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Queiroz MRG, Falsarella PM, Moreira Valle LG, Cayres Mariotti G, Lemos GC, Alfer Junior W, Garcia RG. Is a sampling transition zone important to increase the detection of prostate cancer in systematic prostatic biopsies? Acta Radiol 2021; 62:815-820. [PMID: 32631078 DOI: 10.1177/0284185120938363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Use of transrectal ultrasound (US)-guided biopsies improved diagnosis and treatment for patients with high prostate-specific antigen (PSA) or abnormal digital rectal exam (DRE). PURPOSE To investigate whether taking two transition zone (TZ) biopsies in addition to routine prostate double-sextant biopsies (12-cores) would improve detection rates of prostate cancer (PCa). MATERIAL AND METHODS A retrospective analysis of 1107 in a single institution database after Institutional Review Board approval, which underwent US-guided prostate biopsies from January 2014 to June 2016. All patients with suspected PCa based on positive DRE or high PSA submitted to US-guided prostate biopsy (double-sextant 12-cores alone and 12-cores with two TZ extra cores) were included. RESULTS A total of 1107 patients were included; 120 patients underwent double-sextant 12-cores alone and 987 underwent 12-cores with two TZ extra cores. Among patients submitted to two TZ extra cores, TZs of 755 (76.5%) patients were negative to neoplasia and 232 (23.5%) were positive to neoplasia. Among these patients, 26 (2.6%) had their final Gleason score increased with TZ core; TZ fragments of 20 (2.0%) patients led to a treatment change (re biopsy, active surveillance or from active surveillance to radiation therapy or radical prostatectomy). When the complication rate is analyzed (with or without hospital admission), among the patients submitted to TZ cores, 259 (26.2%) complications were observed; between those submitted to double-sextant 12-cores, 26 (21.7%) complications were observed (P=0.279). CONCLUSION Extended core biopsy protocol with two TZ extra fragments improves detection rates of cancer when compared to double-sextant biopsy protocol without increasing complication rates. TZ routine cores should be considered.
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Affiliation(s)
- Marcos RG Queiroz
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Priscila M Falsarella
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Gustavo C Lemos
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Rodrigo G Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Kim KH, Kim SW, Son HS, Kim DK, Jung DC, Kim HW, Kim JC, Hong SJ, Kim JH. Role of Holmium laser enucleation of the prostate to increase cancer detection rate in patients with gray-zone PSA level. MINERVA UROL NEFROL 2018; 71:72-78. [PMID: 30037211 DOI: 10.23736/s0393-2249.18.03186-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Even though the safety of the treatment for prostate cancer diagnosed by HoLEP has been reported, the diagnostic value of HoLEP for prostate cancer detection has not been confirmed. Therefore, we investigated the diagnostic potential of HoLEP for detecting prostate cancer. METHODS Between December 2009 and October 2015, 359 patients (median age, 70.9 years; range, 66.2-74.8) were treated simultaneously with HoLEP and transrectal prostate needle biopsy (TPNB). Of these, 199 patients with a normal digital rectal examination and serum PSA concentration between 3.5 and 10.0 ng/mL were included in the study. Univariate and multivariate logistic regression analyses were performed to identify the predictive factor for prostate cancer detected by HoLEP. RESULTS Median PSA, prostate volume and PSA density were 4.97 ng/mL (range, 4.20-6.70), 57.40 gm (range, 43.67-77.80) and 0.09 ng/mL2 (range, 0.07-0.12), respectively. Prostate cancer (Gleason score ≥6) was detected in 46 cases (23.1%). Of these, 26 (56.5%) were detected by HoLEP pathology, 11 (23.9%) by TPNB pathology, and 9 (19.6%) by both. Univariate and multivariate logistic regression analyses were performed in 179 patients, including benign prostatic hyperplasia patients (N=153, 76.9%) and patients with cancer detected by HoLEP pathology. PSA density was identified as an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA. CONCLUSIONS HoLEP is a viable modality for detecting prostate cancer in selected cases. PSA density was an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA.
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Affiliation(s)
- Ki H Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Chungcheongnam-do, South Korea
| | - Sang W Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee S Son
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae K Kim
- Department of Urology, CHA Gangnam Medical Center, CHA University, Seoul, South Korea
| | - Dae C Jung
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun W Kim
- Department of Urology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joon C Kim
- Department of Urology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, South Korea
| | - Sung J Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jang H Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea -
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Diffusion-tensor MRI at 3 T: differentiation of central gland prostate cancer from benign prostatic hyperplasia. AJR Am J Roentgenol 2014; 202:W254-62. [PMID: 24555622 DOI: 10.2214/ajr.13.11015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of this article is to retrospectively evaluate the utility of diffusion-tensor imaging (DTI) at 3 T in differentiating central gland prostate cancer from benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Eighty consecutive patients (57 with central gland cancer and 23 without central gland cancer) were included in this study. All patients underwent T2-weighted imaging and DTI at 3 T, followed by surgery. For predicting central gland cancer, experienced and less-experienced radiologists independently analyzed T2-weighted imaging and combined T2-weighted imaging and DTI, respectively. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured for central gland cancers and BPH foci of stromal and glandular hyperplasia. Statistical analyses were performed using McNemar test, linear mixed model, receiver operating characteristic (ROC), and kappa statistics. RESULTS For predicting central gland cancers, the area under the curve (Az) of combined T2-weighted imaging and DTI for the experienced (0.915) and less-experienced reader (0.753) was superior to that of T2-weighted imaging (0.723 vs 0.664; p<0.001). The mean ADC and FA values were 0.77×10(-3) mm2/s and 0.35, respectively, for central gland cancers, 1.22×10(-3) mm2/s and 0.26, respectively, for stromal hyperplasia foci, and 1.59×10(-3) mm2/s and 0.21, respectively, for glandular hyperplasia foci, and the values differed significantly. For differentiating central gland cancer from stromal hyperplasia foci and glandular hyperplasia foci, Az values of ADC versus FA were 0.989 and 1.0 versus 0.818 and 0.916, respectively, and the difference was statistically different. CONCLUSION DTI at 3 T is useful for distinguishing central gland cancers from BPH foci, with significantly different ADC and FA values. Furthermore, ADC showed greater diagnostic accuracy than FA in differentiating central gland cancers from stromal and glandular hyperplasia foci.
