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Feibus AH, Levy J, McCaslin IR, Doucet ME, Sholl AB, Moparty K, Thomas R, Sartor O, Silberstein JL. Racial variation in prostate needle biopsy templates directed anterior to the peripheral zone. Urol Oncol 2016; 34:336.e1-6. [PMID: 27155916 DOI: 10.1016/j.urolonc.2016.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES African Americans (AA) have been reported to have both increased incidence and increased aggressiveness of prostate cancer (PCa) located anterior to the peripheral zone (APZ). We sought to evaluate the utility of prostate biopsies directed toward the APZ in a predominantly AA cohort. METHODS AND MATERIALS We reviewed all patients with PCa found on biopsy schema that included needle biopsies directed at both the peripheral zone (PZ) and APZ from 2010 to 2014. Self-identified race was recorded for all patients. To evaluate the reliability of APZ-directed prostate biopsies, we performed pathologic secondary review of 25 radical prostatectomy specimens. A series of the Mann-Whitney U and Chi-square tests were used to compare variables. RESULTS We identified 398 men, of which 277 (70%) were AA. Compared with non-AA, AA had more National Comprehensive Cancer Network-defined intermediate or high-risk (50% vs. 39%, P = 0.25) PCa. Most patients had PCa limited to the PZ only (n = 190) or in both the PZ and APZ (n = 191). For 17 patients (4%), PCa was limited only to the APZ core(s), 14 (5%) AA vs. 3 (2%) non-AA (P = 0.24). Most of these 17 patients (n = 14, 82%) had Gleason 6 disease. Patients with PCa in both the PZ and APZ had higher serum prostate-specific antigen, prostate-specific antigen density, volume of disease, and increased grade and National Comprehensive Cancer Network category (all P<0.01). Of these patients, there were no differences in race (AA = 135, 71% vs. non-AA = 56, 29%; P = 0.48). In only 21 men (11%), without racial variation, APZ tumor grade was greater than PZ. Radical prostatectomy and APZ-directed biopsies demonstrated a concordance rate of 80% (20/25), false positive rate of 8% (2/25), and false negative rate of 12% (3/25). CONCLUSIONS APZ-directed prostate biopsies are rarely the sole location of PCa and do not show a clear racial predilection. In those men with PCa identified in both regions, the APZ biopsy did not frequently change treatment recommendations. Biopsies directed at the APZ are not of greater benefit to AA than non-AA.
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Affiliation(s)
- Allison H Feibus
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA
| | - Justin Levy
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Ian R McCaslin
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Meggie E Doucet
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA
| | - Andrew B Sholl
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA
| | - Krishnarao Moparty
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA
| | - Raju Thomas
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA
| | - Oliver Sartor
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Jonathan L Silberstein
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA.
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RiChard JL, Motamedinia P, McKiernan JM, DeCastro GJ, Benson MC. Routine Transition Zone Biopsy During Active Surveillance for Prostate Cancer Rarely Provides Unique Evidence of Disease Progression. J Urol 2012; 188:2177-80. [DOI: 10.1016/j.juro.2012.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Indexed: 12/29/2022]
Affiliation(s)
- Jamie L. RiChard
- Department of Urology, Columbia University Medical Center, College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, New York
| | - Piruz Motamedinia
- Department of Urology, Columbia University Medical Center, College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, New York
| | - James M. McKiernan
- Department of Urology, Columbia University Medical Center, College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, New York
| | - G. Joel DeCastro
- Department of Urology, Columbia University Medical Center, College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, New York
| | - Mitchell C. Benson
- Department of Urology, Columbia University Medical Center, College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, New York
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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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de la Rosette JJ, Wink MH, Mamoulakis C, Wondergem N, ten Kate FJ, Zwinderman K, de Reijke TM, Wijkstra H. Optimizing Prostate Cancer Detection: 8 Versus 12-Core Biopsy Protocol. J Urol 2009; 182:1329-36. [PMID: 19683269 DOI: 10.1016/j.juro.2009.06.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Indexed: 10/20/2022]
Affiliation(s)
| | - Margot H. Wink
- Department of Urology, Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Charalampos Mamoulakis
- Department of Urology, Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Niels Wondergem
