Introduction and Objectives
There is still much debate regarding the optimal number of cores taken at the initial prostate biopsy. The aim of the study is to evaluate the incidence of prostate cancer, high grade prostatic intraepithelial neoplasia (HGPIN) and perineural infiltration rates in men who had initial 24-core biopsies and to compare the results with a similar group of men who had initial 10-core biopsy protocol.
Material and Methods
We retrospectively reviewed the contemporary maintained prostate biopsy database of men undergoing prostate biopsies for the first time in two referral centers by using the 10 (Group A) and 24 (Group B) biopsy protocols. Indications for biopsy were abnormal digital rectal examination and elevated age specific PSA Men were stratified according to biopsy protocol and PSA levels. Exclusion criteria were age ≥75 years, PSA >20 or <2.5 ng/ml and clinical stage more than T2. The Mann-Whitney U and Fisher's exact test were used for statistical analysis.
Results
Between April 2004 and August 2007, 2169 men underwent TRUS prostate biopsies at these two referral centers from which 379 were eligible for the study. Group A (10-cores) consisted of 243 (64.11%) men and group B (24-cores) included 139 (35.89%) men. The overall prostate cancer detection rate was 39.09% and 34.55% in Group A and B, respectively (p = 0.43). An overall 9.8% increase in Gleason 7 detection rate was found in Group B (p = 0.24). The HGPIN detection rate in men with negative biopsies was 15.54% and 35.55% in Group A and B, respectively (p <0.001). Regarding patients with PSA <10 ng/ml, the 24-core technique increased Gleason 7 detection rate by 13.4% (p = 0.16) and HGPIN by 23.4% (p = 0.0008), compared to the 10 core technique. The 24-core technique increased the concordance between needle biopsy and prostatectomy specimen compared to 10-core technique (p <0.002). There were no differences in perineural infiltration rates between both groups.
Conclusions
Initial 24-core biopsy protocol increased the detection of clinically sig nificant prostate cancer, HGPIN and improved the prediction of radical prostatecto my Gleason score in men with PSA < 10 ng/ml. It can be beneficial in a selected group of patients who are candidates for active surveillance.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
