Prostate Biopsy Protocol Research Articles

Which protocol for prostate biopsies in patients with a positive MRI? Interest of systematic biopsies by sectors.

Current prostate biopsy (PBx) protocol for prostate cancer (PCa) diagnosis is to perform systematic biopsies (SBx) combined with targeted biopsies (TBx) in case of positive MRI (i.e. PI-RADS ≥ 3). To assess the utility of performing SBx in combination with TBx, we determined the added value of SBx brought to the diagnosis of PCa according to their sextant location and MRI target characteristics. In our local prospectively collected database, we conducted a single-center retrospective study including all patients with a suspicion of PCa, who underwent transrectal ultrasound-guided (TRUS) prostate biopsies (PBx) with a prior MRI and a single lesion classified as PI-RADS ≥ 3. We have characterized the SBx according to their location on MRI: same sextant (S-SBx), adjacent sextant (A-SBx), ipsilateral side (I-SBx) and contralateral side (C-SBx). The added value of SBx and TBx was defined as any upgrading to significant PCa (csPCa) (ISUP ≥2). 371 patients were included in the study. The added value of SBx was 10% overall. Regarding the lesion location and the SBx sextant, the added value of SBx was: 5.1% for S-SBx, 5.4% for A-SBx, 4.9% for I-SBx and 1.9% for C-SBx. The overall added value of SBx was 6.8% for PI-RADS 3 lesions, 14% for PI-RADS 4 lesions and 6.7% for PI-RADS 5 lesions (p = 0.063). The added value of SBx for contralateral side was 1.9% (2/103), 3.1% (5/163) and 0% (0/105) for PI-RADS 3, PI-RADS 4 and PI-RADS 5 lesions, respectively (p = 0,4). The added value of SBx was lower when the number of TBx was higher (OR 0.57; CI 95% 0.37-0.85; p = 0.007). Our results suggest that the utility of performing SBx in the contralateral lobe toward the MRI lesion was very low, supporting that they might be avoided.

Novel sampling scheme with reduced cores in men with multiparametric MRI-visible lesions undergoing prostate biopsy.

To investigate the effects of various prostate biopsy protocols with reduced cores on the detection of clinically significant prostate cancer (csPCa) in individuals with MRI-visible lesions (Prostate Imaging Reporting and Data System ≥ 3). A total of 464 patients with MRI-visible lesions were recruited. All patients underwent two or more targeted biopsies (TB) and systematic biopsies (SB). Several hypothetical biopsy schemes were set-up: TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+SB of the targeted sector (TB+t-SB), and TB+SB of the non-targeted sector (TB+n-SB). A subgroup analysis of patients with multiple MRI-visible lesions was performed. The standard of reference was defined as TB+SB. McNemar test was used to compare csPCa detection rates between various sampling schemes. The detection rates for prostate cancer and csPCa were 72.8% (338 of 464) and 62.1% (288 of 464), respectively. There were 8.0%, 0.3%, 6.3%, 1.0%, and 4.5% cases in which TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+t-SB, and TB+n-SB would have missed csPCa, respectively. All hypothetical schemes, with the exception of TB+contralateral SB (p = 0.063), significantly outperformed TB alone in terms of csPCa detection (p < 0.05). As for the multi-focus cohort, which included 48 cases, none of the non-index lesions had a higher Gleason grade than the index lesions within the same patients. TB+ipsilateral SB might be the optimal biopsy scheme for detecting csPCa. As for the multi-focus cohort, the biopsy of the non-index lesions provided limited pathological information.

