Prostate needle biopsy: 12 vs. 18 cores -- is it necessary?

The aim of this study is to compare the histological results of a prostate needle biopsy scheme of 12 and 18 cores used in 372 consecutive patients submitted to an early stage diagnosis programme for prostate cancer (PCa).

From February 2002 to July 2003 a transperineal TRUS-guided prostate needle biopsy was performed in 372 patients aged 40-73. Indications for biopsy were: suspected DRE, total PSA (PSAt) >10 ng/ml; PSAt equal to 4-10, 2.6-3.9, < or =2.5 ng/ml and PSA F/T <25%, <20% and <15%, respectively. In 256 patients, we performed 12 cores and in 116 cases 18 cores.

159 (42.7%) patients were diagnosed with PCa, 138 (37%) with BPH, 58 (15.7%) with chronic prostatitis, 15 (4%) with a HGPIN, 2 (0.6%) with ASAP. In patients that underwent 12 and 18 cores the incidence of PCa was 39.8 and 49%; the incidence of PCa in patients with PSA < or =10 and >10 ng/ml submitted to 12 and 18 cores was 35 vs. 47% and 57.8 vs. 52%, respectively. The preponderance of clinical stage T1c was 50% (12 cores) vs. 72% (18 cores). The median bioptic Gleason score in both groups resulted 6.6 (12 cores) and 6 (18 cores). In 110 (12 bioptic cores) and in 30 (18 bioptic cores) patients that underwent a RRP, the pTNM proved a significant clinical neoplasm (Gleason score > or =6 and/or tumoral volume >0.5 cm(3)) in the first group in all cases, while in the second group in 28/30 (94%) cases.

Extended schemes of prostate needle biopsy of 18 or more cores increases the PCa diagnosis in early stage and should be adopted for young patients with a PSA <10 ng/ml, negative DRE and in case of rebiopsies.