Introduction: The use of a Vienna nomogram for the initial transrectal ultrasound (TRUS) biopsy was shown to produce higher cancer detection rates. However, a recent prospective study has found no significant differences in its cancer detection compared to octant biopsy. The study objective was to compare prostate cancer detection using the Vienna nomogram versus laterally directed sextant and octant biopsy methods.
Methods and Materials: This retrospective study included all patients with prostate-specific antigen (PSA) of 2 to 40 ng/ml, grouped into the Vienna nomogram (VN) or the sextant/octant (S/O) group. Patients were further subdivided according to prostate volume (> or < 50 ml) and age group (< 60 years and > 70 years). Statistical analysis was performed using chi square, Fisher's exact test, and t test, where appropriate. A p value of < 0.05 was considered significant.
Results: A total of 371 patients qualified with inclusion criteria (VN, n = 190, S/O, n = 181). There were no significant differences in the mean PSA value, age, PSA density, and prostate volume between the 2 groups. Cancer detection rates were slightly higher in the VN group for PSA of 2 to 40 ng/ml (20.5% versus 17.6%), PSA of 2 to 10 ng/ml (16.6% versus 13.7%), younger age (16.1% versus 10%), and prostate volumes above 50 ml. These differences were not significant.
Conclusion: The use of a Vienna nomogram did not offer significant advantages in cancer detection on initial TRUS biopsy compared to sextant or octant methods. Strategies employing the standard 8 to 10 core biopsy incorporating the lateral and apical zones should be used regardless of age and prostate volume.
KEYWORDS: Prostate cancer, biopsy, Vienna nomogram, sextant
CORRESPONDENCE: Praveen Singam, Urology Unit, Department of Surgery, UKM Medical Center, Jalan Yaacob Latif, 56100 Cheras, Kuala Lumpur, Malaysia ( )
CITATION: UroToday Int J. 2012 October;5(5):art 47.
DOI: http://dx.doi.org/10.3834/uij.1944-5784.2012.10.06