12-core Transrectal Biopsy Research Articles

The roles of fine needle aspiration and needle core biopsies in the diagnosis of primary prostatic cancer

For more than 50 years, needle core and aspiration biopsy techniques have been used to detect carcinoma of the prostate. Each has had vigorous proponents and many technical innovations have been made to improve the techniques. This report summarizes the developmental history of the techniques, examines their individual merits, reviews studies comparing the methods, and discusses the complications associated with each. Presently, in patients with abnormal rectal examinations, small-gauge transrectal core biopsy and transrectal aspiration biopsy offer similar detection and false-negative rates with very low frequencies of complications.

Prostate Cancer in Nonurological Patients with Normal Prostates on Digital Rectal Examination

Random systematic ultrasonographically guided transrectal core biopsies of the prostate were performed in 73 patients with pulmonary malignancies to exclude prostate cancer as a primary malignant neoplasm. Of the patients 41 had normal prostates as judged by digital rectal examination, 27 had firm prostates and 5 had clinical stage B nodules. Hypoechoic areas were seen on transrectal ultrasonography in 14 of the 41 patients (34%) with normal prostates. Biopsy of the hypoechoic areas in this subgroup detected only 1 grade II prostate cancer. In another patient with normal transrectal ultrasound grade I cancer was detected by mapping of the prostate with 6 systematic ultrasonographically guided transrectal core biopsies. Of the remaining 39 patients with normal prostates transrectal ultrasound detected no hypoechoic defect in 26, a specificity for the detection of prostate cancer of 67%.Multiple core biopsies revealed prostate cancer in 15 of the 32 cases of palpably abnormal prostates, including 12 that were hypoechoic. Prostate cancer is a rare histopathological finding in men with normal prostates on rectal examination. Transrectal ultrasound detected only 1 of 2 low volume prostate cancers in our study group. Thus, ultrasound seems to have little use in patients with prostates that appear normal on digital examination, and its specificity is low.

Effect of ultrasound guided core biopsy of prostate on serum concentration of prostate specific antigen and acid phosphatase activity.

Forty-three patients had their serum concentrations of prostate specific antigen and activity of tartrate inhibited acid phosphatase measured before and after digital rectal examination, transrectal ultrasonography and transrectal core biopsy. Transrectal core biopsy significantly increased the values for both tumor markers but rectal examination and ultrasonography without biopsy had no such effect. The measurements returned to normal within one week of biopsy in all but four patients who still had slightly increased concentrations of prostate specific antigen. We recommend that the concentration of prostate specific antigen and activity of tartrate inhibited acid phosphatase are checked before biopsy of the prostate is carried on.

Comparison of transrectal prostate digital aspiration and ultrasound-guided core biopsies in 99 men

We compared digital transrectal needle aspiration and transrectal core prostate biopsies obtained with ultrasound guidance in 99 men. Both procedures were effective in identifying prostate cancer; complete sensitivity was 94 percent for aspiration and 90 percent for core biopsy. Aspiration confirmed 87 percent of 38 known cancers and 94 percent of 81 cancers overall, compared with 82 percent and 90 percent with core biopsies. The greatest number of cancers was found when both procedures were considered (95% of known and 98% of all cancers). Grading of both specimens was performed but was not equivalent. Unsatisfactory or inconclusive results by either procedure often obtained when cancer was present. We suggest digital transrectal needle aspiration as a first means of identifying most palpable prostate lesions. Transrectal core biopsies guided by ultrasonography should be used when suspicion of cancer cannot be confirmed by aspiration and when there is no palpable lesion (but clinical suspicion of cancer).

Ultrasound of the Prostate and Its use for Guided Biopsy

The development of ultrasound diagnostics of the prostate is described. With modern ultrasound technique in combination with guided biopsy transrectal ultrasound (TRUS) is a powerful diagnostic means and very likely today's best screening tool (if screening would be regarded as feasible). The author advocates transrectal core biopsy instead of fine-needle aspiration biopsy as histology does not have false positives and forms a firmer basis for grading.

Franzán Transrectal Fine-Needle Biopsy Versus Ultrasound-Guided Transrectal Core Biopsy of the Prostate Gland

Digitally-guided transrectal fine-needle aspiration biopsy was compared with ultrasound-guided transrectal core biopsy of the prostate gland. Both biopsy techniques were equally effective in detecting prostate cancer. Core biopsies were generally graded higher than fine-needle aspirations. The reproducibility was approximately 80% for both methods.

