2000, Volume 3, Issue 1, Pages 43 - 46

Paper

Lateral biopsies added to the traditional sextant prostate biopsy pattern increases the detection rate of prostate cancer JJ Bauer1,4, J Zeng2, W Zhang3, DG McLeod1, IA Sesterhenn3, RR Connelly4, SK Mun2 & JW Moul4 1Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA     2Imaging Science and Information Systems Center (ISIS), Department of Radiology, Georgetown University Medical Center, Washington, DC 20007, USA     3Department of Genitourinary Pathology, Armed Forces Institute of Pathology (AFIP), Washington, DC 20306-6000, USA     4Center for Prostate Disease Research (CPDR), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA     Correspondence to: JW Moul, Center for Prostate Disease Research (CPDR), Department of Surgery, Uniformed Services University of the Health Sciences, 1530 E Jefferson St, Rockville, MD 20852, USA.     The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the US Army or the Department of Defense.

Keywords

3-dimensional simulation;   cancer distribution;   interactive prostate needle biopsy;   prostate cancer

Abstract

Urologists routinely use the systematic sextant needle biopsy technique to detect prostate cancer. However, recent evidence suggests that this technique has a significant sampling error and data based upon whole-mounted step-sectioned radical prostatectomy specimens using a three-dimensional computer-assisted prostate biopsy simulator suggests that an increased detection rate is possible using laterally placed biopsies. The simulated 10-core biopsy pattern (traditional sextant biopsy cores and four laterally placed biopsies in the right and left apex and mid portion of the prostate gland) was shown to be superior to the traditional sextant biopsy. The objective of this pilot study was to confirm the higher prostate cancer detection rate obtained using the 10-core biopsy pattern in patients. We reviewed data on 35 consecutive patients with a pathologic diagnosis of prostate cancer biopsied by a single urologist using the 10-core biopsy pattern. The frequency of positive biopsy was determined for each core. Additionally, the sextant and 10-core prostate biopsy patterns were compared with respect to prostate cancer detection rate. Of the 35 patients diagnosed with prostate cancer, 54.3%(19/35) were diagnosed by the sextant biopsy only. The 10-core pattern resulted in an additional 45.7%(16/35) of patients being diagnosed solely with the laterally placed biopsies. The laterally placed biopsies had the highest frequency of positive biopsies when compared to the sextant cores. In conclusion, biopsy protocols that use laterally placed biopsies based upon a five region anatomical model are superior to the routinely used sextant prostate biopsy pattern. Prostate Cancer and Prostatic Diseases (2000) 3, 43-46

Received 16 November 1999; Accepted 21 March 2000

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