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

2013 ◽  
Vol 4 (2) ◽  
pp. 100 ◽  
Author(s):  
Mohamed Amine Jradi ◽  
Mohamed Dridi ◽  
Mourad Teyeb ◽  
Mokhtar Ould Sidi Mohamed ◽  
Ramzi Khiary ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Prostate Volume ◽  
Cancer Detection Rate ◽  
Dépistage Du Cancer ◽  
Biopsy Protocol ◽  
Group 2 ◽  
Group 1

Introduction: To increase the detection rate of prostate cancer inrecent years, we examined the increase in the number of corestaken at initial prostate biopsy. We hypothesized that an increasingnumber of cores may undermine the accuracy of models predictingthe presence of prostate cancer at initial biopsy in patientssubmitted to 20-core initial biopsy.Methods: A total of 232 consecutive patients with prostatespecificantigen (PSA) between 4 and 20 ng/mL and/or abnormaldigital rectal examination (DRE) underwent 12-core prostate biopsyprotocol (group 1) or 20-core prostate biopsy protocol (group 2).The patients were divided into subgroups according to the resultsof their serum PSA and prostate volume. We evaluated the cancerdetection rate overall and in each subgroup. Clinical datawere analyzed using chi-square analysis and the unpaired t-testor 1-way ANOVA with significance considered at 0.05.Results: The 2 groups of patients were not significantly different withregard to parameters (age, abnormal DRE and serum PSA), althoughmedian prostate volume in group 1 (57.76 ± 26.94 cc) were slightergreater than in group 2. Cancer detection rate for patients submittedto 20 prostate biopsy was higher than patients submitted to 12prostate biopsy (35.2% vs. 25%, p = 0.095). Breakdown to PSAlevel 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, wefound that the improvement of cancer detection rate with 20 prostatebiopsy was significant in patients with a prostate volume greaterthan 60 cc (55% in 20 prostate biopsy vs. 11.3% p < 0.05). Morbidityrates were identical in groups 1 and 2 with no statistically significantdifference. There appeared to be no greater risk of infectionand bleeding with 20 prostate biopsy protocol.Conclusion: The 20-core biopsy protocol was more efficient thanthe 12-core biopsy protocol, especially in patients with prostatespecific antigen <6 ng/mL and prostate volume greater than 60 cc.Introduction : Pour augmenter le taux de détection du cancer de laprostate dans un avenir rapproché, nous avons examiné l’incidenced’une hausse du nombre de carottes prélevées lors de la biopsieprostatique initiale. Notre hypothèse était qu’en raison du nombreaccru de prélèvements, la biopsie à 20 carottes pouvait réduirel’exactitude des modèles de dépistage du cancer de la prostate à labiopsie initiale.Méthodologie : Au total, 232 patients consécutifs avec des tauxd’antigène prostatique spécifique (APS) situés entre 4 et 20 ng/mLet/ou des anomalies au toucher rectal ont subi une biopsie prostatiqueà 12 (groupe 1) ou à 20 carottes (groupe 2). Les patients ontété répartis en sous-groupes en fonction de leurs taux sériques d’APSet de leur volume prostatique. Nous avons évalué le taux de dépistagedu cancer de façon globale et par sous-groupes. Les données cli -niques ont été analysées par la méthode du chi carré et du test tpour échantillons non appariés ou par analyse unilatérale de lavariance (ANOVA), avec un seuil de signification de 0,05.Résultats : On n’a noté aucune différence significative entre lesdeux groupes quant aux paramètres (âge, anomalie au toucher rectalet taux sériques d’APS), malgré que le volume prostatique médianait été légèrement supérieur dans le groupe 1 (57,76 ± 26,94 mL)par rapport au groupe 2. Le taux de dépistage du cancer avec labiopsie prostatique à 20 carottes était plus élevé que le taux obtenuavec la biopsie à 12 carottes (35,2 % vs 25 %, p = 0,095). La répartitiondes patients en fonction des taux d’APS a fait ressortir unavantage pour la biopsie à 20 carottes lorsque les taux d’APS étaientinférieurs à 6 ng/mL (37,1 % vs 12,9 %, p = 0,005). La stratificationdes données selon le volume de la prostate a montré que lahausse des taux de dépistage du cancer associée à la biopsie prostatiqueà 20 carottes était significative lorsque le volume prostatiquedépassait 60 mL (55 % pour la biopsie à 20 carottes vs 11,3 %,p < 0,05). Les taux de morbidité étaient semblables dans les deuxgroupes, la différence n’étant pas significative sur le plan statistique.La biopsie prostatique à 20 carottes ne semblait pas associéeà un risque plus élevé d’infection et d’hémorragie.Conclusion : La biopsie à 20 carottes était plus efficace que la biopsieà 12 carottes, surtout chez les patients dont le taux d’APS était