Evaluation of Initial 24-core Transrectal Prostate Biopsy on the Detection of Significant Prostate Cancer and High-grade Prostatic Intraepithelial Neoplasia

Abstract Purpose: The purpose of the study was to assess the diagnostic value of an initial 24-sample transrectal ultrasound-guided (TRUS) prostate biopsy protocol compared to the 10-core technique. Materials and Methods: We retrospectively reviewed the prostate biopsy database of consecutive men undergoing prostate biopsies under local anesthesia using the 10 (Group A) and 24 (Group B) protocols. Men were stratified according to biopsy protocol and prostate-specific antigen (PSA) levels. Exclusion criteria were age = 75 years and PSA &gt;20 ng/mL. The Mann–Whitney U and Fisher’s exact test were used for statistical analysis. Results: Between November 2018 and August 2020, 169 men underwent TRUS prostate biopsies. Group A (10-cores) consisted of 105 (62.13%) men and Group B (24-cores) included 64 (37.86%) men. The overall prostate cancer detection rate was 41.05% and 36.72% in Groups A and B, respectively (P = 0.48). An overall 9.8% increase in Gleason 7 detection rate was found in Group B (P = 0.24). The high-grade prostatic intraepithelial neoplasia (HGPIN) detection rate in men with negative initial biopsies was 15.54% and 35.55% in Groups A and B, respectively (P &lt; 0.001). In patients with PSA &lt;10 ng/mL, the 24-core technique increased Gleason 7 detection rate by 13.4% (P = 0.16) and HGPIN by 23.4% (P = 0.0008), compared to the 10-core technique. The 24-core technique increased the concordance between needle biopsy and prostatectomy specimen compared to the 10-core technique (P &lt; 0.002). Conclusions: The initial 24-core prostate biopsy protocol did not show any benefit in the detection of prostate cancer compared to the 10-core technique. However, it improved the HGPIN detection and the correlation between biopsy results and radical prostatectomy Gleason score in men with lower PSA levels.

Expedited Workflow for “One-Stop” Magnetic Resonance Imaging and Image Fusion Prostate Biopsy: Implementation and Lessons Learned

Abstract While the standard two-day workflow for magnetic resonance imaging guided ultrasound biopsy of the prostate grants flexibility to health care providers, a one-stop diagnostic pathway may benefit patients. A working relationship between radiology and urology is essential in implementing a streamlined workflow and built-in feedback loops to identify/prevent pitfalls as they arise. Another consideration is the overlap in patient populations at risk for prostate cancer and for poor outcomes from COVID19. Same day MRI and prostate biopsy protocols can reduce hospital/clinic visits and has the potential to optimize patient safety by minimizing the risk of COVID-19 exposure to high risk populations.

Sectoral cancer detection and tolerability of freehand transperineal prostate biopsy under local anaesthesia.

To investigate the feasibility of a freehand transperineal (TP) systematic prostate biopsy protocol under local anaesthesia (LA) and the value of different sectors in diagnosing prostate cancer (PCa). A total of 611 consecutive freehand TP biopsies under LA in 2 hospitals were prospectively evaluated. Cancer detection rate in each of the four different sectors (anterior, mid, posterior, basal) was recorded to evaluate the value of each sector. Procedure tolerability was assessed by pain score and complications were documented. Systematic biopsies were performed in 556 out of 611 men with a median of 20 (IQR 12-24) biopsy cores taken. The median PSA was 9.9 (Inter-quartile range[IQR] 6.4-16.2) ng/mL, and 89.0% were first biopsies. All PCa and ISUP grade group (GG) ≥ 2 PCa (HGPCa) were diagnosed in 41.4% (230/556) and 28.2% (157/556) biopsies respectively. 77.0% HGPCa was diagnosed in ≥2 sectors. Single-sector HGPCa was predominantly found in anterior or posterior sector. Omitting base sector would have missed 1.5% (1/65) HGPCa out of the 219 cases with ≥24-core biopsies performed. Further omission of mid sector would have missed 3.1% (2/65) HGPCa and 7.4% (7/94) ISUP GG1 PCa (in which 3/7 involved 2 sectors). LA TP biopsy was well tolerated and the mean pain scores of the different steps of the procedure were between 1.9-3.1 (out of 10). Post-biopsy fever occurred in 0.3% of patients (2/611) and no sepsis was reported. The risk of urinary retention in men with ≥20 cores in ≥60 ml prostate was 7.8% (14/179), compared with 1.7% (7/423) in other groups (p < 0.001). TP sectoral prostate biopsy under LA was well tolerated with minimal sepsis risk. Basal sector biopsies had minimal additional value to HGPCa detection and its omission can be considered.

Comparison of cross-sectional imaging techniques for the detection of prostate cancer lymph node metastasis: a critical review.

