Initial Extended Transrectal Prostate Biopsy-Are More Prostate Cancers Detected With 18 Cores Than With 12 Cores?

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Clinical Trials / Drug Trials
Article Date: 03 May 2008 - 0:00 PDT

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UroToday.com - Increasing the number of prostate biopsy cores from 10 to 18 is reported to increase the prostate cancer (CaP) detection rate from 30% to 41%. In the April 2008 issue of the Journal of Urology, Dr. Scattoni and associates retrospectively analyzed the detection rates of CaP, high-grade PIN (HGPIN), and atypical glands suggestive of carcinoma (AGSC) in patients undergoing either 18 or 12 core prostate biopsies.

A total of 4,122 men underwent prostate biopsy between 2002 and 2007. Two groups performed prostate biopsies. One group performed 12 cores in 1,684 patients. The other group performed 18 cores in 1,776 men. Biopsies were taken from the right and left apex, mid gland and base. In the 12 core group, 2 samples were taken from each sector and in the 18 core group 1 additional core was taken from each area. When HGPIN or AGSC were found the biopsy was considered negative. Demographic and clinical parameters between the 2 groups were generally similar. The overall CaP, HGPIN, AGSC, and AGSC plus HGPIN detection rates were 39.0%, 10.8%, 3.2%, and 0.46%, respectively. The mean Gleason score was 5.7 and the mean number of positive cores per biopsy was 5.6. The CaP detection rate in the 18 core group was similar to the 12 core group; 39.9% and 38.4%, respectively. More HGPIN was found using 18 cores but AGSC was not different between the 2 groups. Stratifying results by PSA levels showed no benefit for the 18 core group, but the CaP detection rate was higher with 18 cores for patients with a prostate volume greater than 55 cc (31.5% vs. 24.8%). The detection rate for 18 cores was also better if the transition zone measured 30c or greater. Complications were similar for the 2 groups.

This suggests no advantage for an 18 core biopsy schema compared to 12 in men with a prostate volume less that 55cc.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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