Complications and Prostate Cancer Diagnosis Rate of TRUS Prostate Biopsies Using 16 and 18G Needles by Clavien Scoring

2017 ◽  
Vol 84 (4) ◽  
pp. 236-239 ◽  
Author(s):  
Serkan Ozcan ◽  
Mehmet Akif Diri ◽  
Murat Bagcioglu ◽  
Tolga Karakan ◽  
Arif Aydın
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Daily Basis ◽  
Cancer Detection Rate ◽  
Detection Rates ◽  
Prostate Biopsies ◽  
Group 2 ◽  
Group 1

Aim We aimed to compare the 18 and 16-Gauge (G) needles used in transrectal ultrasonography (TRUS)-guided needle biopsy for cancer detection rates and complications using the Clavien Scoring System. Materials and Methods The 80 patients who were included in the study were randomized and divided into two groups. Group 1 (n = 36) had a TRUS-guided prostate biopsy with an 18G needle and Group 2 had a 16G needle (n = 44). The hematuria, bleeding assessment, and infection events were evaluated on a daily basis. These complications were graded according to the Clavien Scoring. Results In Group 1, only five (13%) patients were diagnosed with prostate cancer, and three patients were reported to have atypical small acinar proliferation (ASAP). In Group 2, 16 (36%) patients were diagnosed with prostate cancer and one patient was reported to have ASAP. The difference in the prostate cancer detection rate between the groups was statistically significant. According to the Clavien grading system, the complications were at the Grade 1 level in 25 people in Group 1 in 29 people in Group 2. Grade 2 level complications were not observed in either group. While one person was Grade 3 in Group 1, two people in Group 2 had this rate. There were no significant differences between the groups. Conclusions We found that cancer detection rate increased by increasing the thickness of the needle used in TRUS-guided prostate biopsy without any increase in the complications.

scholarly journals 10-Year Experience in Performing Saturation Prostate Biopsy

2017 ◽  
Vol 57 (4) ◽  
pp. 430-437
Author(s):  
Luis Gabriel Villarraga ◽  
Jose Gustavo Ramos ◽  
José De La Hoz ◽  
Juan Guillermo Cataño Cataño
Keyword(s):  
Prostate Cancer ◽  
Regression Model ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Prostate Volume ◽  
Univariate Analysis ◽  
Cancer Detection Rate ◽  
Wilcoxon Test ◽  
Prostate Cancer Detection

Objective: Identify the prostate cancer detection rate in patients in whom underwenta saturation prostate biopsy as a rebiopsy from January 2005 to February 2015 at SanIgnacio Hospital. Materials and methods: In San Ignacio hospital were performedfrom January 2005 to February 2015, 114 saturation biopsies. The investigatorsmade a univariate analysis of the variables. The association between the variable wasevaluated based on the T-test and Wilcoxon test. P < 0.05 was considered statisticallysignificant. Finally, a regression model was performed to predict significant variablesfor prostate cancer. Results: The cancer detection rate using saturation prostate biopsywas 16.7% of which 84% were categorized as significant. A mean of 19 cores wereobtained. There were statistically significant differences between patients with prostatecancer and healthy patients in the number of previous biopsies, number of samples,prostate volume and PSA density. Conclusion: Saturation prostate biopsy in our studyhas a prostate cancer detection rate of 16.7% and 84% of them were significant in thiscohort of patients.

scholarly journals The sufficiency of 6 core sextant prostate biopsy in patients with prostate specific antigen (PSA) values over 20 ng/mL

2018 ◽  
Vol 90 (2) ◽  
pp. 104 ◽  
Author(s):  
Cem Yücel ◽  
Salih Budak ◽  
Erdem Kısa ◽  
Orcun Celik ◽  
Zafer Kozacıoglu
Keyword(s):  
Cancer Detection ◽  
Prostate Biopsy ◽  
Core Biopsy ◽  
Detection Rate ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Cancer Detection Rate ◽  
Benign Pathology ◽  
Total Psa ◽  
Group 1