Conventional staging for prostate cancer (PCa) is performed for men diagnosed with unfavorable-intermediate or higher risk disease. Computed tomography (CT) of the abdomen and pelvis and whole body bone scan remains the standard of care for the detection of visceral, nodal, and bone metastasis. The implementation of the 2012 United States Preventive Services Task Force recommendation against routine prostate specific antigen (PSA) screening resulted in a rise of metastatic PCa at the time of diagnosis, emphasizing the importance of effective imaging modalities for evaluating metastatic disease. CT plays a major role in clinical staging at the time of PCa diagnosis, but multi-parametric magnetic resonance imaging (MRI) is now integrated into many prostate biopsy protocols for the detection of primary PCa, and may be a surrogate for CT for nodal staging. Current guidelines incorporate both CT and MRI as appropriate cross-sectional imaging modalities for the identification of nodal metastasis in indicated patients. There is an ongoing debate about the utility of traditional cross-sectional imaging modalities as well as advanced imaging modalities in detection of both organ-confined PCa detection and nodal involvement.

Effectiveness of a transrectal prostate needle biopsy protocol with risk-tailored antimicrobials in a veterans cohort

PurposeTo prospectively implement a prostate biopsy protocol to identify high-risk patients for bleeding or infectious complications and use risk-tailored antimicrobials, patient education, and postbiopsy monitoring with the objective of reducing complications. Materials and methodsOverall, 637 consecutive patients from June 2014 to August 2016 underwent prostate biopsy at our Veterans Affairs hospital. In the protocol cohort, patients were screened before biopsy and prophylaxis was tailored (high risk = ceftriaxone; low risk = ciprofloxacin). Patients were also provided additional education about bleeding and monitored for up to 1-hour. We defined complications as any deviation from normal postbiopsy activities. Comparisons were made between preprotocol/postprotocol cohorts. Logistic regression was used to identify risk factors for admissions or complications. ResultsMedian age was 67 years (IQR: 64–69, P = 0.29) in both groups (pre n = 334, post n = 303). Preprotocol, 99% patients received ciprofloxacin; postprotocol, 86% received ciprofloxacin and 14% received ceftriaxone (P<0.001). There were no deaths in either group. There were decreased 30-day complication and hospitalization rates in the postprotocol group (pre 15% vs. post 8.9%, P = 0.025; 3.3% vs. 1.0%, P = 0.048). Sepsis occurred in 2 patients preprotocol and no patients postprotocol. Postprotocol group was associated with decreased 30-day complications on multivariable logistic regression (OR = 0.58, 95% CI: 0.35–0.95, P = 0.031). ConclusionsA screening protocol before prostate biopsy is a targeted approach for selecting prophylactic antimicrobials and closer monitoring postbiopsy for bleeding. Our results suggest that the protocol has a favorable effect on complication and hospitalization rates.

Comparison of the diagnostic yield of various systematic randomized prostate biopsy protocols using prostate phantoms made of devil's tongue jelly

PurposeThe purpose of this study was to compare the diagnostic yield of five systematic randomized protocols using 12-20 biopsy cores with variably-sized phantoms.MethodsA total of 100 prostate phantom models were produced by casting liquid devil’s tongue jelly using silicone molds. Sets of 20 phantoms were created with the following volumes: 20 mL, 40 mL, 60 mL, 80 mL, and 100 mL. Three focal lesions were created by injecting 0.5 mL of warm agar solution stained with red, blue, and green ink into each phantom model. The focal lesions were verified by ultrasonography. The systematic randomized biopsy protocols consisted of 12, 14, 16, 18, and 20 biopsy cores. The diagnostic yield of the multiple systematic biopsy protocols was compared.ResultsThe overall detection rates of each model set were 93.3% for 20 mL, 88.3% for 40 mL, 71.7% for 60 mL, 43.3% for 80 mL, and 30.0% for 100 mL. Statistically significant differences in the detection rate were found between 40 mL and 60 mL and between 60 mL and 80 mL. No statistically significant increase in the detection rate was observed within a given volume set even when the number of core biopsies increased from 12 to 20.ConclusionThe diagnostic yield of systematic randomized biopsies is inversely proportional to the phantom volume.

