Is an extended 20-core prostate biopsy protocol more efficient than the standard 12-core? A randomized multicenter...

Area of Science:

• Urology
• Oncology
• Medical Diagnostics

Background:

• Prostate cancer diagnosis relies on prostate biopsy.
• Optimizing the number of biopsy cores is crucial for accurate detection.
• Current protocols vary, necessitating research into the impact of increased core sampling.

Purpose of the Study:

• To evaluate the impact of increasing initial prostate biopsy cores from 12 to 20.
• To compare cancer detection rates between 12-core and 20-core biopsy protocols.
• To assess differences in cancer characteristics, complications, and patient tolerance.

Main Methods:

• A superiority trial randomized 339 patients with suspected prostate cancer to either a 12-core (PB12) or 20-core (PB20) biopsy protocol.
• Patients had PSA < 20 ng/ml and no digital rectal exam abnormalities.
• Cancer detection, characteristics, complications, and patient tolerance were assessed.

Main Results:

• Cancer was detected in 42.0% of the PB12 group and 48.8% of the PB20 group; the difference was not statistically significant (p >0.2).
• Gleason score, cancer length, and detection rates relative to prostate volume were similar between groups.
• Complication rates and patient-reported tolerance were comparable for both biopsy protocols.

Conclusions:

• Increasing initial prostate biopsy cores from 12 to 20 does not offer a significant advantage in cancer detection.
• The 20-core protocol did not yield superior cancer characteristics or improved patient tolerance compared to the 12-core protocol.
• A 12-core biopsy protocol appears sufficient for initial evaluation of suspected prostate cancer.