Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Are extended biopsies really necessary to improve prostate cancer detection?

Prostate Cancer and Prostatic Diseases volume 6, pages 250–255 (2003)Cite this article

Abstract

The aim of this study is to understand the value of specific sites in extended peripheral and transition zone biopsy schemes in order to define the optimal systematic biopsy regimen correlated with the percentage of positivity of each single bioptic site. A total of 165 consecutive patients underwent transrectal ultrasonography examination to detect prostate cancer followed by a lesion-directed and systematic 14-step biopsy scheme. The detection rate was examined for the lesion-directed and for each zone region biopsy. The frequency of positive biopsies in the various prostate regions was determined to evaluate the diagnostic yield of each biopsy site. Analysis was stratified for prostate-specific antigen (PSA), free-to-total PSA ratio, age, prostate size and digital rectal examination. The biopsy protocol detected 40% of patients (66/165) as positive and 55.1% (91/165) as negative for cancer. Standard sextant biopsy was expected to detect only 51 cancer on 66, lateral peripheral (PZ), transition (TZ) and central zone (CZ) biopsies only 56 cancer on 66, while the combination of sextant, PZ, TZ and CZ biopsies, for a total of 14 zone biopsies, detected 64 on 66 patients with cancer (97%) at recruitment. Sampling only the eight prostate regions with higher frequency of positive cancer biopsy was expected to detect 61 cancer patients against the 64 found with the 14-step scheme. This eight-biopsy regimen outperforms the conventional sextant regimen in cancer detection rate (93 vs 77%) and has an overall detection rate lower by only 3.1% (36.9 vs 40%) compared to the 14-biopsy regimen. This difference in detection rate is even smaller in patients with PSA values <10 ng/ml, age <70 y and prostate size <50 ml. This eight-biopsy scheme, including sampling in PZ and TZ toward the base, should be considered in an initial biopsy scheme to maintain a similar detection rate of an extensive biopsy scheme reducing the number of biopsies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Hodge KK, Mc Neal JE, Terris MK, Stamey TA . Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989; 142: 71–74.

    Article  CAS  Google Scholar 

  2. Flanigan RC et al. Accuracy of digital rectal examination and transrectal ultrasonography in localizing prostate cancer. J Urol 1994; 152: 1506–1509.

    Article  Google Scholar 

  3. Naughton CK et al. Clinical and pathologic tumor characteristics of prostate cancer as a function of the number of biopsy cores: a retrospective study. Urology 1998; 52: 808–813.

    Article  CAS  Google Scholar 

  4. Keetch DW, Catalona WJ, Smith DS . Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. J Urol 1994; 151: 1571–1574.

    Article  CAS  Google Scholar 

  5. Ellis WJ, Brawer MK . Repeat prostate needle biopsy: who needs it?. J Urol 1995; 153: 1496–1498.

    Article  CAS  Google Scholar 

  6. Stamey TA . Making the most out of six systematic sextant biopsies. Urology 1995; 45: 2–12.

    Article  CAS  Google Scholar 

  7. Eskew LA, Bare RL, McCullough DL . Systematic 5 region prostate biopsy strategy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol 1997; 157: 199–202.

    Article  CAS  Google Scholar 

  8. Durkan GC et al. Improving prostate cancer detection with an extended-core transrectal ultrasonography-guided prostate biopsy protocol. BJU Int 2002; 89: 33–39.

    Article  CAS  Google Scholar 

  9. Chen ME et al. Comparison of prostate biopsy schemes by computer simulation. Urology 1999; 53: 951–960.

    Article  CAS  Google Scholar 

  10. Bauer JJ et al. Three dimensional computer-simulated prostate models: lateral prostate biopsies increase the detection rate of prostate cancer. Urology 1999; 53: 961–967.

    Article  CAS  Google Scholar 

  11. Matlaga BR, Eskew LA, Mc Cullogh DL . Prostate biopsy: indications and technique. J Urol 2003; 169: 12–19.

    Article  Google Scholar 

  12. Cheville JC, Reznicek MJ, Bostwick DG . The focus of ‘atypical glands, suspicious for malignancy’ in prostatic needle specimens. Incidence, histologic features, and clinical follow-up of cases diagnosed in a community practice. Am J Clin Pathol 1997; 108: 633–695.

    Article  CAS  Google Scholar 

  13. Wills ML et al. Incidence of high grade prostatic intraepithelial neoplasia in sextant needle biopsy specimens. Urology 1997; 49: 367–373.

    Article  CAS  Google Scholar 

  14. Bostwick DG . Prospective origins of prostate carcinoma. Prostatic intraepithelial neoplasia and atypical adenomatous hyperplasia. Cancer 1996; 78: 330.

    Article  CAS  Google Scholar 

  15. Park S, Shinohara K, Grossfeld GD, Carroll PR . Prostate cancer detection in men with prior high grade prostatic intraepithelial neoplasia or atypical prostate biopsy. J Urol 2001; 165: 1409–1412.

    Article  CAS  Google Scholar 

  16. O' dowd GJ et al. Analysis of repeated biopsy results within 1 year after a noncancer diagnosis. Urology 2000; 55: 553–559.

    Article  CAS  Google Scholar 

  17. Riffenburgh RH, Amling CL . Use of early PSA velocity to predict eventual abnormal PSA values in men at risk for prostate cancer. Prostate Cancer Prostatic Dis 2003; 6: 39–44.

    Article  CAS  Google Scholar 

  18. Uzzo RG et al. The influence of prostate size on cancer detection. Urology 1995; 46: 831–836.

    Article  CAS  Google Scholar 

  19. Karakiewicz PI et al. Outcome of sextant biopsy according to gland volume. Urology 1997; 49: 55–59.

    Article  CAS  Google Scholar 

  20. Mc Neal JE, Redwine EA, Freiha FS, Stamey TA . Zonal distribution of prostatic adenocarcinoma: correlation with histological pattern and direction of spread. Am J Surg Pathol 1988; 12: 897–906.

    Article  CAS  Google Scholar 

  21. Lindert KA . Bacteremia and bacteriuria after transrectal ultrasound guided prostate biopsy. J Urol 2000; 164: 76–80.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urologic Clinic, Magna Graecia University of Catanzaro, Italy

    R Damiano, A Oliva, F Cantiello & R Sacco

  2. Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Italy

    C Esposito

  3. Urologic Clinic, Second University of Naples, Italy

    R Autorino, S Perdonà, M De Sio & M D'Armiento

  4. Department of Oncology, Federico II University of Naples, Italy

    G Di Lorenzo

Authors
  1. R Damiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Autorino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Perdonà
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M De Sio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Oliva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F Cantiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G Di Lorenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R Sacco
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M D'Armiento
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R Damiano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Damiano, R., Autorino, R., Perdonà, S. et al. Are extended biopsies really necessary to improve prostate cancer detection?. Prostate Cancer Prostatic Dis 6, 250–255 (2003). https://doi.org/10.1038/sj.pcan.4500671

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.pcan.4500671

Keywords

This article is cited by

Search

Advanced search

Quick links