Optimal site and number of biopsy cores according to prostate volume prostate cancer detection in Korea

Outcome of TRUS Biopsy with Limited Cores in Patients with PSA More Than 50 ng/dL: Can We Reduce the Number of Cores Without Affecting Outcomes?

The aims of our study were to see outcomes of limited core biopsy and compare its outcomes with standard 12-core biopsy in patients with PSA more than 50 ng/dL. We did a retrospective analysis of 149 patients undergoing prostatic biopsy with PSA more than 50 ng/dL between January 2014 and December 2018. Out of 149 patients, 49 underwent limited core (2 to 6 cores) TRUS biopsy with no systemic 12-core biopsy. Other 100 patients underwent standard 12-core biopsy under TRUS guidance. Total of 149 patient's records were analyzed and were included in the final analysis. There was no significant difference in demographics and prostate-specific antigen among the cohorts. All 49 patients in limited core TRUS biopsy had a positive biopsy with no need of re-biopsy. Fourteen out of 100 patients in TRUS biopsy had a negative biopsy. All 14 patients with negative biopsy had an average follow-up of 3.8 years with no conversion to positive biopsy. Patients with PSA more than 50 ng/dL and high clinical suspicion of prostate cancer can undergo limited core biopsy without systemic 12-core biopsy. In patients with no clinical evidence of prostate cancer, 12-core biopsy remains the gold standard for evaluation of prostate cancer.

The optimal number of initial prostate biopsy cores in daily practice: a prospective study using the Nara Urological Research and Treatment Group nomogram

Background

To elucidate the optimal number of prostate biopsy cores using a nomogram allocating 6–12 biopsy cores, the number generally used in daily practice, based on age and prostate volume (PV).

Methods

We enrolled 936 patients who received an initial prostate biopsy from April 2006 to January 2009. A number of 6–12 biopsy cores was allocated based on age and PV Nara Urological Research and Treatment Group (NURTG) nomogram. To elucidate the predictive parameters of cancer detection in patients with a prostate specific antigen (PSA) value in the gray zone, univariate and multivariate logistic regression analysis were carried out.

Results

The total cancer detection rate and the cancer detection rate in the PSA gray zone (4.1–10.0 ng/mL) were 48.0 and 37.6 %, respectively. The cancer detection rates in the gray zone stratified by patient age of ≤59, 60–64, 65–69, 70–74, 75–79, and ≥80 years were 28.4, 35.0, 26.9, 37.9, 45.7, and 54.8 %, respectively. The significant predictive parameters of cancer detection in the gray zone were age, volume biopsy ratio (VBR: PV divided by number of biopsy cores), PSA density (PSAD), digital rectal examination findings, and transrectal ultrasound findings in univariate analyses. Finally, age, VBR, and PSAD were independent parameters to predict cancer detection in the gray zone. The adverse event profile was acceptable.

Conclusions

Our present study revealed that the cancer detection rate using the NURTG nomogram allocating 6–12 biopsy cores, the number generally used in daily practice, based on age and PV, could provide similar efficacy as previous studies involving more biopsy cores. In older patients the number of biopsy cores could be reduced.

Standards for prostate biopsy

PURPOSE OF REVIEW

A variety of techniques have emerged for the optimization of prostate biopsy. In this review, we summarize and critically discuss the most recent developments regarding the optimal systematic biopsy and sampling labeling along with multiparametric MRI and magnetic resonance-targeted biopsies.

RECENT FINDINGS

The use of 10-12-core-extended sampling protocols increases cancer detection rates compared with traditional sextant sampling and reduces the likelihood that patients will require a repeat biopsy, ultimately allowing more accurate risk stratification without increasing the likelihood of detecting insignificant cancers. As the number of cores increases above 12 cores, the increase in diagnostic yield becomes marginal. However, the limitations of this technique include undersampling, oversampling, and the need for repetitive biopsy. MRI and magnetic resonance-targeted biopsies have demonstrated superiority over systematic biopsies for the detection of clinically significant disease and representation of disease burden, while deploying fewer cores and may have applications in men undergoing initial or repeat biopsy and those with low-risk cancer on or considering active surveillance.