PD42-02 LOWERING POSITIVE MARGIN RATES AT RADICAL PROSTATECTOMY BY COLOR CODING OF BIOPSY SPECIMENS TO PERMIT INDIVIDUALIZED PRESERVATION OF THE NEUROVASCULAR BUNDLES: IS IT FEASIBLE? A PILOT INVESTIGATION.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2018PD42-02 LOWERING POSITIVE MARGIN RATES AT RADICAL PROSTATECTOMY BY COLOR CODING OF BIOPSY SPECIMENS TO PERMIT INDIVIDUALIZED PRESERVATION OF THE NEUROVASCULAR BUNDLES: IS IT FEASIBLE? A PILOT INVESTIGATION. Wei Phin Tan, Patrick Whelan, Ritu Ghai, Shahid Ekbal, and Leslie Deane Wei Phin TanWei Phin Tan More articles by this author , Patrick WhelanPatrick Whelan More articles by this author , Ritu GhaiRitu Ghai More articles by this author , Shahid EkbalShahid Ekbal More articles by this author , and Leslie DeaneLeslie Deane More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1955AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ability of mpMRI to distinguish extracapsular extension from organ-confined disease when a lesion in is contact with the capsule remains poor and has very limited sensitivity. We aim to evaluate whether color-coding of core biopsy specimens aid in preservation of the neurovascular bundles on radical prostatectomy, from an oncological perspective. METHODS MRI guided transrectal ultrasound and biopsy of the prostate was performed in 51 consecutive patients suspected of being high risk for harboring prostate cancer. Core specimens were labeled with blue dye at the deep aspect and red dye at the superficial peripheral aspect of the core. The distance from the tumor to the end of the dyed specimen was measured to determine if there was an area of normal tissue between the prostate capsule and tumor (figure 1). RESULTS Of the 51 patients undergoing prostate biopsy, 30 (58.8 %) were found to have cancer of the prostate. This was Grade Group 1 in 13.7 %, 2 in 25.5 %, 3 in 7.8 %, 4 in 7.8 % and 5 in 3.9 % of the cohort. A total of 461 cores were analyzed in the cohort, of which 122 showed cancer. 4 patients opted to undergo robotic assisted laparoscopic radical prostatectomy. No patients had a positive surgical margin (PSM) or extra prostatic extension (EPE) on radical prostatectomy if there was a margin of normal prostatic tissue seen between the dye and the tumor on prostate biopsy. Color coding the specimen does not alter the cellular architecture, nor does it affect the integrity of DNA/RNA material, thus having no potential for impacting genomic assessment of the tissue for further clinical risk analysis and stratification. CONCLUSIONS Color-coding of prostate biopsy core specimens assists in tailoring the approach to preservation of the neurovascular bundles without compromising early oncological efficacy. Further study is required to determine whether this simple modification of the prostate biopsy protocol is valuable in larger groups of patients. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e814 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Wei Phin Tan More articles by this author Patrick Whelan More articles by this author Ritu Ghai More articles by this author Shahid Ekbal More articles by this author Leslie Deane More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcomes and Complications after Transrectal Ultrasound-Guided Prostate Biopsy

Objective: The use of 10–12-core systemic transrectal ultrasound (TRUS)-guided prostate biopsy protocols with extended-sampling has been an optimizing strategy for diagnosis of prostate cancer. In this study, we aim to examine the cancer detection rate (CDR) and the complications following prostate biopsy at our institution. Materials and Methods: We retrospectively reviewed medical data of patients who underwent TRUS-guided prostate biopsy between 2007 and 2013 at our institution. The pathological outcomes, major complications, and morbidities were recorded and assessed clinically. Results: During the study period, 425 patients who underwent TRUS-guided prostate biopsy were enrolled. The mean age of the participants was 67.9 years. Overall, 75 (17.6%) patients were diagnosed with prostate cancer. Cancer was detected in 0% (0/10), 7.0% (15/215), 16.5% (20/121), and 50.6% (40/79) of patients in the subgroups with patient prostate-specific antigen (PSA) &lt;4 ng/ml, 4–10 ng/ml, 10–20 ng/ml, and &gt;20 ng/ml, respectively. The optimal cutoff values of PSA density were 0.19, 0.29, and 0.78 in the subgroups with patient PSA 4–10 ng/ml, 10–20 ng/ml, and &gt;20 ng/ml. In total, 11 patients had afebrile urinary tract infections (UTI), 9 patients had febrile UTI, and another 2 patients had septic shock after biopsy. The overall incidence of infectious complications was 5.17% (22/425). Other complications were infrequent, consisting only of urinary retention in three patients, hematospermia in two patients, and acute hemorrhagic cerebellar infarction in 1 patient. Conclusion: Our study demonstrated the CDR, the incidence, and type of complications following TRUS-guided prostate biopsy. Further prospective studies are required to determine methods for reducing complications from prostate biopsy.

