The Study Of The Efficacy And Safety Of Extended Prostate Biopsy

The prostate biopsy has evolved from the digitally guided prostate biopsy to current standard transrectal ultrasound-guided (TRUS) systematic biopsy. The first transrectal prostate biopsy was reported by Astraldi in 1937. Watanabe et al. introduced TRUS for diagnostic prostate imaging in the late 1960s. TRUS was not widely used until 1989 when Hodge et al. reported on the efficacy of TRUS-guided biopsies done in a directed fashion based on ultrasound and digital rectal examination findings. Hodge et al. subsequently demonstrated that six random, evenly distributed biopsies were optimal for detection of prostate cancer. The traditional'sextant'biopsies were taken in the parasagittal plane mid-way between the lateral border and the mid-line of the prostate. This development in prostate biopsy technique is important as early stage prostate cancer is neither hypoechoic nor palpable on TRUS. The concept of random, systematic biopsies remains durable in the evolution of prostate biopsy as clinical history and prostate-specific antigen (PSA) remain the primary indications for prostate biopsy today.Purpose:To compare the safety and efficacy of the 10-core biopsy with those of the conventional systematic 6-core and try to identify the combination (number and location) of sampling sites that permits a higher detection of the prostate cancers (PCa) detected by a extended biopsy. Methods:Between October 2006 and April 2010 , 311 consecutive patients with a suspicion of PCa were prospectively enrolled, which included 223 patients who underwent a 6-core biopsy and 88 patients who underwent a 10-core biopsy. Biopsies were performed transrectally under ultrasound guidance. We chose the more lateral sextant scheme of Stamey as the 6-core biopsy .The 10-core biopsy scheme involved obtaining 6 less lateral cores and 4 far lateral additional cores .Results:Cancer detection rates using 6-core biopsy samples and 10-core samples were 73/223 (32.7%), (35/88)39.8%, respectively. The 10-core biopsy improved the cancer detection rate by21.0% compared with the 6-core biopsy ( p < 0.001). The improvement in the diagnostic yield was most marked in patients with a prostate volume>60 cc (28.9%), in patients with normal DRE (31.2%), in patients with an age≥65 (26.2%) and in patients with PSAD>0.15(23.5%)。No statistically significant differences were found in incidence of complications. II(32.3%)and V(35.4%)cores of the 6-core biopsy have higher detection rates, 5(35.2%),7(36.4%)and 9(33.0%)cores of the 10-core biopsy have higher detection rates. The lateral mid(28.9%) and lateral base(27.7%) regions have higher detection rates.Conclusion:We concluded that the 10-core biopsy is a safe and more effective procedure for increasing the detection rate of prostate cancer than the 6-core biopsy especially in patients with a prostate volume>60 cc, age≥65yr, PSAD>0.15,or normal DRE, and the most useful area to be added was found to be cores from the lateral mid and lateral base. The 10-core biopsy do not have a higher incidence of complications than 6-core biopsy.