- Department of Urology, Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Fiebo J.C. ten Kate
- Department of Pathology, Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Koos Zwinderman
- Department of Epidemiology, Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Theo M. de Reijke
- Department of Urology, Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Hessel Wijkstra
- Department of Urology, Academic Medical Center, University Hospital, Amsterdam, The Netherlands
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Abdel-Khalek M, Sheir KZ, El-Baz M, Ibrahiem EH. Is transition zone biopsy valuable in benign prostatic hyperplasia patients with serum prostate-specific antigen >10 ng/ml and prior negative peripheral zone biopsy? ACTA ACUST UNITED AC 2009; 39:49-55. [PMID: 15764271 DOI: 10.1080/00365590410002555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the importance of transition zone (TZ) biopsy in benign prostatic hyperplasia (BPH) patients with serum prostate-specific antigen (PSA) >10 ng/ml and prior negative peripheral zone (PZ) biopsy and to estimate the sensitivity of TZ biopsy. MATERIAL AND METHODS A total of 273 BPH patients with PSA >10 ng/ml and prior negative PZ biopsy underwent an extended biopsy protocol. In patients with a TZ volume <25 cm(3), four TZ biopsies were taken (two cores per side from the apex and base). In patients with a TZ volume > or =25 cm(3) (n=183), six TZ biopsies were taken (three cores per side from the apex, middle and base). Overall, 215 patients were subjected to either transurethral resection of the prostate (n=162) or open enucleation of the adenoma (n=53). RESULTS The extended biopsy revealed prostate cancers in 21.2% of cases (58/273). The zonal distribution of the positive cores was as follow: PZ cancers only in 67.2% of cases (39/58), TZ cancers only in 13.8% (8/58) and PZ+TZ cancers in 19% (11/58). Overall, 73.6% (14/19) and 36.8% (7/19) of TZ cancers were detected at the apex and middle of the TZ, respectively, while no TZ cancers at all were detected at the base (p=0.00015). The incidence of carcinoma on definitive pathology was 5.6% (12/215). Consequently, TZ biopsy detected only 61.3% (19/31) of TZ cancers. The incidence of pure TZ cancers was 7.3%. On the chi(2) test, patient age, serum PSA, transrectal ultrasonography findings and PSA density did not correlate significantly with the detection rate of TZ cancer. Prostate volume (p=0.023), TZ volume (p=0.027) and PSA/TZ density (p=0.007) were predictive of TZ cancers. CONCLUSIONS Although TZ biopsy was the sole site of cancer in only 2.9% of cases (8/273), it improved the cancer detection rate by 14% in this selected group of patients. The majority (74%) of TZ cancers were detected at the apex site. TZ biopsy has a low sensitivity (61%).
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Abdel-Khalek M, El-Baz M, Ibrahiem EH. Is extended 11-core biopsy valuable in benign prostatic hyperplasia patients with intermediate serum prostate-specific antigen (4.1–10 ng/ml) and prior negative sextant biopsy? ACTA ACUST UNITED AC 2009; 38:315-20. [PMID: 15669591 DOI: 10.1080/00365590410028700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the importance of extended 11-core biopsy in benign prostatic hyperplasia (BPH) patients with intermediate prostate-specific antigen (PSA; 4.1-10 ng/ml) and prior negative sextant biopsy. MATERIAL AND METHODS A total of 381 BPH patients with intermediate PSA (4.1-10 ng/ml) and prior negative sextant biopsy underwent extended 11-core biopsy, which included conventional sextant biopsy in addition to five cores from three alternative sites. Two cores were taken from the right and left anterior horns of the peripheral zone (PZ), two from the right and left anterior transition zones (TZs) and one from the midline of the PZ. Overall, 315 patients were subjected to transurethral resection of the prostate (n = 272) or open prostatectomy (n = 43). RESULTS Repeat 11-core biopsy revealed prostate cancer in 66/381 cases (17.3%). The distribution of positive cores on repeat 11-core biopsy was as follows: sextant biopsy sites only in 50% of cases (33/66); alternative sites only in 31.8% (21/66); and sextant plus alternative biopsy sites in 18.2% (12/66). The anterior horn of the PZ was the most frequently positive alternative site (25/33; 75.8%), followed by the TZ (5/33; 15.2%), while the midline site was involved in 9% of cases (3/33). Eleven-core biopsy had a significantly better cancer detection rate compared to sextant biopsy when digital rectal examination was normal (p = 0.009), prostate volume was in the range 30-50 cm (p = 0.033) and PSA density was > or =0.15 (p = 0.024). Six cancer cases out of 315 (1.9%) were diagnosed as a result of the definitive pathology. The sensitivity of 11-core biopsy was 91.6%, compared to 62.5% for sextant biopsy (p < 0.001). CONCLUSION An extended 11-core biopsy protocol is valuable in BPH patients with intermediate PSA (4.1-10 ng/ml) and prior negative sextant biopsy as it significantly improved the overall detection rate in our study by 32% (p = 0.019).
