Optimal site and number of biopsy cores according to prostate volume prostate cancer detection in Korea
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Published on: October 10, 2019
Hong Bang Shim1, Hyoung Keun Park, Sang Eun Lee
1Department of Urology, Seoul Veterans Hospital, Seoul, Korea.
Insights
Lower core biopsy schemes are effective for detecting prostate cancer in Korean men, with a six-core technique being optimal for smaller prostates. Transrectal ultrasound-directed biopsies are not essential, simplifying the procedure.
Area of Science:
- Urology
- Oncology
- Diagnostic Imaging
Background:
- Prostate cancer diagnosis relies on biopsy schemes, with varying effectiveness based on prostate volume.
- Optimizing biopsy strategies is crucial for accurate cancer detection and patient management.
Purpose of the Study:
- To compare the efficacy of different prostate biopsy schemes in detecting prostate cancer among Korean men.
- To evaluate the impact of prostate volume on cancer detection rates with various biopsy protocols.
Main Methods:
- A cohort of 516 Korean men (aged 40-79) was divided into quartiles based on prostate volume (10-162 cm³).
- Cancer detection rates were analyzed across different biopsy core schemes (6, 8, 10, and 12 cores) and prostate volume groups.
- The utility of laterally placed cores and transrectal ultrasonography (TRUS)-directed biopsies was assessed.
Main Results:
- Cancer detection rates decreased significantly as prostate volume increased (P = 0.001).
- Lower core biopsy schemes (6-10 cores) yielded cancer detection rates comparable to the 12-core protocol.
- Laterally placed sextant biopsies were as effective as the six-core scheme, and TRUS-directed biopsies showed low unique cancer detection rates.
Conclusions:
- Reduced core biopsy schemes can achieve similar results to the 12-core protocol in this population.
- A laterally placed, six-core biopsy technique is suitable for prostates < 40 cm³.
- TRUS-directed biopsies and prebiopsy TRUS can be omitted, streamlining the biopsy process.
Objectives:
To compare different biopsy schemes for detecting prostate cancer in Korean men.
Methods:
A total of 516 men, 40 to 79 years old (mean 64.1 +/- 7.8), constituted the study cohort. The patients were divided to quartiles according to prostate volume: 10 to 30, 30.1 to 40, 40.1 to 55, and 55.1 to 162 cm3.
Results:
The cancer detection rates decreased as the prostate volume increased in the quartiles used (P = 0.001). The group-specific cancer detection rate was 20.0% to 23.8%, 22.1% to 25.6%, 23.6% to 26.6%, and 27.7% in the 6, 8, 10, and 12-core groups, respectively. In all patients undergoing sextant biopsy, laterally placed cores, including the apex, lateral mid-gland, and lateral base, seemed as optimal as the six-core biopsy scheme. The unique cancer detection rates of each biopsy region were low in all patients groups and were not significantly different according to prostate volume quartile. Of the patients with suspicious lesions on transrectal ultrasonography, no cancer was present only in the lesion-directed biopsies, even if sextant biopsy technique was used.
Conclusions:
Our data have shown that lower core schemes can be used with results almost similar to those using the 12-core protocol in this population. A laterally placed, six-core technique is an appropriate biopsy scheme in patients with a prostate volume of less than 40 cm3. Transrectal ultrasound-directed biopsies can be omitted even when using six-core biopsy protocols because the yield of these biopsies was low. Prebiopsy transrectal ultrasonography is unnecessary because the prostate volume estimation can be done at the same time as the biopsy.