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Danforth TL, Chevli KK, Baumann L, Duff M. Low incidence of prostate cancer identified in the transition and anterior zones with transperineal biopsy. Res Rep Urol 2012; 4:71-6. [PMID: 24199184 PMCID: PMC3806447 DOI: 10.2147/rru.s37868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Determine the incidence of anterior (AZ) and transition (TZ) zone prostate cancers using a transperineal mapping approach. METHODS A retrospective review of 137 patients with history of previous negative biopsy undergoing transperineal saturation biopsy for an elevated prostate-specific antigen (PSA), high-grade prostate intraepithelial neoplasia, atypical small acinar proliferation history, or abnormal digital rectal exam. The number of biopsy cores was determined by prostate volume and obtained using a predefined template. The electronic medical records were reviewed for patients' clinical and pathological characteristics. RESULTS Forty-one of 137 patients (31.4%) had positive biopsy for prostate adenocarcinoma; 11 were from 24-core, 19 from 36-core, and 11 from 48-core sampling. Glands > 45 mL had a mean of 1.7 previous biopsies and a PSA of 9.1 ng/mL. Glands < 30 mL were 1.3 and 6.3 ng/mL and glands 30-45 mL were 1.4 and 6.5 ng/mL. Glands < 45 mL had a higher number of positive biopsies per total cores. Seven patients chose active surveillance while 34 chose treatment. Of the 36- and 48-cores biopsies, 2.2% and 1.5%, respectively, were positive in the TZ. One patient was AZ-positive, 1 was TZ-positive, and 18 were peripheral zone (PZ)-positive alone. Twelve patients had cancer detected in PZ and TZ. Two patients developed urinary retention and one had a urine infection. CONCLUSION Transperineal saturation biopsy is a safe and efficacious method of prostate cancer detection in patients with previous negative biopsy and high suspicion for cancer. Few cancers were found to originate in the TZ or AZ alone. We recommend that initial biopsy templates should sample PZ with less focus on the TZ.
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Ouzzane A, Puech P, Lemaitre L, Leroy X, Nevoux P, Betrouni N, Haber GP, Villers A. Combined multiparametric MRI and targeted biopsies improve anterior prostate cancer detection, staging, and grading. Urology 2011; 78:1356-62. [PMID: 21840577 DOI: 10.1016/j.urology.2011.06.022] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/21/2011] [Accepted: 06/06/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess the efficacy of magnetic resonance imaging (MRI) in detection of suspicious anterior prostate lesions, and its role in staging and grading of anterior prostate cancer (APC). METHODS Between January 2008 and August 2009, 243 patients had prostate cancer diagnosed at 12-cores posterior systematic biopsies and additional 2-cores transrectal ultrasound-guided, free-hand-targeted biopsy at any area suspicious for malignancy at prebiopsy multiparametric MRI. We conducted a retrospective study of 45 of 243 (19%) patients with an area suspicious for malignancy at MRI predominantly located in the anterior part of the gland, for which targeted biopsies were positive. Targeted vs systematic biopsy cancer detection rate and upgrading based on length of cancer in the most involved core and Gleason score were measured. RESULTS Of the 45 patients, 46 separate APCs were identified at MRI with positive targeted biopsies. APC was not detected by systematic biopsies in 21 (46%) cases and detected in 25 (54%) cases. For these 25 cases, median cancer length of the most involved core in targeted compared with systematic biopsies was 8 mm vs 1 mm (P <.001), respectively. Significant Gleason score upgrading was observed in 11 of 25 (44%) cases. Correlation coefficient between the cancer length on targeted biopsies and the antero-posterior diameter of the area suspicious for malignancy on MRI was r(2) = .6 (P <.001). Separate posterior cancer was diagnosed in 26 patients. CONCLUSIONS Targeted biopsies based on a prebiopsy MRI-detected lesion improved detection rate, volume, and grade of APC compared with currently used 12-cores systematic biopsies.
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Affiliation(s)
- Adil Ouzzane
- Department of Urology, CHU, University Lille, France.