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Puppo P, Introini C, Calvi P, Naselli A. Role of transurethral resection of the prostate and biopsy of the peripheral zone in the same session after repeated negative biopsies in the diagnosis of prostate cancer. Eur Urol 2006; 49:873-8. [PMID: 16439052 DOI: 10.1016/j.eururo.2005.12.064] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 12/16/2005] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the role of the transurethral resection of the prostate (TURP) together with biopsies of the peripheral zone in the diagnosis of prostate cancer after repeated negative transrectal biopsies and increasing prostate-specific antigen (PSA) levels. METHODS From 2003 to 2004, 43 patients, aged 53-69 yr, were seen for a history of at least two negative biopsies for prostate cancer. Thirty-five men had an increasing PSA level and underwent another set of biopsies. Seven patients had prostate cancer (20%); three were lost at follow-up and four had a Charlson comorbidity index >1. The remaining 21 were offered TURP and biopsy of the peripheral zone. Bladder outlet obstruction had no influence on decision-making. Fourteen men accepted. RESULTS Eight patients (57%) had prostate cancer and underwent radical prostatectomy. Six cancers were detected only with TURP, one with TURP and biopsy, and one with biopsy alone. After a median of 9 mo of follow-up, two of six patients underwent rebiopsy for a rising PSA level, but no cancer was detected. CONCLUSIONS TURP combined with a set of transrectal needle biopsies of the lateral portion of the gland is a safe procedure with a high diagnostic power after repeated negative biopsies in patients with persistently increasing PSA levels.
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Affiliation(s)
- Paolo Puppo
- Urology Unit, Department of Surgical Oncology, National Institute for Cancer Research, Genoa, Italy
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Miyake H, Kurahashi T, Muramaki M, Yamanak K, Hara I. Significance of routine transition zone biopsies in Japanese men undergoing transrectal ultrasound-guided prostate biopsies. Int J Urol 2005; 12:964-8. [PMID: 16351652 DOI: 10.1111/j.1442-2042.2005.01188.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: 12/01/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the clinical significance of additional routine transition zone (TZ) biopsies in Japanese men undergoing transrectal ultrasound (TRUS)-guided systematic 8-core peripheral zone (PZ) biopsies. METHODS Between October 2002 and December 2004, a total of 788 consecutive patients underwent TRUS-guided systematic biopsy of the prostate for the fi rst time. As a rule, 10 cores were taken from each patient; that is, 8 cores from the PZ, including the standard sextant cores and 2 cores from the anterior lateral horns, and 2 additional cores from the bilateral TZ. The cancer detection rate was calculated according to several parameters. We also assessed the disease extent on radical prostatectomy specimens according to the cancer location within the biopsy specimens. RESULTS Prostate cancer was detected by 10-core biopsies in 209 (26.5%) of the 788 patients, and 11 of these patients had positive cores only in the TZ; that is, the increase in cancer detection rate by sampling two additional cores from the TZ was 5.3%. Among 209 patients diagnosed as having prostate cancer, radical prostatectomy without any neoadjuvant therapy was performed in 59 patients with positive biopsy cores in the PZ, 7 in the TZ and 32 in both the PZ and TZ. Patients with positive cores in both zones showed significantly less favorable characteristics, indicating more advanced disease than that in those with positive cores in either zone. CONCLUSIONS Routine TZ biopsy did not significantly increase the detection rate of prostate cancer; however, the anatomical location of positive biopsy cores could provide additional information concerning disease extension in patients undergoing radical prostatectomy.