Lowering positive margin rates at radical prostatectomy by color coding of biopsy specimens to permit individualized preservation of the neurovascular bundles: is it feasible? a pilot investigation.

ABSTRACTObjective:To evaluate whether color-coding of prostate core biopsy specimens aids in preservation of the neurovascular bundles from an oncological perspective.Materials and Methods:MRI guided transrectal ultrasound and biopsy of the prostate were performed in 51 consecutive patients suspected of being at high risk for harboring prostate cancer. Core specimens were labeled with blue dye at the deep aspect and red dye at the superficial peripheral aspect of the core. The distance from the tumor to the end of the dyed specimen was measured to determine if there was an area of normal tissue between the prostate capsule and tumor.Results:Of the 51 patients undergoing prostate biopsy, 30 (58.8%) were found to have cancer of the prostate: grade group 1 in 13.7%, 2 in 25.5%, 3 in 7.8%, 4 in 7.8% and 5 in 3.9% of the cohort. A total of 461 cores were analyzed in the cohort, of which 122 showed cancer. Five patients opted to undergo robotic assisted laparoscopic radical prostatectomy. No patients had a positive surgical margin (PSM) or extra prostatic extension (EPE) on radical prostatectomy if there was a margin of normal prostatic tissue seen between the dye and the tumor on prostate biopsy.Conclusion:Color-coding of prostate biopsy core specimens may assist in tailoring the approach for preservation of the neurovascular bundles without compromising early oncological efficacy. Further study is required to determine whether this simple modification of the prostate biopsy protocol is valuable in larger groups of patients.

