PURPOSE: To investigate cancers missed by extended transperineal (TP) 14-core biopsy (TP14PBx) and examined its diagnostic performance.
METHODS: We evaluated 744 men with prostate-specific antigen (PSA) levels in the range 2.5-20 ng/mL or abnormal digital rectal examination underwent three-dimensional 26-core prostate biopsy (3D26PBx), a combination of TP14PBx and transrectal 12-core biopsy (TR12PBx), at initial biopsy. Of 269 patients diagnosed with cancer, 127 subsequently underwent radical prostatectomy (RP). Cancers were grouped into TP-positive cancers (detected through TP14PBx) and TP-negative cancers (those not detected through TP14PBx but detected through TR12PBx). Clinicopathological characteristics and cancer locations of TP-negative cancers were evaluated. For cancer location analysis, the prostate was divided into apex, midprostate, and base regions.
RESULTS: Thirty-seven (14 %) TP-negative cancers were found in 269 biopsy-positive cancers. Median number of positive cores in TP-negative cancers was significantly lower than that in TP-positive cancers (1 vs. 5, p < 0.001). TP-negative cancers had biopsy Gleason score (GS) of 7 or less in 87 % of cases and had significantly lower biopsy GS than those of TP-positive cancers (p = 0.028). Of 20 TP-negative cancers treated with RP, 70 % (14/20) were insignificant cancers (GS < 4+3, volume < 0.5 cc, and organ-confined disease). Of all significant cancers treated with RP, 6 % (6/99) were missed by TP14PBx. TP-negative cancers treated with RP were located more frequently in the apex than in the base (85 vs. 20 %, p < 0.001).
CONCLUSIONS: Initial TP14PBx provides sufficient detectability of significant cancers despite a small risk of missing cancers located in the prostate apex.
Written by:
Takeshita H, Numao N, Kijima T, Yokoyama M, Ishioka J, Matsuoka Y, Koga F, Saito K, Masuda H, Kawakami S, Yamamoto S, Yonese J, Fujii Y, Kihara K. Are you the author?
Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Reference: Int Urol Nephrol. 2013 Mar 26. Epub ahead of print.
doi: 10.1007/s11255-013-0416-0
PubMed Abstract
PMID: 23529272
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