Is transition zone sampling at repeated saturation prostate biopsy still useful?

Area of Science:

• Urology
• Oncology
• Medical Diagnostics

Background:

• Prostate cancer (PCa) detection can be challenging, particularly for tumors confined to the transition zone (TZ).
• Repeated saturation prostate biopsies (SPB) are sometimes employed for persistently suspicious cases.
• The efficacy of TZ-specific sampling in repeated SPB requires further evaluation.

Purpose of the Study:

• To assess the detection rate of prostate cancer (PCa) exclusively within the transition zone (TZ) using directed cores during repeated saturation prostate biopsies (SPB).
• To compare the diagnostic yield of TZ-directed cores in repeated SPB with transurethral resection of the prostate (TURP).

Main Methods:

• Retrospective analysis of 380 and 43 patients undergoing second and third SPB, respectively, for persistently suspicious PCa.
• Biopsy indications included elevated prostate-specific antigen (PSA) levels and abnormal free/total PSA ratios.
• A median of 3 cores were directed to the TZ among a total of 23 cores per patient.

Main Results:

• Prostate cancer (PCa) was detected only in the transition zone (TZ) in 2.5% of cases (2/82) across second and third SPBs.
• In contrast, transurethral resection of the prostate (TURP) revealed PCa in 18.9% (18/95) and 20% (3/15) of patients with previously negative repeated SPBs.
• These findings highlight a significant difference in detection rates between SPB TZ sampling and TURP.

Conclusions:

• Needle biopsies directed at the prostatic transition zone (TZ) during repeated saturation prostate biopsies (SPB) demonstrate a very low incidence of prostate cancer (PCa) detection (2.5%).
• Transurethral resection of the prostate (TURP) offers a substantially higher detection rate (19%) for PCa, including stages T1a and T1b.
• Sampling the TZ with directed needle biopsies in repeated SPB may be omitted due to its low yield.