MP77-05 SIMPLE PROSTATE BIOPSY PROTOCOL WITH AUGMENTED ANTIBIOTICS DECREASES COMPLICATIONS AND ADMISSIONS IN VETERANS

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2017MP77-05 SIMPLE PROSTATE BIOPSY PROTOCOL WITH AUGMENTED ANTIBIOTICS DECREASES COMPLICATIONS AND ADMISSIONS IN VETERANS Kimberly A Maciolek, Sara L Best, Wade A Bushman, David F Jarrard, Tracy M Downs, E Jason Abel, and Kyle A Richards Kimberly A MaciolekKimberly A Maciolek More articles by this author , Sara L BestSara L Best More articles by this author , Wade A BushmanWade A Bushman More articles by this author , David F JarrardDavid F Jarrard More articles by this author , Tracy M DownsTracy M Downs More articles by this author , E Jason AbelE Jason Abel More articles by this author , and Kyle A RichardsKyle A Richards More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2113AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complications following prostate biopsy are rare but can be devastating. The American Urologic Association (AUA) Quality Improvement Summit in 2014 recommended identifying high risk patients and considering augmented antibiotics. We prospectively implemented a biopsy protocol to identify high-risk patients for bleeding or infections and use augmented antibiotics with the objective of reducing complications. METHODS Overall, 637 consecutive patients from June 1, 2014 to August 30, 2016, who underwent prostate biopsy at our Veterans Affairs hospital were evaluated. The prostate biopsy protocol required the provider to document infectious risk factors including prior UTI, antibiotic exposure, and/or recent biopsy to alert the prescriber to substitute IM ceftriaxone for oral ciprofloxacin in high-risk patients. Patients were also monitored closer for bleeding after the biopsy, especially those driving ≥2 hours. We defined complications as any deviations from normal post-biopsy activities. Comparisons were made between pre/post protocol cohorts, and logistic regression was used to identify risk factors for admissions or complications. RESULTS The median age was 67 (IQR 64-69, p=0.4) in both groups (pre n=334, post n=303). 45 patients were deemed high infectious risk with the following patient-reported events: 22 patients with antibiotics for recent UTI, 10 patients with history of complicated UTI/prostatitis, 16 patients with prostate biopsies within 6 months and 3 patients with clean intermittent catheterization or indwelling catheter. Pre-protocol, 98.8% patients received ciprofloxacin empirically; post-protocol, 85.7% received ciprofloxacin and 14.3% received ceftriaxone (p<0.001). There were no deaths in either group. The 30-day complication rates pre- and post-protocol were 16.2% and 8.5% (p=0.001) with infectious complication rates of 1.2% and 1.7% (p=0.74). There was a decrease in 30-day hospitalization rate in the post-protocol group vs. the pre-protocol group (1% vs. 3.6%, p=0.04). On logistic regression, there were reduced odds of 30-day complications (OR 0.48, p=0.004) and 30-day hospitalization (OR 0.27, p=0.04) in the post-protocol group. CONCLUSIONS A screening protocol for bleeding and infectious risks prior to prostate biopsy provides a more targeted approach for selecting prophylactic antibiotics and closer monitoring post-biopsy for bleeding. Rates of infection overall were quite low. Our results suggest that the protocol has a favorable impact on complication and hospitalization rates. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1023 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kimberly A Maciolek More articles by this author Sara L Best More articles by this author Wade A Bushman More articles by this author David F Jarrard More articles by this author Tracy M Downs More articles by this author E Jason Abel More articles by this author Kyle A Richards More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ultrasound analysis of seminal vesicles in prostate cancer invasion: monocentric experience of an extended prostate biopsy scheme.

At present, uniformity does not exist with regard to the indication criteria of seminal vesicle (SV) biopsies. The aim of this study was to define the ultrasonographic (US) patterns observed in SV invaded by prostate cancer (PCa), and propose an extended prostate biopsy protocol when SV invasion (SVI) is suspected. We reviewed 1.252 patients who underwent an initial transrectal ultrasound-guided prostate biopsy for suspicious PCa. We performed a 14-core biopsy scheme, as first intention, including 1 SV sample on each side when SVI is suspected: a nodule at the base of prostate (determined by digital rectal examination or US) and/or an US pattern that suggests a SVI. US patterns of SVs were classified as abnormal by a variation of the body anterior-posterior diameter, asymmetry of the volume, parietal thickness, distance between the SVs and the rectal surface, and altered echogenicity of SVs and the base of the prostate. Of the 137 biopsies performed in SVs, the SVI by PCa was diagnosed in 66.5% of candidate patients. The overall prevalence of SVI was 28.5%. No significant difference was noted between the patients with SVI and without SVI, when comparing age, prostate volume, and total core length, except for preoperative PSA serum levels. The sensitivity of any abnormal finding on transrectal ultrasound for the presence of SVI by PCa is 90.8%, whereas the specificity is 96%. We believe that an extended prostate biopsy protocol to provide the possibility of taking one biopsy core of each SV when SVI is suspected should be considered a complementary procedure for PCa staging.

A Prospective Randomized Trial Comparing the Vienna Nomogram and a Ten-Core Prostate Biopsy Protocol: Effect on Cancer Detection Rate

