Abstract
Purpose
The optimal random prostate biopsy scheme (PBx) in the initial and repeated setting is still an issue of controversy. We performed an analysis of the recent literature about the prostate biopsy techniques.
Methods
We performed a clinical and critical literature review by searching MEDLINE database from January 2005 up to January 2014. Electronic searches were limited to the English language, and the keywords prostate cancer, prostate biopsy, transrectal ultrasound, transperineal prostate biopsy were used.
Results
Prostate biopsy strategy in initial setting. According to the literature and the major international guidelines, the recommended approach in initial setting is still the extended scheme (EPBx) (12 cores). However, there is now a growing evidence in the literature that (a) saturation PBx (>20 cores) (SPBx) might be indicated in patients with PSA <10 ng/ml or low PSA density or large prostate and (b) an individualized approach with more than 12 cores according to the clinical characteristics of the patients may optimize cancer detection in the single patient. Moreover, in the era of multi-parametric MRI (mpMRI), EPBx or SPBX may be substituted by mpMRI-targeted biopsies that have demonstrated superiority over systematic random biopsies for the detection of clinically significant disease and representation of disease burden, while deploying fewer cores. Prostate biopsy strategy in repeat setting. How and how many cores should be taken in the different scenarios in the repeated setting is still unclear. SPBx clearly improves cancer detection if clinical suspicion persists after previous biopsy with negative findings and is able to provide an accurate prediction of prostate tumour volume and grade. Nevertheless, international guidelines do not strongly recommended SPBx in all situations of repeated setting. In the active surveillance and in focal therapy protocols, the optimal schemes have to be defined.
Conclusions
The course of PBx has changed significantly from sextant biopsies to systematic and from extended to SPBx schemes. The issue about the number and location of the cores is still a matter of debate both in initial and in repeat setting. At present, EPBx is sufficient in most of the cases to provide adequate diagnosis and prostate cancer characterization in the initial setting, while SPBx seems to be necessary in repeat setting. The PBx schemes are evolving also because the scenario in which a PBx is necessary is changing. Random prostate PBx do not represent the future, while imaging target biopsy are becoming more popular.
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References
Collin SM, Martin RM, Metcalfe C, Gunnell D, Albertsen PC, Neal D, Hamdy F, Stephens P, Lane JA, Moore R, Donovan J (2008) Prostate-cancer mortality in the USA and UK in 1975-2004: an ecological study. Lancet Oncol 9(5):445–452
Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62(1):10–29
Welch HG, Fisher ES, Gottlieb DJ, Barry MJ (2007) Detection of prostate cancer via biopsy in the Medicare-SEER population during the PSA era. J Natl Cancer Inst 99(18):1395–1400
Hodge KK, McNeal JE, Terris MK, Stamey TA (1989) Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 142(1):71–74
Gore JL, Shariat S, Miles BJ et al (2001) Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol 165:1554–1559
Siu W, Dunn RL, Shah RB et al (2005) Use of extended pattern technique for initial prostate biopsy. J Urol 174:505–509
Scattoni V, Zlotta A, Montironi R, Schulman C, Rigatti P, Montorsi F (2007) Extended and saturation prostatic biopsy in the diagnosis and characterisation of prostate cancer: a critical analysis of the literature. Eur Urol 52(5):1309–1322
Shariat SF, Roehrborn CG (2008) Using biopsy to detect prostate cancer. Rev Urol 10(4):262–280
Graefen M, Schlomm T (2013) From diagnostic tool to disease monitoring: the growing role of prostate biopsies. Eur Urol 63(2):231–233
Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360(13):1320–1328
Andriole GL, Crawford ED, Grubb RL 3rd, Buys SS, Chia D, Church TR, Fouad MN, Gelmann EP, Kvale PA, Reding DJ et al (2009) Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 360(13):1310–1319
Schröder FH (2001) Prostate cancer: natural history and surgical treatment of localised disease. Eur J Cancer 37(Suppl 7):S127–S136
Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA Jr (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level ≤ 4.0 ng per milliliter. N Engl J Med 350(22):2239–2246 (Erratum in: N Engl J Med 2004; 351 (14): 1470)
Caras RJ, Sterbis JR (2014) Prostate cancer nomograms: a review of their use in cancer detection and treatment. Curr Urol Rep 15(3):391
Shariat SF, Karakiewicz PI, Roehrborn CG, Kattan MW (2008) An updated catalog of prostate cancer predictive tools. Cancer 113(11):3075–3099
Eichler K, Hempel S, Wilby J, Myers L, Bachmann LM, Kleijnen J (2006) Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review. J Urol 175(5):1605–1612
Ploussard G, Nicolaiew N, Marchand C et al (2014) Prospective evaluation of an extended 21-core biopsy scheme as initial prostate cancer diagnostic strategy. Eur Urol 65:154–161
Obek C, Ozkan B, Tunc B, Can G, Yalcin V, Solok V (2004) Comparison of 3 different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial. J Urol 172(2):502–505
Onur R, Littrup PJ, Pontes JE, Bianco FJ Jr (2004) Contemporary impact of transrectal ultrasound lesions for prostate cancer detection. J Urol 172(2):512–514
Toi A, Neill MG, Lockwood GA, Sweet JM, Tammsalu LA, Fleshner NE (2007) The continuing importance of transrectal ultrasound identification of prostatic lesions. J Urol 177(2):516–520
Frauscher E, Helweg G, Gotwald TF et al (1998) The value of contrast-enhanced color Doppler ultrasonography in the diagnosis of prostate cancer. Radiology 209:417
Halpern EJ, Rosenberg M, Gomolla LG (2001) Contrast enhanced sonography of the prostate. Radiology 219:219–225
Babaain RJ, Troncoso P, Bhadkamkar DA, Johston DA (2001) Analysis of clinicopathologic factors predicting outcome after radical prostatectomy. Cancer 91:1414–1422
Mian BM, Naya Y, Okihara F et al (2006) Role of the prostate biopsy schemes in accurate prediction of Gleason score. Urology 67:379–383
Moore CM, Robertson NL, Arsanious N, Middleton T, Villers A, Klotz L, Taneja SS, Emberton M (2013) Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol 63(1):125–140
Siddiqui MM, Rais-Bahrami S, Truong H, Stamatakis L, Vourganti S, Nix J, Hoang AN, Walton-Diaz A, Shuch B, Weintraub M, Kruecker J, Amalou H, Turkbey B, Merino MJ, Choyke PL, Wood BJ, Pinto PA (2013) Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 64(5):713–719
Robertson NL, Emberton M, Moore CM (2013) MRI-targeted prostate biopsy: a review of technique and results. Nat Rev Urol 10(10):589–597
Rais-Bahrami S, Siddiqui MM, Turkbey B, Stamatakis L, Logan J, Hoang AN, Walton-Diaz A, Vourganti S, Truong H, Kruecker J, Merino MJ, Wood BJ, Choyke PL, Pinto PA (2013) Utility of multiparametric magnetic resonance imaging suspicion levels for detecting prostate cancer. J Urol 190(5):1721–1727
Nelson AW, Harvey RC, Parker RA, Kastner C, Doble A, Gnanapragasam VJ (2013) Repeat prostate biopsy strategies after initial negative biopsy: meta-regression comparing cancer detection of transperineal, transrectal saturation and MRI guided biopsy. PLoS One 8(2):e57480
Hambrock T, Hoeks C, Hulsbergen-van de Kaa C, Scheenen T, Fütterer J, Bouwense S, van Oort I, Schröder F, Huisman H, Barentsz J (2012) Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-weighted magnetic resonance imaging-guided biopsies versus a systematic 10-core transrectal ultrasound prostate biopsy cohort. Eur Urol 61(1):177–184
Linder BJ, Frank I, Umbreit EC, Shimko MS, Fernández N, Rangel LJ, Karnes RJ (2013) Standard and saturation transrectal prostate biopsy techniques are equally accurate among prostate cancer active surveillance candidates. Int J Urol 20(9):860–864
Cooner WH, Mosley BR, Rutherford CL Jr, Beard JH, Pond HS, Terry WJ et al (1990) Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol 143:1146–1152
Naughton CK, Miller DC, Mager DE, Ornstein DK, Catalona WJ (2000) A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection. J Urol 164(2):388–392
Punglia RS, D’Amico AV, Catalona WJ, Roehl KA, Kuntz KM (2003) Effect of verification bias on screening for prostate cancer by measurement of prostate-specific antigen. N Engl J Med 349(4):335–342
Jones JS, Patel A, Schoenfield L, Rabets JC, Zippe CD, Magi-Galluzzi C (2006) Saturation technique does not improve cancer detection as an initial prostate biopsy strategy. J Urol 175(2):485–488
