Elsevier

Urology

Volume 61, Issue 1, January 2003, Pages 167-171
Urology

Adult urology
Influence of prostate volume in the detection of prostate cancer

https://doi.org/10.1016/S0090-4295(02)02103-9Get rights and content

Abstract

Objectives

To assess the influence of prostate volume on prostate cancer (CaP) detection in men who underwent repeated sextant transrectal ultrasound biopsy of the prostate.

Methods

Between September 1991 and September 2000, 4376 men underwent sextant transrectal ultrasound-guided biopsy of the prostate. Of the 4376 men, 556 underwent repeat biopsy because of persistent prostate-specific antigen elevation (greater than 4 ng/mL) and/or an abnormal digital rectal examination or suspicious pathologic findings. The percentage of CaP missed on the initial biopsy and detected on the repeat biopsy between arbitrary prostate volumes of less than 50 and 50 cm3 or greater and between less than 37.5 and 37.5 cm3 or greater, the median prostate volumes of men with CaP, were compared. Patient age, prostate-specific antigen level, digital rectal examination findings, and Gleason score in each volumetric cutoff group were also compared.

Results

CaP was detected in 22% of men who underwent a repeat biopsy. The percentage of CaP missed on the initial biopsy but subsequently detected on the repeat biopsy consistently increased as the volume increased. A statistically significant difference in the percentage of CaP not detected on the initial biopsy was found between prostate volumes of less than 50 and 50 cm3 or greater and between less than 37.5 and 37.5 cm3 or greater (P <0.05). No statistically significant difference in prostate-specific antigen, age, digital rectal examination, or Gleason score was found between each volumetric cutoff group.

Conclusions

A significant percentage of men are diagnosed with CaP after a repeat biopsy. We have demonstrated that the percentage of CaP missed on the initial biopsy and detected on the repeat biopsy increases as the prostate volume increases. The results of our study suggest that in men with large prostates, traditional sextant biopsies may not be adequate to detect CaP.

Section snippets

Material and methods

At our institution, 4376 men underwent transrectal ultrasound (TRUS)-guided sextant biopsy of the prostate between August 1991 and September 2000. Of these, 556 men underwent a repeat biopsy after an initial negative biopsy. The indications for the repeat biopsies were a persistently abnormal PSA level and/or abnormal DRE findings (palpation by the clinician of a firm prostate or nodules) or, less commonly, the finding of suspicious histologic features on the initial biopsy, such as severe

Results

Of the 4376 men biopsied, 1325 (30.3%) were found to have CaP on the initial biopsy (group 1). Of the 3051 men with an initial negative biopsy, 556 underwent a repeat biopsy, of whom 125 (22%) were diagnosed with CaP (group 2). The indications for repeat biopsy were elevated PSA with or without abnormal DRE findings in 469 (84.5%), abnormal DRE findings only in 32 (5.8%), prostatic intraepithelial neoplasia in 28 (5%), and atypia in 26 (4.7%). The mean age, PSA level, percentage with abnormal

Comment

Despite the somewhat arbitrary conception of its method, the TRUS-guided sextant biopsy of the prostate has become the standard method for the detection of CaP. Although widely used, concern exists regarding its accuracy. Several studies have reported that 20% to 40% of men with an initially negative biopsy will subsequently be found to have CaP on a repeat biopsy.6, 7 It is also known that the positive yield of a single sextant TRUS-guided biopsy decreases as the prostate volume increases.2, 3

Conclusions

We found a statistically significant inverse relationship between prostate volume and the ability of sextant TRUS-guided biopsy to detect CaP. These findings illustrate the inadequacy of TRUS-guided sextant biopsy in detecting CaP in men with large prostates and that more extensive biopsy strategies may need to be selectively used.

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