BackgroundWe evaluated whether the Vienna nomogram increases the detection rate of transrectal ultrasound-guided prostate biopsy compared with a 10-core biopsy protocol. Patients and MethodsIn the present prospective randomized study, men eligible for prostate biopsy were randomized to a Vienna nomogram protocol (group A) or a 10-core protocol (group B). They were further stratified according to age (≤ 65, > 65 but ≤ 70, and > 70 years) and prostate volume (≤ 30, > 30 but ≤ 50, > 50 but ≤ 70, and > 70 cm3). The cancer detection rate (CDR) was compared between the groups by logistic regression analysis, with adjustment for age as necessary, overall and with age and prostate volume stratification. Additional statistical analysis was performed with Fisher's exact test for contingency tables and the Mann-Whitney U test for 2 independent samples. P < .05 was considered statistically significant. A subgroup analysis was performed for patients with serum prostate-specific antigen levels of 2 to 10 ng/mL. ResultsFrom January 2009 to July 2010, 456 patients were enrolled, 237 to the Vienna nomogram group and 219 to the 10-core group. No significant differences were found in serum prostate-specific antigen or prostate volume between the 2 groups. Multivariate analysis with adjustment for age revealed no significant differences in CDR, with 42.6% in group A and 38.4% in group B (P = .705). When stratified by age and prostate volume, no statistically significant differences were found in the CDR between the groups in all subclasses. Also, in the subgroup analysis, CDR was not significantly different, 37.9% versus 34.7% for groups A and B, respectively (P = .891). ConclusionThese results study suggest that the use of the Vienna nomogram does not significantly increase the overall CDR compared with a 10-core biopsy scheme. Further prospective randomized studies, with adequate sample sizes, are needed to definitively determine the best prostate biopsy protocol.

Analysis of repeated 24-core saturation prostate biopsy: Inverse association between asymptomatic histological inflammation and prostate cancer detection.

Saturation prostate biopsy protocols have been developed to improve the prostate cancer (PCa) detection rate, particularly in the setting of repeat biopsies. The present study attempted to clarify the association between PCa detection and various risk factors in repeat saturation biopsies. A retrospective analysis was conducted on 78 Japanese patients for whom findings had caused suspicion of PCa despite previous negative prostate biopsies, and who consecutively underwent a 24-core transperineal repeat biopsy at Toyama University Hospital (Toyama, Japan). PCa was confirmed histologically in 16 of the 78 patients (20.5%). A univariate analysis revealed that the prostate-specific antigen (PSA) level at repeat biopsy was higher (P<0.01), the fPSA/tPSA ratio was lower (P=0.04), the total prostate volume was smaller (P=0.01) and the PSA density was higher (P<0.01) in PCa patients than in patients with benign prostatic disease (BPD). Histological inflammation was more frequently observed in BPD patients than in PCa patients (P<0.01). A multivariate analysis revealed that histological inflammation was the only independent predictor of the presence of a malignant lesion on repeat biopsy (odds ratio, 0.027; P=0.01). It must be considered that inflammation may cause a PSA increase in some patients with a negative initial biopsy, leading to unnecessary repeat biopsy.

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The goal of our analyses was to rationally stratify patients diagnosed with low-risk prostate cancer who were potentially eligible for active surveillance (AS) according to the scheme adopted at prostate biopsy. In this specific context, we demonstrated that patients who fulfilled the inclusion criteria for AS according to the Prostate Cancer Research International: Active Surveillance (PRIAS) study 1 Bul M. Zhu X. Valdagni R. et al. Active surveillance for low-risk prostate cancer worldwide: the PRIAS study. Eur Urol. 2013; 63: 597-603 Abstract Full Text Full Text PDF PubMed Scopus (387) Google Scholar with ≤12 cores taken at initial biopsy had a significantly lower probability of having an insignificant cancer confirmed and a higher risk of harboring an unfavorable disease at radical prostatectomy as compared with those patients whose biopsies consisted of 13-18 cores and 13-18 or ≥19 cores, respectively. Editorial CommentUrologyVol. 84Issue 3PreviewIn light of the increased role of prostate cancer risk stratification and wider introduction of active surveillance (AS) protocol for very low and low-risk prostate cancer in clinical practice, this article represents a significant input in development of initial optimal prostate biopsy protocol. In fact, in this manuscript authors used the criteria for AS according to Prostate Cancer Research International: Active Surveillance (PRIAS) study criteria. In fact, recently published short-term data from the PRIAS study comprise the world's largest patient cohort treated with AS protocol (ref.11). Full-Text PDF

Editorial Comment

In light of the increased role of prostate cancer risk stratification and wider introduction of active surveillance (AS) protocol for very low and low-risk prostate cancer in clinical practice, this article represents a significant input in development of initial optimal prostate biopsy protocol. In fact, in this manuscript authors used the criteria for AS according to Prostate Cancer Research International: Active Surveillance (PRIAS) study criteria. In fact, recently published short-term data from the PRIAS study comprise the world's largest patient cohort treated with AS protocol (ref.11).