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Patel V, Merrick GS, Allen ZA, Andreini H, Taubenslag W, Singh S, Butler WM, Adamovich E, Bittner N. The Incidence of Transition Zone Prostate Cancer Diagnosed by Transperineal Template-guided Mapping Biopsy: Implications for Treatment Planning. Urology 2011; 77:1148-52. [PMID: 21334045 DOI: 10.1016/j.urology.2010.11.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 10/27/2010] [Accepted: 11/03/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Vareel Patel
- University of Medicine, Dentistry of New Jersey, Newark, NJ, USA
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7
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Haarer CF, Gopalan A, Tickoo SK, Scardino PT, Eastham JA, Reuter VE, Fine SW. Prostatic Transition Zone Directed Needle Biopsies Uncommonly Sample Clinically Relevant Transition Zone Tumors. J Urol 2009; 182:1337-41. [PMID: 19683261 DOI: 10.1016/j.juro.2009.06.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Chadwick F. Haarer
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Anuradha Gopalan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Satish K. Tickoo
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Peter T. Scardino
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - James A. Eastham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Samson W. Fine
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
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Hwang SI, Lee HJ, Cho JY, Kim SH, Lee SE, Byun SS, Hong SK, Choe GY. Should transition zone biopsies be added to 12-core systematic biopsies of the prostate? JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:281-284. [PMID: 19309725 DOI: 10.1002/jcu.20565] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To investigate the value of additional transition zone (TZ) biopsies following 12-core biopsies in the detection and staging of prostate cancer. METHODS From October 2006 to March 2007, 199 transrectal sonographic (TRUS)-guided prostate biopsies (group 1) in 12 peripheral zones (PZ) were performed. Another 199 consecutive patients (group 2) underwent two TZ biopsies in addition to twelve PZ biopsies from March 2007 to July 2007. Mean prostate-specific antigen (PSA) level, prostate volume, Gleason score, and cancer detection rate of each group were compared. The anatomic distribution of prostate cancer in group 2 was also analyzed. RESULTS Prostate cancer was detected in 76 of 199 patients (38.2%) in group 1 and 71 out of 199 patients (35.3%) in group 2. The cancer detection rate, mean PSA level, prostate volume, and Gleason score were not statistically different in the 2 groups. Cancer was detected by additional TZ biopsies alone in just one out of 71 patients (1.4%). CONCLUSION Routine TZ biopsies following 12-core systematic biopsies are not warranted for the detection of TZ cancer because of their low additional yield.
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Affiliation(s)
- Sung Il Hwang
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
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Garcia JJ, Al-Ahmadie HA, Gopalan A, Tickoo SK, Scardino PT, Reuter VE, Fine SW. Do prostatic transition zone tumors have a distinct morphology? Am J Surg Pathol 2008; 32:1709-14. [PMID: 18769336 PMCID: PMC3010973 DOI: 10.1097/pas.0b013e318172ee97] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous studies have proposed that the morphologic spectrum of prostatic glands of variable size with tall columnar cells displaying basally oriented nuclei and clear to pale pink cytoplasm (TZ-LOOK) is characteristic of the well to moderately differentiated component of transition zone (TZ) tumors. However, the specificity of these findings has not been well studied. In a recent report, we identified dominant peripheral zone (PZ) and TZ tumors situated anterior to the prostatic urethra. Currently, we evaluate the histopathologic features of 215 dominant tumors, including 63 TZ and 73 anterior PZ lesions and an additional cohort of 79 posterior PZ tumors, in radical prostatectomy specimens, to identify the prevalence of this morphology in tumors of different zonal origin. Each dominant tumor was assigned a TZ-LOOK extent score of 0 to 4, with 0 = no such morphology, 1 = 1% to 25%, 2 = 26% to 50%, 3 = 51% to 75%, and 4 = >75%. Overall, 121/215 (56%) tumors showed some degree of this histology, including 56 of 63 (89%) TZ tumors and 65 of 152 (43%) PZ tumors (P<0.0001). Thirty-seven of 215 (17%) lesions had scores of 3 to 4, with 31 (84%) of these being of TZ origin. However, only 31/63 (49%) TZ tumors had >50% TZ-LOOK. Among PZ tumors, 6/152 (4%) had predominant (>50%) TZ-LOOK morphology, yet 23/152 (15%) of all PZ tumors and 23/65 (35%) of PZ tumors displaying any degree of TZ-LOOK had scores of 2 to 3 (>25%; nonfocal). In tumors of both zones with predominant (scores 3 to 4; >50%) TZ-LOOK histology, darker glands of usual acinar adenocarcinoma was often seen at the periphery. Conversely, in tumors with nonpredominant TZ-LOOK (scores 1 to 2; 50% of this histology are very likely of TZ origin, but this scenario occurs in only half of TZ tumors. Importantly, the TZ-LOOK is nonfocal in up to 35% of PZ tumors exhibiting any degree of this morphology. Given this lack of specificity, caution should be exercised in assigning zone of origin based on this histologic appearance, especially in limited samples such as prostate needle biopsy.
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Affiliation(s)
- Joaquin J. Garcia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, NY, NY, United States
| | - Hikmat A. Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, NY, NY, United States
| | - Anuradha Gopalan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, NY, NY, United States
| | - Satish K. Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, NY, NY, United States
| | - Peter T. Scardino
- Department of Urology, Memorial Sloan Kettering Cancer Center, NY, NY, United States
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, NY, NY, United States
| | - Samson W. Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, NY, NY, United States
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van den Bergh RC, Roobol MJ, Wolters T, van Leeuwen PJ, Schröder FH. The Prostate Cancer Prevention Trial and European Randomized Study of Screening for Prostate Cancer risk calculators indicating a positive prostate biopsy: a comparison. BJU Int 2008; 102:1068-73. [DOI: 10.1111/j.1464-410x.2008.07940.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shigemura K, Arakawa S, Yamanaka K, Kataoka N, Yuien K, Fujisawa M. Significance of lateral biopsy specimens during transrectal ultrasound-guided prostate biopsies in Japanese men. Int J Urol 2008; 14:935-8. [PMID: 17880293 DOI: 10.1111/j.1442-2042.2007.01865.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Lateral biopsies are thought to have a better cancer detection rate compared with standard sextant biopsies. This study aimed to determine whether lateral peripheral zone biopsies in Japanese men who underwent transrectal ultrasound-guided prostate biopsies provided a significantly higher cancer detection rate than sextant biopsies. METHODS Between 1999 and 2004, data were collected from 461 men who underwent prostate biopsy and had enough data regarding the performance of lateral biopsies for statistical analysis. There were two categories in this study: (i) patients who underwent sextant prostate biopsies; and (ii) patients who underwent sextant biopsies plus lateral biopsies. RESULTS Prostate cancer was detected in 141 (30.6%) of 461 patients. It was detected in 24 (22.2%) of 108 patients who underwent sextant biopsies and 117 (33.1%) of 353 patients who underwent sextant plus lateral biopsies. Lateral biopsies were not associated with a statistically higher rate of positive biopsy findings; however, we found a significantly higher ratio of patients with positive findings in those with prostate specific antigen (PSA) levels <or=10 ng/mL (10 of 40, 25%) than in those with PSA levels >10 ng/mL (one of 71, 1.4%) among those who had positive cores only in lateral biopsy samples (P < 0.0001). CONCLUSIONS Lateral biopsies did not show a significantly higher detection ratio of prostate cancer compared to sextant biopsies. However, lateral biopsies were more effective than sextant biopsies in patients with lower PSA levels. Our findings might be useful for the establishment of biopsy strategies to detect prostate cancer, especially in patients with lower PSA levels.
