Reassessing the Diagnostic Yield of Saturation Biopsy of the Prostate (original) (raw)
Objective: Prostate biopsy remains the gold standard for detection of prostate cancer (PCa). This study was performed to determine whether saturation biopsy (24 cores) detects more prostate cancer than a standard 12-18 core office biopsy technique. Methods: We conducted a nonrandomized cohort study of a consecutive series of prostate biopsies. The primary outcome assessed by both univariate and multivariate analysis was the detection of PCa, whereas the secondary outcomes of HGPIN (high-grade prostatic intraepithelial neoplasia) and ASAP (atypical small acinar proliferation) were also analyzed. Results: From September 2005 to June 2006, a total of 469 patients undergoing prostate biopsy were included in this study. A standard office prostate biopsy was performed in 301 men, whereas 168 underwent a saturation biopsy. Age, body mass index (BMI), prostate volume, and family history of PCa were similar. However, patients in the saturation biopsy cohort were more likely to have had prior biopsies, higher prebiopsy PSA, longer PSA doubling times, and to carry more frequent diagnoses of HGPIN or ASAP (all p < 0.05). After adjusting for covariates, saturation biopsy did not detect more abnormal pathology than standard office prostate biopsy, including PCa (OR, 1.2; p = 0.339), HGPIN (OR, 1.4; p = 0.368), or ASAP (OR, 2.2; p = 0.201). Conclusions: Saturation biopsy does not appear to detect more abnormal prostate pathology than standard office biopsy of the prostate. This procedure may be associated with increased cost and patient morbidity.
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10-Year Experience in Performing Saturation Prostate Biopsy
Universitas Médica
Objective: Identify the prostate cancer detection rate in patients in whom underwenta saturation prostate biopsy as a rebiopsy from January 2005 to February 2015 at SanIgnacio Hospital. Materials and methods: In San Ignacio hospital were performedfrom January 2005 to February 2015, 114 saturation biopsies. The investigatorsmade a univariate analysis of the variables. The association between the variable wasevaluated based on the T-test and Wilcoxon test. P < 0.05 was considered statisticallysignificant. Finally, a regression model was performed to predict significant variablesfor prostate cancer. Results: The cancer detection rate using saturation prostate biopsywas 16.7% of which 84% were categorized as significant. A mean of 19 cores wereobtained. There were statistically significant differences between patients with prostatecancer and healthy patients in the number of previous biopsies, number of samples,prostate volume and PSA density. Conclusion: Saturation prostate biopsy i...
The Journal of Urology, 2008
Purpose: It has been reported that the prostate cancer detection rate in men with prostate specific antigen 2.5 ng/ml or greater undergoing saturation (20 cores or greater) prostate biopsy as an initial strategy is not higher than that in men who undergo 10 to 12 core prostate biopsy. At a median followup of 3.2 years we report the cancer detection rate on subsequent prostate biopsy in men who underwent initial saturation prostate biopsy. Materials and Methods: Saturation prostate biopsy was used as an initial biopsy strategy in 257 men between January 2002 and April 2006. Cancer was initially detected in 43% of the patients who underwent saturation prostate biopsy. In the 147 men with negative initial saturation prostate biopsy followup including digital rectal examination and repeat prostate specific antigen measurement was recommended at least annually. Persistently increased prostate specific antigen or an increase in prostate specific antigen was seen as an indication for repeat saturation prostate biopsy. Results: During the median followup of 3.2 years after negative initial saturation prostate biopsy 121 men (82%) underwent subsequent evaluation with prostate specific antigen and digital rectal examination. Median prostate specific antigen remained 4.0 ng/ml or greater in 57% of the men and it increased by 1 ng/ml or greater in 23%. Cancer was detected in 14 of 59 men (24%) undergoing repeat prostate biopsy for persistent clinical suspicion of prostate cancer. No significant association was demonstrated between cancer detection and initial or followup prostate specific antigen, or findings of atypia and high grade prostatic intraepithelial neoplasia on initial saturation prostate biopsy. Cancers detected on repeat prostate biopsy were more likely to be Gleason 6 and organ confined at prostatectomy than were those diagnosed on initial saturation prostate biopsy. Conclusions: Previous experience suggests that, while office based saturation prostate biopsy improves cancer detection in men who have previously undergone a negative prostate biopsy, it does not improve cancer detection as an initial biopsy technique. We now report that the false-negative rate on subsequent prostate biopsy after initial saturation prostate biopsy is equivalent to that following traditional prostate biopsy. These data provide further evidence against saturation prostate biopsy as an initial strategy.