Was a Change to a Urologist Owned Pathology Laboratory Associated with a Change in Prostate Biopsy Use?

IntroductionWe assessed the impact of self-referral to urologist owned pathology facilities on prostate biopsy practice patterns, clinical decision making and pathology service use. MethodsWe reviewed a transrectal ultrasound guided prostate biopsy database during 2 periods, including 1) August 5, 2008 to April 10, 2010 (613 days) when pathology samples were sent to an independent service laboratory, and 2) June 11, 2010 to February 13, 2012 (613 days) when samples were assessed at a urologist owned pathology laboratory. We also examined data on 3 additional preceding equal length periods before urologist ownership to determine baseline biopsy rates. Billing databases were used to identify the number of new patient visits for increased prostate specific antigen and/or abnormal digital rectal examination. The Student t-test, and Wilcoxon rank sum and chi-square tests were used for statistical comparisons. ResultsAll biopsies were obtained using a standard transrectal ultrasound guided prostate biopsy protocol. The biopsy rate in patients with increased or abnormal digital rectal examination was 39% during the urologist owned pathology laboratory era, and 35%, 40%, 35% and 40% during the 4 preceding independent service laboratory periods of equal length. There was no statistically significant difference in patient age, rate of abnormal digital rectal examination or indications for repeat transrectal ultrasound guided prostate biopsy among the periods. The prostate cancer detection rate was 45% in the independent service laboratory era and 46% in the urologist owned pathology laboratory era. ConclusionsSelf-referral of transrectal ultrasound guided prostate biopsy specimens to urologist owned pathology facilities was not associated with a significant variation in the biopsy rate, the repeat biopsy rate, indications triggering repeat biopsy or the cancer detection rate.

The 20-core prostate biopsy as an initial strategy: impact on the detection of prostatic cancer

To increase the detection rate of prostate cancer in recent years, we examined the increase in the number of cores taken at initial prostate biopsy. We hypothesized that an increasing number of cores may undermine the accuracy of models predicting the presence of prostate cancer at initial biopsy in patients submitted to 20-core initial biopsy. A total of 232 consecutive patients with prostate-specific antigen (PSA) between 4 and 20 ng/mL and/or abnormal digital rectal examination (DRE) underwent 12-core prostate biopsy protocol (group 1) or 20-core prostate biopsy protocol (group 2). The patients were divided into subgroups according to the results of their serum PSA and prostate volume. We evaluated the cancer detection rate overall and in each subgroup. Clinical data were analyzed using chi-square analysis and the unpaired t-test or 1-way ANOVA with significance considered at 0.05. The 2 groups of patients were not significantly different with regard to parameters (age, abnormal DRE and serum PSA), although median prostate volume in group 1 (57.76 +/- 26.94 cc) were slighter greater than in group 2. Cancer detection rate for patients submitted to 20 prostate biopsy was higher than patients submitted to 12 prostate biopsy (35.2% vs. 25%, p = 0.095). Breakdown to PSA level showed a benefit to 20 prostate biopsy for PSA <6 ng/mL (37.1% vs. 12.9%, p = 0.005). Stratifying results by prostate volume, we found that the improvement of cancer detection rate with 20 prostate biopsy was significant in patients with a prostate volume greater than 60 cc (55% in 20 prostate biopsy vs. 11.3% p < 0.05). Morbidity rates were identical in groups 1 and 2 with no statistically significant difference. There appeared to be no greater risk of infection and bleeding with 20 prostate biopsy protocol. The 20-core biopsy protocol was more efficient than the 12-core biopsy protocol, especially in patients with prostate specific antigen <6 ng/mL and prostate volume greater than 60 cc.

136 A randomized multicenter trial comparing 12 to 20-core prostate biopsy protocol

136 A randomized multicenter trial comparing 12 to 20-core prostate biopsy protocol