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Affiliation(s)
- Katsumi Shigemura
- Department of Urology, Nishiwaki Municipal Hospital, Nishiwaki, Japan
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Uno H, Nakano M, Ehara H, Deguchi T. Indications for Extended 14-Core Transrectal Ultrasound-Guided Prostate Biopsy. Urology 2008; 71:23-7. [DOI: 10.1016/j.urology.2007.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 07/26/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
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Stamatiou K, Alevizos A, Karanasiou V, Mariolis A, Mihas C, Papathanasiou M, Bovis K, Sofras F. Impact of additional sampling in the TRUS-guided biopsy for the diagnosis of prostate cancer. Urol Int 2007; 78:313-7. [PMID: 17495488 DOI: 10.1159/000100834] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 05/29/2006] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the diagnostic value of 10+ systematic sampling technique when performing transrectal ultrasound-guided (TRUS) prostate biopsy, compared with the sextant biopsy technique for patients with suspected prostate cancer. METHODS 286 patients with suspected prostate cancer were included in the study. Patients were eligible for the study if they had serum levels of prostate-specific antigen (PSA) >4 ng/ml or ratio PSA <0.25 and/or an abnormal digital rectal examination (DRE). The population sample was divided in three groups: (1) those with positive PSA, PSA ratio and DRE (70 patients); (2) those with positive PSA and PSA ratio but normal DRE (178 patients), and (3) those with positive PSA and PSA ratio, positive PSA velocity and a negative biopsy in the previous 6-month period (38 patients). In addition to the conventional sextant prostate biopsy cores, four more biopsies were obtained from the lateral peripheral zone (10 core biopsy protocol). Additional cores (total of 12-14) were also randomly selected in case of larger prostates (>60 ml) or from suspicious foci revealed by transrectal ultrasound. All additional biopsy cores were submitted separately to the pathological department. RESULTS Cancer was detected in 55.7% (39/70) and 69% (48/70) of the patients (for sextant core and for the extended biopsy protocols, respectively) in the first study group, 11% (20/178) and 23% (41/178) of the patients (for the sextant and the extended biopsy protocols, respectively) in the second study group, and 42% (16/38) and 63% (24/38) of the patients (for the sextant and the extended biopsy protocols, respectively) in the third study group. The addition of the lateral peripheral zone (PZ) of the prostate to the sextant biopsy showed a 23, 105 and 50% increase in the number of cancers diagnosed in the first, second and third study groups, respectively. The improvement of cancer detection rate (sensitivity) was statistically significant for all groups evaluated. CONCLUSION The 10+ systematic TRUS-guided prostate biopsy improves the detection rate of prostate cancer compared to the sextant biopsy technique alone, especially when performed in men with positive PSA, PSA ratio, and negative DRE.
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Pelzer AE, Bektic J, Berger AP, Halpern EJ, Koppelstätter F, Klauser A, Rehder P, Horninger W, Bartsch G, Frauscher F. Are Transition Zone Biopsies Still Necessary to Improve Prostate Cancer Detection? Eur Urol 2005; 48:916-21; discussion 921. [PMID: 16126324 DOI: 10.1016/j.eururo.2005.07.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 07/20/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The present retrospective study was designed to investigate the value of transition zone (TZ) biopsies for prostate cancer (PC) detection rate in a combined contrast enhanced color Doppler targeted (CECD) and gray-scale systematic biopsy (SB) approach. METHODS PSA screening participants totalling 1475 with tPSA of >1.25 ng/ml (fPSA< or =18%) were assessed. Ten SB and additionally 5 or fewer CECD were performed. The impact of TZ biopsies on the PC detection rate and the biological significance of the detected TZ-cancers were analyzed. RESULTS Out of 1475 biopsied patients, 395 (26.8%) were identified as PC patients; 5925 biopsy cores from these patients were analyzed. In 86 patients (21.8% of PC), we found 102 PC- positive cores in the TZ, and only in 9 of them solitary TZ-cancers without any other PC-location (2.3% of PC or 0.6% of all investigated patients). Pathologic findings after retropubic prostatectomy (RPE) revealed multifocal adenocarcinoma including involved peripheral zone (PZ) in eight of these nine patients, and solitary TZ-cancer in one patient. There was no positive correlation between prostate volume and TZ-detection rate and no patient with solitary TZ-PC after rebiopsy. CONCLUSION Biopsy revealed 9 solitary TZ cancers (1.8%) and RPE revealed only one of them to be truly TZ-confined cancer (0.6%). Furthermore PC-detection did not improve, even in patients with rebiopsy, and there was no correlation between detection of TZ-cancers and prostate volume. A combined use of CECD and SB to investigate participants of a PSA-screening program suggests that TZ-biopsies do not improve PC detection rate and are therefore unnecessary.
