[Yield diagnosis of the peripheral cores in 10 needle extended prostate biopsy]

To value if the increase in the number of cylinders in the prostate's biopsy raise the diagnostic performance of this test.

In March 2005 we initiate this prospective study with patients who are subject to a first prostate Biopsy by a PSA between 4 and 10 ng/ml and negative rectal touch. Transrectal, echodirected prostatic biopsies with ten punctures are carried out according to the following programme as follows: 6 Biopsies according to classic sextant technique, to what we add 4 cylinders from the most lateral zones of the prostate (lateral horns). The variables are analyzed: Age, Total PSA, Free PSA/Total PSA, prostatic volume and PSA density.

We value 90 patients consecutively. Prostatic adenocarcinoma was diagnosed to 37 of the 90 patients, which means that the diagnostic rate of the extended Biopsy reached a 41%. Nevertheless, the rate for the classic sextant Biopsy was 32.3%. These differences are statistically significant (Mcnemar test 0.008); besides, this supposes a 27% increase in the diagnostic rentability. The "extra" cylinders in the lateral horns detected 8 tumours which were not detected in the cylinders of the the sextant, and 5 of them presented a Gleason higher or equal to 6.

In our centre we think that the Biopsy extended to 10 cylinders is an adequate strategy for potential prostatic adenocarcinoma patients who are going to be subject to their first Biopsy. Realizing the clinic relevance of the tumours diagnosed thanks to "extra" cylinders, we do not think that this modality implies an over-diagnosis and consequently an overtreatment of the prostate cancer.