients with PSA <50 ng/mL underwent a 12-core TRUS guided prostate biopsy including six peripheral biopsies. The six peripheral biopsies were directed laterally towards the base, mid-zone and apices. Remainder were standard para-sagittal sextant biopsies. Patients were stratified into three groups (PSA 10–20 ng/mL, 20–50 ng/mL and >50 ng/mL). Results: Mean age of 436 patients with PSA >10 ng/mL was 70.3years. 270 (62%) men had cancer. Cancer detection rates for different PSA levels were 46% (10–20 ng/mL), 76% (20–50 ng/mL) and 93% (>50 ng/mL). Higher PSA levels and advanced clinical stage were associated with increased cancer detection rates. All patients with clinical T3 and T4 disease had biopsy diagnosed CaP. Conclusion: TRUS guided prostate biopsy in patients with PSA >10 ng/mL did not require 12 cores to diagnose CaP. CaP diagnosis required 8 cores in men with PSA 10–20 ng/mL. These cores were right and left peripheral basal and apical, and right and left para-sagittal basal and apical biopsy. Only 6 cores were necessary to diagnose CaP in men with PSA >20 ng/mL which were right and left peripheral basal and apical, and para-sagittal apical biopsies. We suggest limited TRUS prostate biopsy protocols for men with PSA >10 ng/mL.