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Diergarten T, Martirosian P, Kottke R, Vogel U, Stenzl A, Claussen CD, Schlemmer HP. Functional Characterization of Prostate Cancer by Integrated Magnetic Resonance Imaging and Oxygenation Changes During Carbogen Breathing. Invest Radiol 2005; 40:102-9. [PMID: 15654255 DOI: 10.1097/01.rli.0000149490.59417.6e] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the changes in oxygenation of prostate cancer induced by carbogen breathing using blood oxygen level-dependent (BOLD) magnetic resonance image (MRI) with an endorectal coil (eMRI). MATERIALS AND METHODS In 32 patients with biopsy-proven prostate cancer, endorectal MRI was performed at 1.5 Tesla using the BOLD method. Images were acquired during 4 x 4-minute episodes alternating between room air and carbogen (95% O2/5% CO2) breathing. In each episode, 40 images were acquired (T2*-weighted EPI sequence, 12-14 slices, 3-mm thickness). All patients underwent radical prostatectomy; BOLD-MRI findings were correlated with the histopathologic results. RESULTS BOLD-MRI could be evaluated in 29 patients, and revealed heterogeneous signal changes of normal prostate and cancer tissue similar to the heterogeneity of prostate tissue in anatomic/pathologic preparation. A significant signal intensity increase (P = 0.004) was found in normal central gland and peripheral zone during carbogen breathing. Signal enhancement in carcinoma was significantly lower (P = 0.004) compared with the contralateral normal side. CONCLUSION Intrinsic blood-tissue contrast-functional MRI during carbogen breathing may help detect and characterize prostate carcinoma from normal tissue, particularly in small 1-sided carcinomas. This may be useful for identifying candidates for radiotherapy and monitoring noninvasive therapeutic approaches.
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Affiliation(s)
- Till Diergarten
- Department of Radiology, Eberhard-Karls University Tübingen, Germany.
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Meng MV, Franks JH, Presti JC, Shinohara K. The utility of apical anterior horn biopsies in prostate cancer detection. Urol Oncol 2004; 21:361-5. [PMID: 14670545 DOI: 10.1016/s1078-1439(03)00031-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We sought to determine the utility of adding apical anterior horn biopsies to systematic prostate sampling regimens in detecting cancer in men with measured prostate volume < or =50 cc. We reviewed the biopsy data of consecutive men referred for an abnormal digital rectal exam or PSA elevation > or =4.0 ng/mL. All of these patients underwent lesion directed biopsy as well as a systematic 12-core biopsy regimen consisting of the standard sextant, bilateral lateral mid- and lateral base-sites, and bilateral apical anterior horn sites. Overall cancer detection and unique cancer detection rates were calculated for each of the 12 sites, stratified by race, age, PSA, and findings on digital rectal exam. In addition, cancer detection rates of various biopsy schemes were calculated and compared. There were 255 men undergoing biopsy who had calculated prostate volume < or =50 cc, and the prostate cancer detection rate was 47%. The overall cancer detection rate of apical anterior horn biopsies ranged between 29% and 56%. The utility of these biopsies was greatest in men with normal rectal exam and PSA <10 ng/mL, with unique cancer detection rates of 6% and 4%, respectively. Including the apical anterior horn biopsies in an 8-biopsy scheme (anterior, apex, lateral mid, lateral base) yielded cancer detection rates greater than 91% in all subgroups that were not statistically different from extended 10- and 12-core biopsy regimens. Apical anterior horn prostate biopsies target cancers that are potentially in the anterior region of the prostate, a region under-sampled using traditional schemes. The use of these biopsies as part of an 8-core biopsy pattern provides high cancer detection in all groups of patients and may represent a new standard.
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Affiliation(s)
- Maxwell V Meng
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
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Kobayashi T, Nishizawa K, Watanabe J, Ogura K, Mitsumori K, Ide Y. Effects of sextant transrectal prostate biopsy plus additional far lateral cores in improving cancer detection rates in men with large prostate glands. Int J Urol 2004; 11:392-6. [PMID: 15157208 DOI: 10.1111/j.1442-2042.2004.00818.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether additional, far lateral cores improve the diagnostic performance of transrectal sextant biopsy in men with large prostate glands. METHODS Men with prostate volumes of 50 mL or greater in transrectal ultrasonography who were suspected of prostatic adenocarcinoma were prospectively enrolled. Biopsy criteria were defined as 2.0 ng/mL or greater of serum total prostate-specific antigen and/or abnormal findings on digital rectal examination. Four cores of far lateral biopsies were added to the standard sextant technique. RESULTS Of 104 patients enrolled in the present study and undergoing biopsy, 14 (13.5%) were diagnosed as having prostate cancer and 27 (26.0%) were diagnosed as having prostatic intraepithelial neoplasia (PIN) or an atypical gland. There were no cases where cancer was only detected in the additional cores, whereas PIN/atypical gland was uniquely detected from the additional, far lateral sites in eight of the 27 patients who were diagnosed with this condition. CONCLUSIONS Although the number of patients diagnosed as having PIN/atypical gland might increase with the addition of far lateral cores, this additional sampling does not improve cancer detection rates in men with large prostate glands.
