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N25 Are sextant biopsies still justified?

      Introduction and Objectives

      The aim of this study was to evaluate the usefulness of sextant biopsy for prostate cancer detection at first biopsy.

      Material and Methods

      All patients who had undergone sextant prostate biopsy at single institution since May 2007 to Apr 2008 were included into the study. The prostate specific antigen (PSA), total prostate volume (TPV), age and pathological report were analyzed. All patients were divided into several groups according to TPV (<30 vs. 30–40 vs. 40–50 vs. 50–60 vs. 60–70 vs. >70 mL), PSA (≤4 vs. 4–7 vs. 7–10 vs. 10–15 vs. 15–20 vs. >20 ng/mL) and age (<50 vs. 50–60 vs. 60–70 vs. >70 years). Logistic regression, Shi square test and descriptive statistic were used for the analysis of prospectively collected data using SPSS 13.0 statistical analysis software for Windows.

      Results

      For 855 of 899 study patients sextant biopsy was performed. Median patient age was 67 (range 32–87) years, median PSA was 6.63 (range 0.43–590) ng/mL, median TPV was 42.3 (range 14.30–240) mL. Prostate cancer was detected in 311 cases and overall detection rate was 36.37%. Logistic regression analysis shows that TPV (Exp(B) 0.624 95.0% CI 0.563–0.691) and PSA (Exp(B) 1.572; 95.0% CI 1.4–1.76) are the most powerful parameters for prediction of PCa (p = 0.0001) at sextant biopsy. Using the formula of logistic regression, the table of probabilities for detection of the PCa at different values of TPV and PSA was composed (Table 1).
      Tabled 1
      PSA/TPV<3030–4040–5050–6060–70>70
      ≤4.037.227.018.712.68.25.3
      4.0–7.048.236.726.618.412.38.1
      7.0–10.059.447.736.226.218.112.1
      10.0–15.069.758.947.235.825.817.8
      15.0–20.078.369.258.446.735.325.4
      >20.085.078.068.857.946.234.9
      Prostate cancer detection probability using six cores biopsy varies from 26.0 to 85.0% in small and middle volume prostates (up to 50 mL). Logistic regression analysis was performed in different age groups of patients. Only for the youngest patients (up to 50 years) no significant parameter for PCa detection at first sextant biopsy was found. In other age groups PSA and TPV strongly influence such detection.

      Conclusions

      Our study data shows that sextant biopsy can not be recommended if prostate volume is more than 60 mL and PSA concentration less than 10 ng/mL. In such cases prostate cancer detection rate has not reached acceptable level. The sextant biopsy is still justified independently of PSA level or age in prostates up to 50 mL.