Adult urologyInfluence of prostate volume in the detection of prostate cancer
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.
References (20)
- et al.
Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate
J Urol
(1989) - et al.
The influence of prostate size on cancer detection
Urology
(1995) - et al.
Outcome of sextant biopsy according to gland volume
Urology
(1997) - et al.
Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values
J Urol
(1994) - et al.
The significance of prior benign needle biopsies in men subsequently diagnosed with prostate cancer
J Urol
(1999) - et al.
The effect of prostate volume on the yield of needle biopsy
J Urol
(1998) - et al.
The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer
Urology
(1997) - et al.
Prostate cancer detectionrelationship to prostate size
Urology
(1999) - et al.
A prospective randomized trial comparing 6 versus 12 prostate biopsy coresimpact on cancer detection
J Urol
(2000) - et al.
Prospective evaluation of systematic sextant transition zone biopsies in large prostate for cancer detection
Urology
(1998)
Cited by (41)
Editorial comment
2013, UrologyPercentage of free prostate-specific antigen: Implications in modern extended scheme prostate biopsy
2011, UrologyCitation Excerpt :Similarly, the association of a low prostate volume with an increased risk of prostate cancer at biopsy was not surprising. Patients with large prostates will have lower cancer detection rates when a sextant biopsy scheme is used.25-27 However, these variables were only significant for those with a PSA level >4.0 ng/mL.
Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy: Results from the SEARCH database
2008, Journal of UrologyCitation Excerpt :Since the prostates of men treated with finasteride were 24% smaller, it has been proposed that the increased rate of high grade disease was due to superior sampling in smaller glands.2 Indeed, previous studies found higher prostate cancer detection rates in smaller prostates when controlling for PSA and biopsy core number.6–9 Assuming uniform distribution of high grade disease across all prostate sizes, larger prostates should be more likely to have high grade disease undiscovered at biopsy and later upgraded after prostatectomy.
Cancer Imaging With Fluorine-18-Labeled Choline Derivatives
2007, Seminars in Nuclear MedicineCitation Excerpt :Currently, ultrasound-guided prostate biopsy is the most common method for diagnosing this disease. However, conventional prostate biopsy using standard 6 or 12 needle templates is susceptible to sampling error, with a false-negative rate as high as 20% regardless of the number of needles used.32,33 A few studies have preliminarily investigated FCH-PET as a method for improving cancer localization in the prostate.