Abstract
The introduction of prostate-specific antigen screening has resulted in stage migration and an increased incidence of localized prostate cancer. In this era of increasing nonpalpable disease, it has become necessary to systematically sample the entire prostate gland. Transrectal ultrasound-guided prostate biopsy procedures have evolved greatly over the past decade from the original sextant biopsy. Technological advances, better understanding of zonal anatomy of the prostate, whole mount sectioning of radical prostatectomy specimens, and computer modeling of localized prostate cancers have all led to extended biopsy core protocols directed at the lateral zones of the gland. These have increased the diagnostic accuracy of needle biopsy and have become a standard regimen. However, it remains controversial how to proceed with repeat biopsy in the face of an initial benign diagnosis, and optimal biopsy strategy remains undefined. It is hoped that quantitative analysis of prostate biopsy histology may eventually provide some prognostic information to guide the patient and urologist in preoperative planning.
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References and Recommended Reading
Ries LAG, Eisner MP, Kosary CL, et al. eds:, SEER Cancer Statistics Review 1973–1997. Bethesda: National Cancer Institute; 2000.
American Urological Association: Prostate-specific antigen (PSA) best practice policy. Oncology (Huntingt) 2000, 14:267–272.
Catalona WJ, Smith DS, Ornstein DK: Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4 ng/mL and benign prostate examination: enhancement of specificity with free PSA measurements. JAMA 1997, 277:1452–1555.
Renfer LG, Schow D, Thompson IM, et al.: Is ultrasound guidance necessary for transrectal prostate biopsy? J Urol 1995, 154:1390–1391.
Devonec M, Fendler JP, Monsallier M, et al.: The significance of the prostatic hypoechoic area: results in 226 ultrasonically guided prostatic biopsies. J Urol 1990, 143:316–319. This article defines the ultrasound characteristics of the prostate gland and prostate cancer.
Hodge KK, McNeal JE, Terris MK, et al.: Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989, 142:71–74. This is a seminal reference on sextant biopsies, which defined the standard for transrectal core biopsies of the prostate.
Catalona WJ, Smith DS, Ratliff TL, et al.: Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 1991, 324:1156–1161.
Brawer MK, Chetner MP, Beatie J, et al.: Screening for prostatic carcinoma with prostate-specific antigen. J Urol 1992, 147:841–845.
Keetch DW, Catalona WJ, Smith DS: Serial prostatic biopsy in men with persistently elevated serum prostate-specific antigen levels. J Urol 1994, 151:1571–1574.
Ellis WJ, Brawer MK: Repeat prostate needle biopsy: who needs it? J Urol 1995, 153:1496–1498.
Fleshner NE, Fair WR: Indications for transition zone biopsy in the detection of prostatic carcinoma. J Urol 1997, 157:556–558.
Uzzo RG, Wei JT, Waldbaum RS, et al.: The influence of prostatic size on cancer detection. Urology 1995, 46:831–836.
Karakiewicz PI, Bazinet M, Aprikian AG, et al.: Outcome of sextant biopsy according to gland volume. Urology 1997, 49:55–59.
Stamey TA: Making the most out of six systematic sextant biopsies. Urology 1995, 45:2–12.
Eskew LA, Bare RL, McCullough DL, et al.: Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol 1997, 157:199–202. This article introduced the concept of extended biopsy protocols.
Chang JJ, Shinohara K, Bhargava V, et al.: Prospective evaluation of lateral biopsies of the peripheral zone for prostate cancer detection. J Urol 1998, 160:2111–2114.
Bauer JJ, Zeng J, Weir J, et al.: Three-dimensional computersimulated prostate models: lateral prostate biopsies increase the detection rate of prostate cancer. Urology 1999, 53:961–967.
Bauer JJ, Zeng J, Zhang W, et al.: Lateral biopsies added to the traditional sextant prostate biopsy pattern increases the detection rate of prostate cancer. Prostate Cancer Prostatic Dis 2000, 3:43–46.
Babaian RJ, Toi A, Kamoi K, et al.: A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 2000, 163:152–157.
Levine MA, Ittman M, Melamed J, et al.: Two consecutive sets of transrectal ultrasound guided sextant biopsies of the prostate for detection of prostate cancer. J Urol 1998, 159:471–475.
Arnold PM, Niemann TH, Bahnson RR: Extended sector biopsy for detection of carcinoma of the prostate. Urol Oncol 2001, 6:91–93.
Naughton CK, Ornstein DK, Smith DS, et al.: Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores. J Urol 2000, 163:168–171.
