The Efficacy of Routine Sextant Prostate Biopsy Plus Selective Lesion-directed Prostate Biopsy

Cho, Seung Hoon; Kim, Sun Il; Park, Hae Young

Abstract

PURPOSE: The systematic routine sextant biopsy technique has been widely used in diagnosing prostatic cancer. But this technique may not include an adequate sampling of the prostate. We conducted a prospective study to evaluate the efficacy of the routine sextant prostate biopsy plus selective lesion-directed prostate biopsy method.
MATERIALS AND METHODS
120 men with abnormal digital rectal examination (DRE) and/or prostate-specific antigen (PSA) > or = 4.0ng/ml underwent a total of 122 routine sextant prostate biopsy (RSB) only or RSB plus selective lesion-directed prostate biopsy (SLB). SLB included one of the followings: digital-guided biopsy, hypoechoic lesion-directed biopsy or transitional zone biopsy if there were palpable nodule on DRE, hypoechoic lesion on transrectal ultrasonography (TRUS), or previous history of negative biopsy, respectively.
RESULTS
The mean age of patients was 67.6 years (43-86) and the mean PSA level was 7.63ng/ml (0.47-over 155). 37.7% had cancer detected on biopsy. Detection rate in RSB plus SLB group (53.6%, 30 of 56) was higher than in RSB group (24.2%, 16 of 66). In RSB plus SLB group, 4 had cancer detected in SLB core(s) only. The positive rate of biopsy core was higher in the SLB core (72.9% (35/48)) than in the RSB core (54.4% (98/180)) (p= 0.022).
CONCLUSIONS
In the presence of a suspicious lesion or the history of a previously negative biopsy, the addition of SLB or transitional zone biopsy may increase the detection rate of prostatic cancer.