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Onder AU, Yaycioglu O, Ataus S, Gul U, Demirkesen O, Yalcin V, Solok V. Transition zone biopsy and prediction of extraprostatic extension at radical prostatectomy. Int J Urol 2003; 10:302-6; discussion 307-8. [PMID: 12757598 DOI: 10.1046/j.1442-2042.2003.00622.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is limited data in the literature that suggests that transition zone (TZ) biopsy might be useful for the prediction of extraprostatic extension (EPE) in clinically localized prostate cancer. We studied the role of TZ biopsy in the prediction of EPE. METHODS Transition zone biopsies were performed in addition to systematic peripheral zone (PZ) biopsies between November 1995 and December 1999. During this period, 59 patients underwent radical prostatectomy for clinically localized disease. Final pathological results were compared with preoperative clinical and biopsy findings. RESULTS Of the 59 patients who underwent radical prostatectomy, 46 had cancer only in the PZ cores and 13 had cancer both in the PZ and the TZ cores at the biopsy. Final histopathological results revealed EPE in 19 (32%) patients and positive surgical margins in 22 (37%). In univariate analysis of age, prostate-specific antigen (PSA), mean percentage of positive PZ cores, mean biopsy Gleason score and positive TZ biopsy, there was a significant difference for serum PSA levels (P = 0.021), presence of positive TZ cores (P = 0.018) and percentage of positive PZ cores in patients with and without EPE (P < 0.001). In multivariate analysis, the single independent predictor of EPE was the percentage of positive PZ biopsy cores (P = 0.0227). There was agreement between the side of positive TZ biopsy and EPE in seven of eight patients. CONCLUSION Taking two TZ cores in addition to peripheral sextant biopsy did not result in better prediction of EPE. The relationship between TZ involvement and the presence of EPE can be investigated further in radical prostatectomy specimens.
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Affiliation(s)
- Ali Ulvi Onder
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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19
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YAYCIOGLU O. Author's Reply. Int J Urol 2003. [DOI: 10.1046/j.1442-2042.2003.00625.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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KUROKAWA K. Editorial Comment. Int J Urol 2003. [DOI: 10.1046/j.1442-2042.2003.00623.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Meng MV, Shinohara K, Grossfeld GD. Significance of high-grade prostatic intraepithelial neoplasia on prostate biopsy. Urol Oncol 2003; 21:145-51. [PMID: 12856644 DOI: 10.1016/s1078-1439(03)00009-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The early diagnosis of prostate cancer has been facilitated by the development of serum prostate-specific antigen (PSA) testing and evolution in transrectal ultrasound-guided biopsy of the prostate. Over a decade has passed since the initial recommendations for systematic sextant sampling of the prostate to increase the accuracy of cancer detection. Subsequently, variations in the number and location of biopsies have been proposed to maximize prostate cancer detection and obtain more complete information regarding tumor grade, tumor volume, and local stage. Although current biopsy strategies provide a wide sampling of the prostate gland, biopsy histology may not be conclusive for either the presence or absence of adenocarcinoma. High-grade prostatic intraepithelial neoplasia (HGPIN) is found in a significant fraction of patients undergoing transrectal prostate biopsies. In this article, we discuss the significance of high-grade prostatic intraepithelial neoplasia and other abnormal histology findings and current evidence addressing the presence of cancer and need for additional prostate biopsies.
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Affiliation(s)
- Maxwell V Meng
- Department of Urology, University of California San Francisco, 400 Parnassus Ave., 6 Floor, San Francisco, CA, USA.
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22
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Basillote JB, Armenakas NA, Hochberg DA, Fracchia JA. Influence of prostate volume in the detection of prostate cancer. Urology 2003; 61:167-71. [PMID: 12559290 DOI: 10.1016/s0090-4295(02)02103-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the influence of prostate volume on prostate cancer (CaP) detection in men who underwent repeated sextant transrectal ultrasound biopsy of the prostate. METHODS Between September 1991 and September 2000, 4376 men underwent sextant transrectal ultrasound-guided biopsy of the prostate. Of the 4376 men, 556 underwent repeat biopsy because of persistent prostate-specific antigen elevation (greater than 4 ng/mL) and/or an abnormal digital rectal examination or suspicious pathologic findings. The percentage of CaP missed on the initial biopsy and detected on the repeat biopsy between arbitrary prostate volumes of less than 50 and 50 cm3 or greater and between less than 37.5 and 37.5 cm3 or greater, the median prostate volumes of men with CaP, were compared. Patient age, prostate-specific antigen level, digital rectal examination findings, and Gleason score in each volumetric cutoff group were also compared. RESULTS CaP was detected in 22% of men who underwent a repeat biopsy. The percentage of CaP missed on the initial biopsy but subsequently detected on the repeat biopsy consistently increased as the volume increased. A statistically significant difference in the percentage of CaP not detected on the initial biopsy was found between prostate volumes of less than 50 and 50 cm3 or greater and between less than 37.5 and 37.5 cm3 or greater (P <0.05). No statistically significant difference in prostate-specific antigen, age, digital rectal examination, or Gleason score was found between each volumetric cutoff group. CONCLUSIONS A significant percentage of men are diagnosed with CaP after a repeat biopsy. We have demonstrated that the percentage of CaP missed on the initial biopsy and detected on the repeat biopsy increases as the prostate volume increases. The results of our study suggest that in men with large prostates, traditional sextant biopsies may not be adequate to detect CaP.
