BERKELEY, CA (UroToday.com) - The best prostate biopsy protocol for detecting clinically significant cancer has been a controversial subject for more than 2 decades.
Over diagnosis of prostate cancer and missing clinically significant tumours are but two of the problems facing the urologist when deciding how many biopsy cores should be taken. Prostate volume and patient age are additional criteria that need to be considered. A recent study from Vienna introduced a nomogram to determine the optimum number of cores to be taken during prostate biopsies, based on patient age and total prostate volume. The objective of the nomogram is to decrease the number of biopsies taken in older men to avoid detection of insignificant prostate cancer. Conversely, it also increases the number of biopsies taken in younger men and in those patients with larger prostates in an attempt to detect clinically significant tumours. Using the nomogram, the investigators found a significant increase in the prostate cancer detection rate when compared to a historical 8-core prostate biopsy group. The primary goal of our study was to determine if using the Vienna nomogram would yield a higher cancer detection rate than a standard 8-core biopsy protocol. Unlike the Vienna study, which was performed in a prostate cancer screening setting, our population included patients referred to a tertiary urology unit.
We randomized 303 patients into group A (number of biopsy cores determined according to the Vienna nomogram, n = 152) or group B (8-core biopsy, n = 151). Overall, the cancer detection rate was higher in the 8-core biopsy group (38.4%) than in the Vienna group (35.5%), although the difference was not statistically significant. The proportion of patients with DRE suspicious of malignancy was slightly higher in the 8-core group, because of the fact that patients were not stratified according to DRE findings before randomisation. When controlling for this discrepancy in the subgroup of patients with PSA <10 ng="" ml="" and="" benign="" dre="" the="" 8-core="" biopsy="" protocol="" still="" had="" a="" higher="" cancer="" detection="" rate="" 26="" 9="" vs="" 21="" 6="" nss="" analysis="" of="" different="" subgroups="" prostate="" volume="">50ml, age <60 or="">70 years) did not reveal a significant difference between the two biopsy protocols. Furthermore, no significant difference was found in the complication rate between the Vienna and 8-core group.
We did not find statistically significant differences in cancer detection rate or complications when comparing the Vienna nomogram to a standard 8-core prostate biopsy protocol.
Written by:
Angus Lecuona, and Chris F. Heyns as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Tygerberg Hospital and University of Stellenbosch, Western Cape, South Africa.
UroToday.com Prostate Cancer Section
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