Objective: In this study, we aimed to investigate sufficiency of 6 core prostate biopsy in patients with PSA levels elevated above 20 ng/mL. Materials and methods: The medical record of the patients who received prostate biopsy at our institution between August 2011 to August 2016 who had serum total PSA values above 20 ng/mL, were reviewed retrospectively. In this study, we included 40 patients who received 6 core prostate biopsy and 40 patients who received 12 core prostate biopsy. A total number of 80 patients were enrolled in this study. Patients were divided into two groups, a 6 core biopsy group and a 12 core biopsy group. These groups are compared according to age, total PSA, prostate volume and final pathological diagnosis.Results: Based on final pathological diagnosis, 2 patients (5%) had benign pathology and 38 patients (95%) had PCa in both group 1 and 2. The cancer detection rate in both groups was 95%. Although there were higher values of mean age, mean total PSA, and mean prostate volume in group 1, there was no statistically significantly difference at this variables in both groups. Conclusion: Although taking 6 core biopsies is not recently recommended, we proved that 6 core biopsy is adequate for patients with PSA values above 20 ng/mL.

scholarly journals The eternal enigma in prostatic biopsy access route

2017 ◽  
Vol 89 (3) ◽  
pp. 245 ◽  
Author(s):  
Andrea Fabiani ◽  
Emanuele Principi ◽  
Alessandra Filosa ◽  
Lucilla Servi
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Digital Rectal Examination ◽  
Cancer Detection Rate ◽  
Prostatic Biopsy ◽  
Patient Age ◽  
Rectal Examination ◽  
Transperineal Prostate Biopsy

Dear Editors,We read with interest the article by Di Franco and co-workers (1). The introduction of prostatic magnetic resonance and the relative fusion-biopsy have not yet allowed the expected improvements in prostate biopsy. To our knowledge, there are no works that demonstrate the superiority of fusion techniques on the remaining ultrasound guided prostate biopsies that are still the widely used in the diagnosis of prostate cancer. Furthemore, these technologies are expensive exams and they are not yet available in all centers, especially in those minors. We work at a “minor” center and we always keep in mind that the goal of  prostatic biopsy is the diagnosis and the staging of prostatic neoplasms.. However, it remains uncertain which of the two techniques, transperineal (TP) or transrectal (TR), is superior in terms of detection rate during first biopsy setting. Several studies have compared the prostate cancer detection rate but TR and TP access route in prostatic gland sampling seems to be equivalent in terms of efficiency and complications, as reported by Shen PF et al. (2), despite several methodological limitations recognized in their work. The results reported by Di Franco CA et al. represent the real life experience of most urologists that perform the PB based on their own training experience and available technical devices. From an historical viewpoint, the TP route has been the first one to be used to reach the prostate, both for diagnostic and therapeutic purposes. To date, because it seems to be more invasive and difficult, the TP route is less used worldwide than the TR one (2). Theoretically, the TP approach should detect more prostate cancer than the TR way  because the cores of the TP approach are directed longitudinally to the peripheral zone and the anterior part of the prostate (4). The results reported by Di Franco et al. seems to confirm these considerations. However, our real life experience differ from the conclusions reached in their work. We recently conducted a prospective evaluation of 352 patients who underwent their first prostate biopsy because of a suspicious of prostate cancer (elevated prostate specific antigen (PSA) and/or abnormal digital rectal examination and/or abnormal findings on transrectal prostatic ultrasound). Patients was randomized as following. A total of 187 patients (Group A) underwent a prostatic biopsy with a transperineal approach in a lithotomic position,  using a biplane probe (8818 BK Medical, Denmark) and a fan technique with a single perineal median access (5). The remnants 165 patients (Group B) underwent a transrectal ultrasound guided prostate biopsy in a left lateral position, using a end fire probe configuration (8818 BK Medical, Denmark) and a sagittal technique. The bioptic prostatic mapping was performed with a 12-core scheme sec. Gore (3) by a single experienced operator and the histopathologic evaluation was performed by a single dedicated uro-pathologist. Statistical evaluations were made with a T Student test  (p<0,005). Group A and Group B was similar in term of mean patient age (67,9 years and 67 years respectively), mean total PSA (12,1 ng/ml vs 12 ng/ml) and digital rectal examination positivity (22% vs 29%).  The global cancer detection rate was 33,69% (63/187) in the transperineal prostate biopsy group and 48,48 % (80/165) in the transrectal approach (p=0.0047).  No significant statistical differences were found in the complications rates between the two groups. Statistical evaluation of site of tumor localization reveal only a trend to statistical significance in apical site tumors diagnosed with the TR approach versus the TP technique. The TR approach had a better diagnostic accuracy than TP technique in case of PSA<4 ng/ml, intermediate prostate volume (30 and 50 ml), normal digital rectal examination without any relationship with the patient age. In our experience, two aspect may explain the difference between the two group in term of global detection rate. First, we usually perform transrectal biopsy with a sagittal technique that simulates the transperineal way of needle incidence with the prostatic gland. The lateral and anterior gland portions may be sampled more accurately. Second, our transperineal approach consists in a single perineal median access that can make more difficult the gland sampling between the two lobes. However, there was no significant difference in core positivity rate at the peripheral zone, medium gland, apex or any other site such as reported in many randomized clinical trials (2). Unlike the conclusions reported by Di Franco et al., in our experience we found a statistically significant difference between the TR and TP approach, at the first biopsy setting, in term of global cancer detection rate. No differences were found in terms of complications. Moreover, our data suggest that TR approach had a better diagnostic accuracy than TP technique in case of  PSA<4 ng/ml, prostate volume 30-50 ml, normal digital rectal examination without any relationship with the patient age. The further step of the statistical evaluation of our data will be the definition of the possibility that the TR biopsy determine a better staging of prostate cancer than TP approach as first procedure.    REFERENCES 1)      Di Franco CA, Jallous H., Porru D. et al. A retrospective comparison between transrectal and transperineal prostate biopsy in the detection of prostate cancer Arch Ital Urol Androl 2017; 89(1), 55-92)      Shen FP, Zhu YC, Wei WR et al. The results of transperineal vs transrectal prostate biopsy: a systematic review and meta-analysis. Asian Journal of Androl 2012; 14: 310-15.3)      Gore JL., Shariat SF, Miles BJ., et al. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol 2001; 165: 1554-59.  4)      Abdollah F., Novara G., Briganti A. et al. Trasrectal versus transperineal saturation re biopsy of the prostate: is there a difference in cancer detection rate? Urology 2011; 77:9215)      Novella G, Ficarra V, Galfano A, et al. Pain assessment after original transperineal prostate biopsy using a coaxial needle. Urology. 2003; 62 : 689-92. 