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Affiliation(s)
- Jay B Basillote
- Division of Urology, Lenox Hill Hospital, New York, New York 10021, USA
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24
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Ito K, Ohi M, Yamamoto T, Miyamoto S, Kurokawa K, Fukabori Y, Suzuki K, Yamanaka H. The diagnostic accuracy of the age-adjusted and prostate volume-adjusted biopsy method in males with prostate specific antigen levels of 4.1-10.0 ng/mL. Cancer 2002; 95:2112-9. [PMID: 12412164 DOI: 10.1002/cncr.10941] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The authors evaluated a new age-adjusted and prostate volume-adjusted biopsy method for the detection of prostate carcinoma through the transperineal and the transrectal approaches in men with PSA levels of 4.1-10.0 ng/mL. METHODS The value of the adjusted biopsy method was calculated by using the following four factors: 1) life expectancy in Japanese men in 1998, 2) prostate volume estimated by transrectal ultrasonography, 3) tumor doubling time (4 years), and 4) tumor volume that influenced death (20 cc). The number of biopsy sites was set at 8-20. Between August, 1999 and December, 2001, 100 men age <or= 79 years with prostate specific antigen (PSA) levels of 4.1-10.0 ng/mL underwent age-adjusted and volume-adjusted, systematic prostate biopsy. RESULTS The detection rate for the adjusted biopsy method was 46% (46 of 100 men). The clinical stage of prostate carcinoma was Stage II in 85% of patients and Stage III in 15% of patients. If routine six-sextant biopsy had been performed in all of the men who underwent adjusted systematic biopsy, then 15 of 46 patients (33%) with prostate carcinoma would have been missed. The detection rates of prostate carcinoma in men who underwent adjusted biopsies were relatively high, especially in men with PSA levels of 6.1-10.0 ng/mL, men age <or= 64 years, men with prostate volumes >or= 50 cc, and men with PSA density (PSAD) levels <or= 0.15 ng/mL/cc compared with the detection rates from six-sextant and directed biopsies. The high detection rates were observed from biopsy sites at the posterior aspect of the lateral lobe through both the transperineal approach and the transrectal approach and at the anterior aspect of the transition zone through the transperineal approach. CONCLUSIONS The age-adjusted and prostate volume-adjusted prostate biopsy method was more useful for detecting clinically significant disease compared with the traditional six-sextant biopsy method. This adjusted biopsy method was especially useful in patients age <or= 64 years, patients with large prostate volumes (>/= 50 cc), and patients with PSAD levels <or= 0.15 ng/mL/cc. The authors recommend that patients undergo an additional transition zone biopsy at the anterior aspect through the transperineal approach.
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Affiliation(s)
- Kazuto Ito
- Department of Urology, Gunma University School of Medicine, Maebashi, Japan.
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The Role of the Biopsy of the Transitonal Zone and of the Seminal Vesicles in the Diagnosis and Staging of Prostate Cancer. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1569-9056(02)00056-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Endorectal sonography for prostatic imaging was first described in 1968 and gained wide acceptance, particularly since the 1980s. Presently, extended biopsies consist of the sextant biopsy pattern plus various combinations of anteriorly directed biopsies and posterolateral sampling that includes the anterior horn of the peripheral zone. The cancer detection rate for transrectal ultrasound-guided prostate biopsies has fallen, and the repeat biopsy rate has risen. The future will most likely see fewer biopsies performed but with wiser guiding systems.
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Affiliation(s)
- Martha K Terris
- Section of Urology (112C), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
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Abstract
Advances in the diagnosis of early stage disease, and particularly the introduction of prostate-specific antigen (PSA) testing, have had a dramatic effect on the presentation and clinical management of prostate cancer during the past ten years. As a result, there have been significant epidemiological changes in countries where early diagnosis is recommended. The importance of PSA testing for the diagnosis of localized prostate cancer has become well established in clinical practice and this is reflected by improved outcomes from definitive treatment. The contribution of PSA-related parameters and molecular forms of PSA both to cancer detection and prediction of pathological stage continue to be explored. Concerns about the reliability of the standard sextant biopsy technique for cancer detection relate to the need for re-biopsy in a growing number of patients with negative biopsies and an increasing proportion of patients with low volume, multifocal disease. In men with cancer, additional prognostic information can be derived from biopsy findings, with important therapeutic implications. This relates also to the need for reliable markers indicating pathological stage and risk of progression. The opportunities for the prevention of prostate cancer have grown with improved understanding of its biology and the genetic basis of the early steps associated with malignant transformation. In the future, the need for therapeutic intervention is likely to be most influenced by successful prevention strategies.
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Affiliation(s)
- M R Feneley
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
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28
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Carroll PR. Prostate biopsy: a wealth of information when done and interpreted correctly. J Clin Oncol 2000; 18:1161-3. [PMID: 10715283 DOI: 10.1200/jco.2000.18.6.1161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Burton JL, Oakley N, Anderson JB. Recent advances in the histopathology and molecular biology of prostate cancer. BJU Int 2000; 85:87-94. [PMID: 10619953 DOI: 10.1046/j.1464-410x.2000.00422.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J L Burton
- Department of Pathology, Division of Oncology and Cellular Pathology, University of Sheffield Medical School, UK.
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30
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31
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Presti JC. Prostate cancer: assessment of risk using digital rectal examination, tumor grade, prostate-specific antigen, and systematic biopsy. Radiol Clin North Am 2000; 38:49-58. [PMID: 10664666 DOI: 10.1016/s0033-8389(05)70149-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Refinement in the local staging and risk assessment for prostate cancer patients utilizing clinical parameters is ongoing. DRE, tumor grade, and PSA provide some useful information for risk assessment in individual patients. More recent studies using percent free PSA levels and systematic biopsy results have added additional staging information and may play a more significant role in the future in risk assessment. This information should supplement additional imaging tests in the management of these patients.