SUMMARY

A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection, avoidance of a repeat biopsy while minimizing the detection of insignificant prostate cancers. MRI-guided prostate biopsy has an evolving role in both initial and repeat prostate biopsy strategies, as well as active surveillance, potentially improving sampling efficiency, increasing the detection of clinically significant cancers, and reducing the detection of insignificant cancers.

Optimization of prostate biopsy: review of technique and complications

A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection and avoidance of a repeat biopsy while minimizing the detection of insignificant prostate cancers. Magnetic resonance imaging-guided prostate biopsy has an evolving role in both initial and repeat prostate biopsy strategies, potentially improving sampling efficiency, increasing the detection of clinically significant cancers, and reducing the detection of insignificant cancers. Hematuria, hematospermia, and rectal bleeding are common complications of prostate needle biopsy, but are generally self-limiting and well tolerated. All men should receive antimicrobial prophylaxis before biopsy.

Investigation of optimal prostate biopsy schemes for Chinese patients with different clinical characteristics

PURPOSE

To investigate the optimal schemes of prostate biopsy according to prostate volume (PV), age and transrectal ultrasound (TRUS) status in Chinese men.

METHODS

923 consecutive patients who underwent initial TRUS-guided systematic 12-core prostate biopsy (12PBx) were enrolled in this study. The 12PBx was obtained by overlapping of conventional sextant, lateral base, mid-gland of peripheral zone and apex. Each sample was individually marked and inked before fixation. Patients were divided into 8 subgroups on the basis of independent risk factors investigated using logistic regression model. Subsequently, 12PBx was defined as self-control for the analysis of biopsy schemes (6-, 8- and 10PBx) on individual core basis. The prostate cancer detection rates (CDRs) of 6-, 8-, 10- and 12PBx were compared for each individual subgroup.

RESULTS

The 12PBx detected 253 (27.4%) cases of prostate cancer (PCa), of which 67.2, 47.1 and 61.3% were located in the base, mid-gland and apex, respectively. Multivariate analysis indicated that age, TRUS status and PV were independent risk factors for PCa detection. CDR increased with increasing biopsy cores. However, for patients with age ≥65 years, positive TRUS and PV <38.5 cm(3), CDR of 8PBx (30.6%) was similar to 10PBx (32.2%) and 12PBx (32.2%); for patients with age ≥65 years, negative TRUS and PV <38.5 cm(3) or ones with age ≥65 years, positive TRUS and PV ≥38.5 cm(3), 10PBx was as effective as 12PBx in detecting PCa (27.8, 27.5 vs. 28.9, 29.3%, respectively).

CONCLUSION

Age, TRUS status and PV were independent risk factors for PCa detection. Traditional sextant biopsy is not recommended. 8-, 10-, or 12PBx as an individual biopsy scheme might be adopted according to these risk factors for Chinese patients.

An overview of prostate diseases and their characteristics specific to Asian men

In this paper, we reviewed the features of common prostate diseases, such as benign prostatic hyperplasia (BPH), prostate cancer (PCa) and chronic prostatitis (CP) that are specific to Asian men. Compared to the Westerners, Asians exhibit particular characteristics of prostate diseases. Through summarizing the epidemiology, symptomatology, diagnostics and therapeutics of these diseases, we find that Asians have a lower incidence of PCa than whites, but the incidences of BPH and CP are similar. Asian men with CP often suffer from fewer disease sites, but have a higher frequency of pain during urination rather than after sexual climax. Prostate-specific antigen (PSA) is a widely used marker for the diagnosis of PCa in both Asian and Western countries. Although the PSA level may be lower in Asians, the threshold used is based on whites. After reviewing the treatments available for these diseases, we did not find a fundamental difference between Asians and whites. Furthermore, the selection for the most appropriate treatment based on the individual needs of patients remains a challenge to urologists in Asia. After considering the traits of prostate diseases that are specific to Asian men, we hope to pave the way for the development of specific diagnostic and therapeutic strategies targeted specifically to Asian men.