Value of random US-guided transrectal prostate biopsy

One hundred sixty-four men underwent ultrasound-guided transrectal biopsy of a hypoechoic prostatic nodule suspicious for malignancy, and random biopsy of normal-appearing areas of the gland. The contribution of random biopsy to diagnosis, staging, and management of prostatic carcinoma was evaluated. A diagnosis of carcinoma was made in 71 patients (43.3%). Carcinoma was diagnosed at biopsy of only the nodule in 56 of these patients (79%), at both the nodule and random biopsy site in 10 (14%), and only at the random biopsy site in five (7%). Random biopsy did not result in significant alteration of clinical staging. However, management was altered in five patients with positive results at random biopsy only, four of whom underwent surgery. The additional yield from random prostatic biopsy was small but distinct and had clinical relevance. The authors conclude that random biopsy is a useful procedure in the evaluation of patients with prostatic nodules.