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Affiliation(s)
- Hideaki Miyake
- Department of Urology, Hyogo Medical Center for Adults, Akashi, Japan.
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9
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De Luca S, Caccia P, Giargia E, Randone D. Transition Zone Carcinoma of the Prostate Gland: Evaluation of the Incidence and Biological Behaviour. Urologia 2005. [DOI: 10.1177/039156030507200116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
About 25% of all prostate cancers occur in the transition zone (TZ). TZ carcinoma are often well differenziateci and considered clinically unimportant. On the other site a subset of these tumours characterized by high tumour grade has a significant risk of extraprostatic spread, margin positivity and possible biochemical failure. Routine TZ biopsy does not substantially increase the prostate cancer detection rate; however, it can be useful in patients that require repeat biopsy. We retrospectively analyzed 13 patients with TZ prostate carcinoma in order to evaluate the incidence and the biological behaviour of these types of neoplasm.
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Affiliation(s)
- S. De Luca
- Divisione di Urologia, Ospedale Gradenigo, Torino
| | - P. Caccia
- Divisione di Urologia, Ospedale Gradenigo, Torino
| | - E. Giargia
- Divisione di Urologia, Ospedale Gradenigo, Torino
| | - D.E. Randone
- Divisione di Urologia, Ospedale Gradenigo, Torino
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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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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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12
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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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Fink KG, Hutarew G, Esterbauer B, Pytel A, Jungwirth A, Dietze O, Schmeller NT. Evaluation of transition zone and lateral sextant biopsies for prostate cancer detection after initial sextant biopsy. Urology 2003; 61:748-53. [PMID: 12670559 DOI: 10.1016/s0090-4295(02)02502-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the value of transition zone and lateral sextant biopsies for the detection of prostate cancer after a previous sextant biopsy was negative. METHODS A total of 74 prostates after radical prostatectomy were used to perform biopsies ex vivo. First, a sextant biopsy was taken, then two different rebiopsy techniques were performed. Rebiopsy technique A consisted of a laterally placed sextant biopsy and two cores per side of the transition zones only. Rebiopsy technique B included a standard sextant biopsy and two cores per side from the lateral areas of the prostate. The biopsies were taken using ultrasound guidance to sample the areas of interest precisely. RESULTS The initial sextant biopsy found 39 prostate cancers. Rebiopsy technique A found 12 cancers (34%). In this group, a laterally placed sextant biopsy found 12 cancers; transition zone biopsies revealed cancer in 5 cases, but no additional tumor was found. Rebiopsy technique B detected 23 prostate cancers (66%). Fourteen tumors were found after a second standard sextant biopsy, and nine additional tumors were found in the lateral areas. CONCLUSIONS Sextant biopsy has a low sensitivity of only 53%. A biopsy including the transition zones is not the ideal technique for detecting the remaining tumors. Therefore, transition zone biopsies should be reserved for patients with multiple previous negative biopsies of the peripheral zone. A subsequent sextant biopsy with additional cores from the lateral areas of the prostate is favorable if rebiopsy is necessary after a negative sextant biopsy.
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Affiliation(s)
- Klaus G Fink
- Department ofUrology and Andrology, St. Johannsspital, Landeskrankenanstalten Salzburg, Salzburg, Austria
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Zacharias M, Jenderka KV, Heynemann H, Fornara P. [Transrectal ultrasound of the prostate. Current status and prospects]. Urologe A 2002; 41:559-68. [PMID: 12524943 DOI: 10.1007/s00120-002-0245-8] [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: 11/28/2022]
Abstract
In recent years the role of ultrasound in the diagnosis of prostate carcinoma has increased in importance. In view of the increasing incidence of prostate cancer, which is the most frequent malignant neoplasm in men, TRUS (transrectal ultrasound) is an important imaging method in the diagnosis of various prostate diseases. This paper provides a basic overview of physical and technical bases of TRUS investigation of the prostate. It concerns technical developments and modern techniques designed to improve its value in diagnosis. Impressive innovations in ultrasound equipment, particularly in the area of colour-coded Doppler sonography in association with microbubble-enhanced colour Doppler ultrasound, have given rise to justifiable hope of improvements in the early diagnosis of prostate cancer.