Naughton CK, Miller DC, Mager DE, et al.: A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection. J Urol 2000, 164:388–392.
Presti JC, Chang JJ, Bhargava V, et al.: The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol 2000, 163:163–166.
Gore JL, Shariat SF, Miles BJ, et al.: Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol 2001, 165:1554–1559.
Ravery V, Goldblatt L, Royer B, et al.: Extensive biopsy protocol improves the detection rate of prostate cancer. J Urol 2000, 164:393–396.
Epstein JI, Walsh PC, Carter HB: Importance of posterolateral needle biopsies in the detection of prostate cancer. Urology 2001, 57:1112–1116.
Djavan B, Waldert M, Zlotta A, et al.: Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol 2001, 166:856–860.
O’Dowd GJ, Miller MC, Orozco R, et al.: Analysis of repeated biopsy results within 1 year after a noncancer diagnosis. Urology 2000, 55:553–559.
Fowler JE, Bigler SA, Miles D, et al.: Predictors of first repeat biopsy cancer detection with suspected local stage prostate cancer. J Urol 2000, 163:813–818.
Borboroglu PG, Comer SW, Riffenburgh RH, et al.: Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies. J Urol 2000, 163:158–162.
Park S, Shinohara K, Grossfeld GD, et al.: Prostate cancer detection in men with prior high grade intraepithelial neoplasia or atypical prostate biopsy. J Urol 2001, 165:1409–1414.
Borboroglu PG, Sur RL, Roberts JL, et al.: Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy. J Urol 2001, 166:866–870.
Allen EA, Kahane H, Epstein JI: Repeat biopsy strategies for men with atypical diagnoses on initial needle biopsy. Urology 1998, 52:803–807.
Liu IJ, Macy M, Lai Y-H, et al.: Critical evaluation of the current indications for transition zone biopsies. Urology 2001, 57:1117–1120.
Vanasupa BP, Miller TA, Schwartz BF: Diagnosis of prostate adenocarcinoma using transurethral resection of the prostate after multiple negative transrectal biopsies and persistently elevated prostate-specific antigen level. Urology 2000, 56:1056xi-1056xii.
Stamey TA: Editorial Comment: Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol 1997, 157:202–203.
Moul JW: Prostate biopsy quantitative histology as a staging and prognostic factor. J Urol 2002, 167:526–527.
Freedland SJ, Csathy GS, Dorey F, et al.: Percent prostate needle biopsy tissue with cancer is more predictive of biochemical failure or adverse pathology after radical prostatectomy than prostate-specific antigen or Gleason score. J Urol 2002, 167:516–520.
Conrad S, Graefen M, Pichlmeier U, et al.: Prospective validation of an algorithm with systematic sextant biopsy to predict pelvic lymph node metastasis in patients with clinically localized prostate cancer. J Urol 2002, 167:521–525.
Naughton CK, Smith DS, Humphrey PA, et al.: Clinical and pathologic tumor characteristics of prostate cancer as a function of the number of biopsy cores: a retrospective study. Urology 1998, 52:808–813.
Yang XJ, Lecksell K, Potter SR, et al.: Significance of small foci of Gleason score 7 or greater prostate cancer on needle biopsy. Urology 1999, 54:528–532.
de la Taille A, Katz A, Bagiella E, et al.: Perineural invasion on prostate needle biopsy: an independent predictor of final pathologic stage. Urology 1999, 54:1039–1043.
Sebo TJ, Bock BJ, Cheville JC, et al.: The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol 2000, 163:174–178.
Egevad L, Norberg M, Mattson S, et al.: Estimation of prostate cancer volume by multiple core biopsies before radical prostatectomy. Urology 1998, 52:653–658.
Sanwick JM, Dalkin BL, Nagle RB: Accuracy of prostate needle biopsy in predicting extracapsular tumor extension at radical retropubic prostatectomy: application in selecting patients for nerve-sparing surgery. Urology 1998, 52:814–819.
D’Amico AV, Whittington R, Malkowicz SB, et al.: Utilizing predictions of early prostate-specific antigen failure to optimize patient selection for adjuvant systemic therapy trials. J Clin Oncol 2000, 18:3240–3246. A very useful reference for counseling patients, and for use in day-today practice.
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Donahue, T., Moul, J. Diagnostic accuracy of prostate needle biopsy. Curr Urol Rep 3, 215–221 (2002). https://doi.org/10.1007/s11934-002-0067-7
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DOI: https://doi.org/10.1007/s11934-002-0067-7