OBJECTIVE: To investigate the diagnostic performance and safety of a three-dimensional 14-core biopsy (3D14PBx) method, which is a combination of the transrectal (TR) 6-core and transperineal (TP) 8-core biopsy methods. This 14-core method was designed to achieve both a cancer detection rate and grading accuracy of more than 95% of the three-dimensional 26-core biopsy (3D26PBx) method, which is a combination of the TR 12-core and TP 14-core biopsy methods.
PATIENTS AND METHODS: Between December 2005 and August 2010, 1103 men underwent 3D14PBx at our institutions and they were analyzed prospectively. Biopsy criteria included an elevated PSA from 2.5 to 20 ng/mL or abnormal DRE findings or both. The primary end-point of the present study was diagnostic performance and the secondary end-point was safety. We applied recursive partitioning to the entire study cohort to delineate the unique contribution of each sampling site to overall and clinically significant cancer detection.
RESULTS: Prostate cancer was detected in 503 of the 1103 patients (45.6%). Age, family history of prostate cancer, DRE, PSA, %-free PSA and prostate volume were associated with positive biopsy result significantly and independently. Of the 503 cancers detected, 39 (7.8%) were clinically locally advanced (cT3a or greater), 348 (69%) had a biopsy Gleason score (GS) of 7 or greater, and 463 (92%) and more met the definition of biopsy-based significant cancer. Recursive partitioning analysis revealed that each sampling site contributed uniquely to both the overall and the biopsy-based significant cancer detection rate of the 3D14PBx method. The overall cancer positive rate of each sampling site ranged from 14.5% in the TR far lateral base (lb) to 22.8% in the TR far lateral apex (la). As of August 2010, 210 patients (42%) had undergone radical prostatectomy, which revealed that 55 (26%) had pathologically non-organ-confined disease, 174 (83%) had prostatectomy GS 7 or greater and 185 (88%) and more met the definition of prostatectomy-based significant cancer.
CONCLUSIONS: This is the first prospective analysis of the diagnostic performance of an extended biopsy method which is a simplified version of the somewhat redundant super-extended 3D26PBx. As expected, each sampling site uniquely contributed not only to overall cancer detection but also to significant cancer detection. 3D14PBx is a feasible systematic biopsy method in men with PSA < 20 ng/ml.
Written by:
Takeshita H, Kawakami S, Numao N, Sakura M, Tatokoro M, Yamamoto S, Kijima T, Komai Y, Saito K, Koga F, Fujii Y, Fukui I, Kihara K. Are you the author?
Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Reference: BJU Int. 2014 Apr 15. Epub ahead of print.
doi: 10.1111/bju.12772
PubMed Abstract
PMID: 24731079
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