PROSTATE CANCER DETECTION WITH OFFICE BASED SATURATION BIOPSY IN A REPEAT BIOPSY POPULATION
Journal of Urology, 2004
Purpose: Patients at increased risk for prostate cancer with previously negative biopsies pose a diagnostic challenge. We have previously demonstrated that extensive saturation biopsy can be performed in an office setting. We now report the diagnostic yield of office saturation biopsy in patients at increased risk for prostate cancer and at least 1 negative prior biopsy.
Role of “saturation biopsy” in the detection of prostate cancer among difficult diagnostic cases
Urology, 2002
To determine the role of extensive prostate biopsy ("saturation biopsy") among selected men with unexplained worrisome prostate-specific antigen (PSA) parameters. Clinicians are commonly faced with the dilemma of elevating PSA levels despite negative prostate biopsy results in patients without symptoms of prostatitis. Methods. Thirty-seven patients underwent saturation biopsy. This consisted of 24 peripheral zone cores, 6 to 12 transition zone cores, and 2 lateral lobe transurethral samples. All procedures were done under anesthesia. Patients were discharged home with catheters in situ. All patients had undergone at least three prior sets of transrectal ultrasound-guided prostate biopsies, including transition zone assessment. Twelve, eight, and five patients had had four, five, and six prior prostate biopsies, respectively. Specimens were sent for pathologic examination in groups of six to determine the marginal benefit of the additional sampling. Results. The mean age of the cohort was 62.4 years (range 39 to 75). The median PSA and percent free PSA was 22.4 ng/mL (range 7.8 to 73.8) and 0.11 (range 0.04 to 0.17), respectively. Five patients (13.5%) had detectable carcinoma at saturation biopsy. The grade distribution was Gleason score 8 for 1 patient, Gleason score 7 for 2 patients, and Gleason score 6 for 2 patients. In all cases, carcinoma was detected in the first 18 peripheral zone cores. Acute prostatitis was noted in 19% of specimens. The procedure was well tolerated, although 4 patients required prolonged (greater than 1 week) catheter drainage for urinary retention. All patients were spontaneously voiding by week 3.
European Urology, 2006
Objectives: We explored the yield of saturation biopsy and developed a nomogram predicting the probability of prostate cancer (PCa) on the basis of saturation biopsy. Materials and methods: Between 2001 and 2004, saturation biopsies (average of 24 cores) were performed in 161 men with persistently elevated prostate specific antigen (PSA) level (median, 9 ng/ml). All had at least two previously negative, eight-core biopsy sessions. PCa predictors on saturation biopsy were integrated within multivariate nomograms. Results: PCa detection was 41% (n = 66 of 161). PSA density and transition zone volume were the most significant predictors of PCa on saturation biopsy. The accuracy of the nomogram with the best performance characteristics was 72%. Conclusions: Saturation biopsy may be indicated in men with a persistent suspicion of PCa. High-risk individuals can be identified accurately with our nomogram.
