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Transrectal Saturation Biopsy Improves Risk Stratification (Reclassification) of Patients with Prostate Cancer on
Ahmed ElShafei1,2, Ganesh Kartha1, Asmaa Hatem1
1Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Urology Practice
|August 10, 2023
Summary
Saturation prostate biopsy is more effective than extended biopsy for detecting prostate cancer progression during surveillance. This is crucial for active surveillance management and patient selection, ensuring accurate monitoring of disease aggressiveness.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Accurate prostate cancer staging is vital for active surveillance protocols.
- Transrectal saturation biopsy and extended prostate biopsy are used to monitor patients on active surveillance.
Purpose of the Study:
- To compare the accuracy of transrectal saturation biopsy versus extended prostate biopsy in detecting prostate cancer progression in patients undergoing active surveillance.
Main Methods:
- A review of 277 patients with prostate cancer on active surveillance was conducted.
- Patients met specific criteria including clinical stage, Gleason score, PSA levels, and diagnostic biopsy core positivity.
- Recategorization or progression was defined as no longer meeting low-risk criteria on confirmatory or surveillance biopsies.
Main Results:
- Saturation biopsy (≥20 cores) was more likely to detect cancer progression on subsequent surveillance biopsies compared to extended biopsy (10-14 cores).
- Cancer recategorization occurred in 25% of biopsies on the first confirmatory biopsy.
- No significant difference was found between biopsy types for detecting recategorization on the first confirmatory biopsy (21.5% vs 29.4%).
Conclusions:
- Disease progression is more frequently identified on the first confirmatory biopsy than on later surveillance biopsies.
- Saturation prostate biopsy demonstrated a higher likelihood of identifying disease progression on subsequent surveillance biopsies.
- While saturation biopsy showed a trend towards higher recategorization rates on initial confirmatory biopsies, the difference was not statistically significant.
