Current prostate biopsy protocols cannot reliably identify patients for focal therapy: correlation of low-risk...

Focal therapy appears to be an attractive alternative approach for patients with localized prostate cancer (PCa). Identifying suitable candidates is crucial to the success of focal therapy. Currently, standard transrectal ultrasound (TRUS)-guided prostate biopsy remains the widespread approach to evaluate patient suitability. In this study, we evaluated the ability of current biopsy protocols to predict cancer characteristics in radical prostatectomy (RP) specimens. We reviewed 4437 cases from 2000 to 2008 in our PowerPath database, and identified 158 patients with low-risk cancer, defined as a pre-biopsy PSA level or= 10%), and 46 (29%) were upgraded to GS >or= 7 at RPs. When patients were stratified by total biopsy core numbers, extended biopsy core protocols were not significantly more reliable in identifying unilateral and low volume prostate cancer patients. One core positive on biopsy was not significantly superior to > 2 positive cores in predicting unilateral, low volume, low stage cancer at prostatectomy. These findings indicate that current standard prostate biopsy protocols have limited accuracy in identifying candidates for focal therapy.