Saturation Technique Does Not Improve Cancer Detection as an Initial Prostate Biopsy Strategy
Journal of Urology, 2006
We reported on the results of a sequential cohort study comparing office based saturation prostate biopsy to traditional 10-core sampling as an initial biopsy. Materials and Methods: Based on improved cancer detection of office based saturation prostate biopsy repeat biopsy, we adopted the technique as an initial biopsy strategy to improve cancer detection. Two surgeons performed 24-core saturation prostate biopsies in 139 patients undergoing initial biopsy under periprostatic local anesthesia. Indication for biopsy was an increased PSA of 2.5 ng/dl or greater in all patients. Results were compared to those of 87 patients who had previously undergone 10-core initial biopsies. Results: Cancer was detected in 62 of 139 patients (44.6%) who underwent saturation biopsy and in 45 of 87 patients (51.7%) who underwent 10-core biopsy (p Ͼ0.9). Breakdown by PSA level failed to show benefit to the saturation technique for any degree PSA increase. Men with PSA 2.5 to 9.9 ng/dl were found to have cancer in 53 of 122 (43.4%) saturation biopsies and 26 of 58 (44.8%) 10-core biopsies. Complications included 3 cases of prostatitis in each group. Rectal bleeding was troublesome enough to require evaluation only in 3 men in the saturation group and 1 in the 10-core group. Conclusions: Although saturation prostate biopsy improves cancer detection in men with suspicion of cancer following a negative biopsy, it does not appear to offer benefit as an initial biopsy technique. These findings suggest that further efforts at extended biopsy strategies beyond 10 to 12 cores are not appropriate as an initial biopsy strategy.
Saturation biopsies on autopsied prostates for detecting and characterizing prostate cancer
BJU International, 2009
OBJECTIVES-To evaluate a 36-core saturation biopsy scheme on autopsied prostate glands to estimate the detection rate based on the true cancer prevalence, and to compare the cancer features on biopsy with whole-mount pathological analysis, as saturation biopsies have been proposed as a tool to increase the prostate cancer detection rate, and as a staging tool to identify potentially insignificant cancers before surgery. MATERIAL AND METHODS-We took 36-core needle biopsies in 48 autopsied prostates from men who had no history of prostate cancer. The first 18 cores corresponded to an extended biopsy protocol including six cores each in the mid peripheral zone (PZ), lateral PZ and central zone. Six additional cores were then taken in each of these three locations. We compared the histological characteristics of step-sectioned prostates with the biopsy findings. Tumours were considered clinically insignificant if they were organ-confined with an index tumour volume of <0.5 mL and Gleason score of ≤6. RESULTS-The pathological evaluation identified 12 (25%) cases of prostate cancer and 22 tumour foci; seven prostate cancers were significant. Of the 22 tumour foci, 16 (73%) were in the PZ. The first 18 cores detected seven cancers (58%), of which five were clinically significant. The last 18 cores detected four cancers, all of which were already detected by the first 18 cores. Of the five cancers remaining undetected by biopsies, two were clinically significant and three were insignificant. Comparison of the histological characteristics between biopsies and step-sectioned prostates showed an overestimation of Gleason score by saturation biopsies in three of seven cases. CONCLUSIONS-The evaluation of saturation biopsies based on the true prevalence of prostate cancer showed no increase in detection rate over a less extensive 18-core biopsy. Also, saturation biopsies might overestimate the final Gleason score on whole-mount analysis.
Predicting Low-Risk Prostate Cancer from Transperineal Saturation Biopsies
Prostate cancer, 2016
Introduction. To assess the performance of five previously described clinicopathological definitions of low-risk prostate cancer (PC). Materials and Methods. Men who underwent radical prostatectomy (RP) for clinical stage ≤T2, PSA <10 ng/mL, Gleason score <8 PC, diagnosed by transperineal template-guided saturation biopsy were included. The performance of five previously described criteria (i.e., criteria 1-5, criterion 1 stringent (Gleason score 6 + ≤5 mm total max core length PC + ≤3 mm max per core length PC) up to criterion 5 less stringent (Gleason score 6-7 with ≤5% Gleason grade 4) was analysed to assess ability of each to predict insignificant disease in RP specimens (defined as Gleason score ≤6 and total tumour volume <2.5 mL, or Gleason score 7 with ≤5% grade 4 and total tumour volume <0.7 mL). Results. 994 men who underwent RP were included. Criterion 4 (Gleason score 6) performed best with area under the curve of receiver operating characteristics 0.792. At d...
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