Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2012;5(9):892-9.
Epub 2012 Oct 20.

Optimization of prostate cancer diagnosis by increasing the number of core biopsies based on gland volume

Priya N Werahera  1 , Kathryn Sullivan, Francisco G La Rosa, Fernando J Kim, M Scott Lucia, Colin O'Donnell, Rameshwar S Sidhu, Holly T Sullivan, Beth Schulte, E David Crawford
Affiliations
Clinical Trial

Optimization of prostate cancer diagnosis by increasing the number of core biopsies based on gland volume

Priya N Werahera et al. Int J Clin Exp Pathol. 2012.

Abstract

In this prospective, non-randomized phase-I clinical trial, we comparatively studied the performance of six laterally-directed biopsies or the modified fan-shaped biopsies (MFSB), midline sextant biopsies (MB), and transition zone biopsies (TZB) and examine their prostate cancer (PCa) detection rates. A total of 114 patients received combinations of MFSB, MB, and TZB based on prostate gland volume: those ≤15 cc received 8 biopsies; those >15 cc but ≤ 50 cc received 14 biopsies; and those >50 cc received 20 biopsies. The mean prostate-specific antigen (PSA) level, Gleason score, and prostate volume were 8.0 ng/ml, 6.4, and 47 cc, respectively. PCa detection rate of the MB was 25% while the MFSB was 22%. The overall PCa detection rate was 33.3% with all biopsies. PCa and high-grade prostatic intraepithelial neoplasia (HG-PIN) detection rates decrease as the size of the prostate increases. PCa detection rates were 50.0% for volumes ≤19.9 cc and volumes of >50 cc had a detection rate of 25.8%. PSA levels of <3.0 had PCa detection rates of 15% which increased to 58% with PSA levels >9.0. In a multivariate analysis, only TZB was significant for PCa diagnosed by PSA (β=7.4, p<0.01). Our study showed that it is important to perform both the lateral MFSB and the MB to improve overall PCa detections rates. Thus, we recommend performing MB, MFSB, and TZB based on prostate volume, as follows: 8 biopsies for ≤15 cc; 14 for those >15 cc but ≤50 cc, and 14-20 for those >50 cc.

Keywords: PSA; Prostate cancer; gleason score; prostate gland volume; transrectal core biopsies.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Proposed biopsy scheme based on size of the prostate where midline sextant biopsy (MB) is denoted by A-H, modified fan-shaped biopsy (MFSB) is denoted by A1-H1, and transition zone biopsy (TZB) is denoted by U-W.
Figure 2
Figure 2
Prostate Cancer and high-grade prostatic intraepithelial neoplasia (HG-PIN) diagnosed according to prostate gland volume in 20 cc increments.
Figure 3
Figure 3
Prostate cancer and high-grade prostatic intraepithelial neoplasia (HG-PIN) diagnosed according to the proposed biopsy scheme.
Figure 4
Figure 4
Prostate cancer and high-grade prostatic intraepithelial neoplasia (HG-PIN) diagnosed according to serum PSA.
See this image and copyright information in PMC

References

    1. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61:212–236. - PubMed
    1. Djavan B, Milani S, Remzi M. Prostate biopsy: who, how and when. An update. Can J Urol. 2005;12(Suppl 1):44–48. - PubMed
    1. Thompson IM, Ankerst DP, Chi C, Lucia MS, Goodman PJ, Crowley JJ, Parnes HL, Coltman CA Jr. Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA. 2005;294:66–70. - PubMed
    1. Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA Jr. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004;350:2239–2246. - PubMed
    1. Montironi R, Mazzuccheli R, Scarpelli M, Lopez-Beltran A, Fellegara G, Algaba F. Gleason grading of prostate cancer in needle biopsies or radical prostatectomy specimens: contemporary approach, current clinical significance and sources of pathology discrepancies. BJU Int. 2005;95:1146–1152. - PubMed

Publication types