The Efficacy of 12-Site Biopsy Protocol in Men with Elevated Serum Prostate-Specific Antigen Level Only

Park, Hyoung Keun; Byun, Seok Soo; Sohn, Dong Wan; Hong, Sung Kyu; Lee, Eunsik; Lee, Sang Eun; Lee, Hak Jong

Abstract

Purpose
We evaluated the improvement in the rate of prostate cancer detection with the use of an extensive 12-site biopsy protocol in patients with only an elevated level of serum prostate-specific antigen (PSA).
Materials and Methods
A total of 109 men with elevated PSA levels between 3 and 20ng/ml, but with no abnormal finding on digital rectal and transrectal ultrasound examinations, received transrectal ultrasound- guided prostate biopsies, which were performed at 12 sites, including the routine sextant and 6 far lateral regions (lateral apex, mid-lobe and base). The improvement in the detection rate was assessed according to the PSA level and prostate volume.
Results
The mean age and PSA level of the patients were 63.5 8.6 years and 7.0 3.7ng/ml, respectively. Twenty-eight (25.7%) out of 109 men were diagnosed with prostate cancer. A traditional sextant biopsy detected 19 (67.9%) of the 28 prostate cancer patients, while 9 (32.1%) cancers were detected in the lateral region only. Overall, this extensive protocol resulted in a significant improvement, 8.3% (17.4 to 25.7%), in the detection rate (p=0.032). The improvement in men with a PSA of 10 ng/ml or less was 8.1% (14.0% to 22.1%, p=0.007) and in those with a PSA greater than 10 ng/ml the improvement was 8.7% (30.4% to 39.1%, p=0.162). The improvement in men with a prostate volume of 50cc or less was 8.0% (22.3% to 30.3%, p=0.083) and in those with a prostate volume greater than 50cc this was 9.1% (6.1% to 15.2%, p=0.043).
Conclusions
The twelve-site biopsy protocol is a more efficient method in men with a PSA and prostate volume of 10ng/ml or less and greater than 50cc, respectively, compared to the sextant protocol.