Optimal number of transrectal biopsy cores according to prostate volume for cancer detection

Congress:

ECR 2012

Poster Number:

C-0098

Type:

Scientific Exhibit

Keywords:

Genital / Reproductive system male, Ultrasound, Biopsy, Neoplasia

Authors:

N. Boukadoum¹, C. H. Kaidi¹, A. Chouakria¹, A. Lankar¹, A. Kadi¹, S. Draquat²; ¹Annaba/DZ, ²Constantine/DZ

DOI:

10.1594/ecr2012/C-0098

DOI-Link:

https://dx.doi.org/10.1594/ecr2012/C-0098

Fig. 1: Diagram showing 12-core TRUS-guided biopsy.

Fig. 2: packaging of each core biopsy in an independent container

Fig. 3: Inclusion of two cores from each sextant in paraffin

Table 1: Prostate cancer detection rate of the 12-cores biopsy protocol according to...

Purpose

Since the introduction of the systematic sextant biopsy protocol by Hodge, several groups have demonstrated that standard sextant prostate biopsies significantly underestimate cancer and proposed more extensive biopsy schemes involving 10–18 cores. The most efficient number of prostate biopsies remains a matter of debate. Many studies showed an inverse relationship between prostate size and the likelihood of detecting prostate cancer in a sampling. For this reason, the ideal number of cores to be taken may depend on the size of the gland as calculated by...

Methods and Materials

From November 2009 to November 2010 we enrolled 167 consecutive patients with a suspicion of prostate cancer (prostate specific antigen greater than 4 ng/ml and/or positive digital rectal examination). We excluded from the present analysis the patients who underwent a re-biopsy after one or more previous negative sets and the patients who underwent the first set of biopsy for a PSA greater than 20 ng/ml. All patients were adequately informed about the method of execution of the procedure and its potential complications and were asked...

Results

Median patient age was 70 years (range 56 to 86), median total PSA was 12.5 ng/ml (range 4 to 19,9) and median prostate volume was 66.47 cc (range 18 to 164) in the whole study group. Digital rectal examination was not suspicious in 116 of the 167 patients (69.5%). Suspicious lesions were detected on ultrasonography in 61 of the 167 patients (36.5%), which revealed cancer in 32 patients. With 12-core scheme, prostate cancer was detected in 55 patients (33%). Gleason score was 6 in a...

Conclusion

TRUS-guided prostate biopsy is a safe procedure. Prostate volume is the most relevant variable in the planning of the optimal number of cores in the first biopsy set. A protocol with more than 10 peripheral cores is only recommended in patients with prostate volume larger than 70 cc.

References

Vashi, A., R., Wojno, K. J., Gillespie, B. and Oesterling, J. E.: A model for the number of cores per prostate biopsy based on patient age and prostate gland volume. J Urol 1998;159: 920 Presti J.C. JR., Chang J.J., Bhargava V., Shinohara K. : The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies : results of a prospective clinical trial. J. Urol. 2000;163:163-166. Uzzo R G., Wei J T., Waldbaum R S., Perlmutter A P, Byrne J C, Vaughan E D....