Comparison of Fine-Needle Aspiration and Ultrasound-Guided Core Biopsy of Palpable Prostatic Lesions*

Digitally guided transrectal fine-needle aspiration (FNA) and sonographically guided transrectal core biopsy were performed in 55 patients with a palpably abnormal prostate. Prostate cancer was diagnosed in 25 (45%) of the cases by core biopsy, FNA biopsy, or both. The initial core biopsy showed benign disease in 12% (3/25) of the patients with prostate cancer compared with 8% (2/25) using fine-needle biopsy. Both FNA and ultrasound-guided biopsy are highly sensitive procedures; however, both are associated with false-negative results. In the present study, if either FNA or ultrasound-guided biopsy were performed alone then two or three cases of prostate cancer, respectively, would have been missed, whereas none of these cases would have been missed using both biopsy methods together. Perhaps combining FNA and ultrasound-guided core biopsy in selected patients with small abnormalities will provide greater sensitivity and patient convenience without significant additional morbidity.

Random Systematic Versus Directed Ultrasound Guided Transrectal Core Biopsies of the Prostate

Random systematic ultrasound guided transrectal core biopsies of the prostate were compared to directed biopsies of specific hypoechoic defects in 136 men with abnormal prostates on digital rectal examination. Prostate cancer was diagnosed in 83 of 136 patients (62 per cent). In 80 of 83 individuals (94 per cent) the cancer was detected by random systematic biopsies alone. Of 57 men in whom random systematic and directed biopsies were obtained the results of biopsy agreed in 86 per cent, while in 9 per cent random systematic biopsies found cancers missed by directed biopsies and in 5 per cent directed biopsies diagnosed cancers missed by random systematic prostate biopsies.Ultrasound guided random systematic biopsy is simple and easily learned. When combined with additional directed biopsies of the rare hypoechoic areas not included in the pattern of systematic sampling, it provides a highly accurate means to diagnose prostate cancer, minimizing observer and sampling errors.This technique of prostate mapping with 6, 1.5cm. cores provides valuable additional information on cancer volume, Gleason grade and the potential location of surgically positive margins, all without compromising the operation or the chance for a surgical cure.

Ultrasound Guided Transrectal Core Biopsies of the Palpably Abnormal Prostate

Ultrasound imaging and ultrasound guided transrectal core biopsies were performed in 251 consecutive men with abnormal prostates on digital rectal examination. A hypoechoic defect on ultrasound was identified in 227 of 251 patients (90 per cent) corresponding to the area of palpable nodularity or abnormal firmness. A mean of 6.25 biopsies were obtained per patient using a commercially available spring-loaded gun. Biopsies were positive for cancer in 165 of the 251 prostates (66 per cent). Palpable nodules more often were hypoechoic and more often contained cancer than less distinct areas of abnormal firmness on digital examination. Among the clinical stages Bl, B2 and B3 nodules 70, 76 and 88 per cent, respectively, were positive for cancer, as were 100 per cent of the clinical stage C prostates. Of 77 abnormally firm, nonnodular prostates 36 per cent were positive for cancer. Random biopsy of the contralateral normal lobe in 56 men with clinical stage Bl or B2 nodules showed cancer present contralaterally in 42 and 60 per cent, respectively; 20 per cent had positive biopsies despite a contralateral isoechoic ultrasound. In 78 patients with prior digitally guided biopsies, ultrasound guided biopsies confirmed previously diagnosed cancers in 94 per cent. However, in 23 of 43 patients (53 per cent) with previous negative digitally guided biopsies, ultrasound guided biopsies made the new diagnosis of cancer. Complications, including post-biopsy fever and bleeding, occurred in 6 of 251 patients (2.4 per cent). The combination of the new spring-loaded biopsy guns and transrectal ultrasound guidance of biopsies provides the urologist with a tool that allows multiple prostate cores to be obtained safely and painlessly, reducing the sampling error and increasing the accuracy in diagnosing prostate cancer in the man with a palpable abnormality of the prostate.

Basal Cells of Prostate in Fine-Needle Aspiration

Fine-needle aspiration in conjunction with a transrectal core biopsy was performed on a 58-year-old man who presented with a prostate nodule. The aspirate contained many cell clusters that were negative for prostatic acid phosphatase and cytologically appeared to be basal cells. The entity of basal cell hyperplasia of the prostate is discussed with reference to its appearance in aspiration cytologic examination. Emphasis is placed upon the possibility that these cells may be mistaken for cancer cells.

Needle Biopsy of the Prostate: A Re-evaluation

Needle Biopsy of the Prostate: A Re-evaluation