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Biopsies of the transitional zone of the prostate. Should it be done on a routine basis, when and why?
C Deliveliotis1, J Varkarakis, S Albanis
1Department of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece. nikistra@hol.gr
Purpose:
In this prospective study we try to evaluate the necessity of performing additional transitional zone biopsies as part of the standard sextant biopsies procedure in order to detect prostate cancer.
Materials And Methods:
During a 12-month period we performed biopsies in 420 patients. All patients had two additional biopsies of the transitional zone biopsies. 289 of them were biopsies for the first time because they had an elevated PSA and/or a suspicious DRE. One hundred and thirty-one had a repeat biopsy because of the remaining elevated PSA after the previous negative one.
Results:
Of the 420 patients 143 (34%) had cancer, with 11 (7%) having cancer in the transitional zone only. Patients initially evaluated because of high PSA and or a positive DRE had only 2 (2.1%) cancers exclusively in the transitional zone. We found that this percentage rises (18.7%) when the patients had already at least one previous negative biopsy of the peripheral zone, and during the repeat biopsy the transitional zone is samples.
Conclusions:
The low yield of transitional zone biopsies (2.1%) during first time sampling of the prostate does not warrant their systematic use for the early detection of prostate cancer. Instead the effectiveness of biopsies in that area is higher when the biopsy is repeated after an initial previous negative biopsy of the peripheral zone.