POS-03.91: Can the prostate cancer detection rate be improved with a saturation technique of prostate biopsy?

Urology ◽  
2007 ◽  
Vol 70 (3) ◽  
pp. 300-301 ◽  
Author(s):  
S. Mallick ◽  
F. Comoz ◽  
S. Le Toquin ◽  
Y. Fouques ◽  
C. Jeanne-Pasquier ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Cancer Detection Rate ◽  
Prostate Cancer Detection

scholarly journals 3D versus 2D Systematic Transrectal Ultrasound-Guided Prostate Biopsy: Higher Cancer Detection Rate in Clinical Practice

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Alexandre Peltier ◽  
Fouad Aoun ◽  
Fouad El-Khoury ◽  
Eric Hawaux ◽  
Ksenija Limani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Transrectal Ultrasound ◽  
Daily Practice ◽  
Cancer Detection Rate ◽  
Prior History ◽  
Detection Rates ◽  
Significant Difference

Objectives. To compare prostate cancer detection rates of extended 2D versus 3D biopsies and to further assess the clinical impact of this method in day-to-day practice.Methods. We analyzed the data of a cohort of 220 consecutive patients with no prior history of prostate cancer who underwent an initial prostate biopsy in daily practice due to an abnormal PSA and/or DRE using, respectively, the classical 2D and the new 3D systems. All the biopsies were done by a single experienced operator using the same standardized protocol.Results. There was no significant difference in terms of age, total PSA, or prostate volume between the two groups. However, cancer detection rate was significantly higher using the 3D versus the 2D system, 50% versus 34% (P<0.05). There was no statistically significant difference while comparing the 2 groups in term of nonsignificant cancer detection.Conclusion. There is reasonable evidence demonstrating the superiority of the 3D-guided biopsies in detecting prostate cancers that would have been missed using the 2D extended protocol.

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