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Affiliation(s)
- M Zacharias
- Universitätsklinik und Poliklinik für Urologie, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Strasse 16, 06112 Halle/S.
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15
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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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Mai KT, Moazin M, Morash C, Collins JP. Transitional zone and anterior peripheral zone of the prostate. A correlation of small-volume cancer in the biopsy cores and high psa with positive anterior margins in radical prostatectomy specimens. Urol Int 2001; 66:191-6. [PMID: 11385304 DOI: 10.1159/000056613] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prognostically significant prostatic adenocarcinomas (PAC) may pose diagnostic problems if they were localized in the anterior peripheral zone (APZ) or transitional zone (TZ). MATERIALS AND METHODS 108 cases of PAC were reviewed along with serum PSA and TRUS biopsies. The PACs were divided into 22 TZ, 17 APZ and 69 posterior peripheral zone (PPZ) PACs according to the location of the main tumor mass in the TZ and anterior or posterior half of the peripheral zone in the radical prostatectomy (RP) specimens. RESULTS In comparison with PPZ PAC, TZ PAC had a higher cancer volume in RP specimens (4 +/- 2.1 vs. 2.5 +/- 1.7 cm3, p < 0.01), a higher serum PSA (16.5 +/- 9.8 vs. 8.4 +/- 4.5 microg/l, p < 0.001), a biopsy with a small cancer volume (3.8 +/- 2.1 vs. 11.8 +/- 9.4 mm, p < 0.005), and a lower Gleason's score (4.8 +/- 2.1 vs. 6.5 +/- 1.7). APZ PAC was characterized by the cancer volume in RP and biopsy and PSA intermediate between those of TZ and PPZ PAC. Among 24 PACs with a total cancer core length of <3 mm, 19 cases were from the TZ and APZ groups and also had a higher cancer volume and PSA than those from the PPZ group (2.9 +/- 1.8 vs. 1.5 +/- 1.3 and 13.7 +/- 8.3 vs. 9.6 +/- 4 microg/l, respectively). Furthermore, there was a better correlation coefficient (r(2)) of tumor volume in the biopsy and RP for PPZ than for all zones PAC (r2 = 0.75 vs. 0.29). TZ and APZ carcinomas were associated with extension or satellite nodules of PAC in the PPZ that may be diagnosed with biopsies. These PACs were associated with positive anterior resection margin due to extracapsular extension of the carcinoma or intracapsular dissection in 6 and 5 cases respectively. CONCLUSIONS TZ and APZ PACs accounted for the poor correlation between the tumor volume in the biopsy and the RP, and were associated with positive anterior resection margins. One core biopsy with a total cancer core length of <3 mm and PSA >10 microg/l are suspicious for TZ and APZ PCA in patients with undetectable tumors with DRE or TRUS. Clinically insignificant PACs tend to be associated with cancer core <3 mm and PSA <10 microg/l.
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Affiliation(s)
- K T Mai
- Division of Anatomical Pathology, Department of Laboratory Medicine, The Ottawa Hospital, Civic Campus, University of Ottawa, Ottawa, Ont., Canada.
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Abstract
The field of prostate cancer research is poised for dramatic improvements in our ability to better diagnose men at risk of prostate cancer and to better predict prognosis and response to treatment. Histopathologic and molecular analyses lie at the heart of these issues. Improvements in our understanding of the mechanisms of prostate carcinogenesis and in determining why the prostate seems to be so highly targeted for cancer development will lead to rational strategies of disease prevention.
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Affiliation(s)
- M J Putzi
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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