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Affiliation(s)
- J C Presti
- Department of Urology, University of California San Francisco, USA
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PRESTI JOSEPHC, CHANG JAMESJ, BHARGAVA VIVEK, SHINOHARA KATSUTO. THE OPTIMAL SYSTEMATIC PROSTATE BIOPSY SCHEME SHOULD INCLUDE 8 RATHER THAN 6 BIOPSIES: RESULTS OF A PROSPECTIVE CLINICAL TRIAL. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67995-5] [Citation(s) in RCA: 232] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- JOSEPH C. PRESTI
- From the Departments of Urology and Pathology, University of California School of Medicine and the San Francisco Veterans Administration Medical Center, San Francisco, California
| | - JAMES J. CHANG
- From the Departments of Urology and Pathology, University of California School of Medicine and the San Francisco Veterans Administration Medical Center, San Francisco, California
| | - VIVEK BHARGAVA
- From the Departments of Urology and Pathology, University of California School of Medicine and the San Francisco Veterans Administration Medical Center, San Francisco, California
| | - KATSUTO SHINOHARA
- From the Departments of Urology and Pathology, University of California School of Medicine and the San Francisco Veterans Administration Medical Center, San Francisco, California
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33
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THE SIGNIFICANCE OF PRIOR BENIGN NEEDLE BIOPSIES IN MEN SUBSEQUENTLY DIAGNOSED WITH PROSTATE CANCER. J Urol 1999. [DOI: 10.1097/00005392-199911000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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34
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EPSTEIN JONATHANI, WALSH PATRICKC, AKINGBA GEORGE, CARTER HBALLENTINE. THE SIGNIFICANCE OF PRIOR BENIGN NEEDLE BIOPSIES IN MEN SUBSEQUENTLY DIAGNOSED WITH PROSTATE CANCER. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68189-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- JONATHAN I. EPSTEIN
- From the Departments of Pathology and Urology, The Johns Hopkins University School of Medicine and James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - PATRICK C. WALSH
- From the Departments of Pathology and Urology, The Johns Hopkins University School of Medicine and James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - GEORGE AKINGBA
- From the Departments of Pathology and Urology, The Johns Hopkins University School of Medicine and James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - H. BALLENTINE CARTER
- From the Departments of Pathology and Urology, The Johns Hopkins University School of Medicine and James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
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35
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Terris MK. Sensitivity and specificity of sextant biopsies in the detection of prostate cancer: preliminary report. Urology 1999; 54:486-9. [PMID: 10475359 DOI: 10.1016/s0090-4295(99)00148-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the true-negative and false-negative rates of sextant prostate biopsies, the most common method of prostate cancer diagnosis. METHODS Forty-three men scheduled for prostatectomy as part of a surgical procedure for bladder pathologic findings agreed to participate in this study. All patients had normal digital rectal examination findings. Immediately before prostatectomy all patients underwent sextant biopsies. The location, amount, and Gleason grade of any cancer identified on the biopsies were recorded. After surgery, the prostate was serially sectioned. The location, grade, and volume of any prostatic adenocarcinoma identified was recorded and compared with the results of the biopsy specimens. RESULTS There were 33 patients without prostate cancer in either the biopsies or the prostatectomy specimen. No patients had cancer on the biopsies and no cancer in the prostatectomy specimen. In 6 patients, cancer was found in both the biopsies and the prostatectomy specimens; these cancers were 0.9, 2.1, 2.8, 3. 1, 4.2, and 6.5 cc in volume. In the remaining 4 patients, there was no cancer on the biopsies but the prostatectomy specimen revealed cancers of 0.05, 0.1, 0.3, and 2.5 cc. The overall sensitivity for sextant biopsies was 60.0%, with a specificity of 100%. When only cancers greater than 2 cc or cancers in the peripheral zone were considered, the sensitivity rose to 83.3% and 71.4%, respectively, with a minimal decrease in specificity (97.3% and 97.2%, respectively). In contrast, when transition zone cancers were evaluated, the sensitivity fell to 33.3%. CONCLUSIONS Sextant biopsies are fairly sensitive for the detection of tumors greater than 2 cc and those in the peripheral zone; however, repeat biopsies should be strongly considered in patients with a high clinical suspicion for prostate cancer and negative initial sextant biopsies.
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Affiliation(s)
- M K Terris
- Section of Urology, Veterans Affairs Palo Alto Health Care System, California 94304, USA
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36
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CHANG JAMESJ, SHINOHARA KATSUTO, BHARGAVA VIVEK, PRESTI JOSEPHCJR. PROSPECTIVE EVALUATION OF LATERAL BIOPSIES OF THE PERIPHERAL ZONE FOR PROSTATE CANCER DETECTION. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62254-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- JAMES J. CHANG
- From the Departments of Urology and Pathology, University of California School of Medicine and San Francisco Veterans Administration Medical Center, San Francisco, California
| | - KATSUTO SHINOHARA
- From the Departments of Urology and Pathology, University of California School of Medicine and San Francisco Veterans Administration Medical Center, San Francisco, California
| | - VIVEK BHARGAVA
- From the Departments of Urology and Pathology, University of California School of Medicine and San Francisco Veterans Administration Medical Center, San Francisco, California
| | - JOSEPH C. JR. PRESTI
- From the Departments of Urology and Pathology, University of California School of Medicine and San Francisco Veterans Administration Medical Center, San Francisco, California
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