Zaytoun OM, Moussa AS, Gao T, Fareed K, Jones JS (2011) Office based transrectal saturation biopsy improves prostate cancer detection compared to extended biopsy in the repeat biopsy population. J Urol 186(3):850–854
Jiang X, Zhu S, Feng G, Zhang Z, Li C, Li H, Wang C, Xu Y (2013) Is an initial saturation prostate biopsy scheme better than an extended scheme for detection of prostate cancer? A systematic review and meta-analysis. Eur Urol 63(6):1031–1039
Scattoni V, Raber M, Abdollah F, Roscigno M, Dehò F, Angiolilli D et al (2010) Biopsy schemes with the fewest cores for detecting 95 % of the prostate cancers detected by a 24-core biopsy. Eur Urol 57(1):1–8
Li YH, Elshafei A, Li J, Gong M, Susan L, Fareed K, Jones JS (2013) Transrectal saturation technique may improve cancer detection as an initial prostate biopsy strategy in men with prostate-specific antigen <10 ng/ml. Eur Urol. doi:10.1016/j.eururo.2013.05.047
Thompson IM, Ankerst DP, Chi C, Goodman PJ, Tangen CM, Lucia MS, Feng Z, Parnes HL, Coltman CA Jr (2006) Assessing prostate cancer risk: results from the prostate cancer prevention trial. J Natl Cancer Inst 98(8):529–534
Gallina A, Chun FK, Suardi N, Eastham JA, Perrotte P, Graefen M, Hutterer G, Huland H, Klein EA, Reuther A et al (2008) Comparison of stage migration patterns between Europe and the USA: an analysis of 11 350 men treated with radical prostatectomy for prostate cancer. BJU Int 101(12):1513–1518
Hogarth RM, Karelaia N (2007) Heuristic and linear models of judgment: matching rules and environments. Psychol Rev 114(3):733–758
Chun FK, Karakiewicz PI, Briganti A, Gallina A, Kattan MW, Montorsi F, Huland H, Graefen M (2006) Prostate cancer nomograms: an update. Eur Urol 50(5):914–926 (discussion 926)
Kawakami S, Numao N, Okubo Y, Koga F, Yamamoto S, Saito K, Fujii Y, Yonese J, Masuda H, Kihara K et al (2008) Development, validation, and head-to-head comparison of logistic regression-based nomograms and artificial neural network models predicting prostate cancer on initial extended biopsy. Eur Urol 54(3):601–611
Ide H, Yasuda M, Nishio K, Saito K, Isotani S, Kamiyama Y, Muto S, Horie S (2008) Development of a nomogram for predicting high-grade prostate cancer on biopsy: the significance of serum testosterone levels. Anticancer Res 28(4C):2487–2492
Kawakami S, Okuno T, Yonese J et al (2007) Optimal sampling sites for repeat prostate biopsy: a recursive portioning analysis of three-dimensional 26-core systematic biopsy. Eur Urol 51:675–683
Delongchamps NB, de la Roza G, Jones R, Jumbelic M, Haas GP (2009) Saturation biopsies on autopsied prostates for detecting and characterizing prostate cancer. BJU Int 103(1):49–54
Scattoni V, Raber M, Capitanio U, Abdollah F, Roscigno M, Angiolilli D et al (2011) The optimal rebiopsy prostatic scheme depends on patient clinical characteristics: results of a recursive partitioning analysis based on a 24-core systematic scheme. Eur Urol 60(4):834–841
Djavan B, Ravery V, Zlotta A et al (2001) Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol 166:1679–1683
Campos-Fernandes JL, Bastien L, Nicolaiew N et al (2009) Prostate cancer detection rate in patients with repeat extended 21-sample needle biopsy. Eur Urol 55:600–609
Tan N, Lane B, Li J et al (2008) Prostate cancers diagnosed at repeat biopsy are smaller and less likely to be high grade. J Urol 180:1325–1329
Lane BR, Zippe CD, Abouassaly A, Schoenfield L, Magi-Galluzzi C, Stephen Jones L (2008) Saturation technique does not decrease cancer detection during follow-up after initial prostate biopsy. J Urol 179:1749–1750
Guichard G, Larre S, Gallina A et al (2007) Extended 21-sample needle biopsy protocol for diagnosis of prostate cancer in 1000 consecutives patients. Eur Urol 52:430–435
Jones JS (2007) Saturation biopsy for detecting and characterizing prostate cancer. BJU Int 99(6):1340–1344
Simon J, Kuefer R, Bartsch G Jr, Volkmer BG, Hautmann RE, Gottfried HW (2008) Intensifying the saturation biopsy technique for detecting prostate cancer after previous negative biopsies: a step in the wrong direction. BJU Int 102(4):459–462
Stewart CS, Leibovich BC, Weaver AL, Lieber MM (2001) Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol 166:86–91 (discussion 92)
Borboroglu PG, Corner SW, Riffenburgh RH, Amling CL (2000) Extensive repeat trans-rectal ultrasound guided prostate biopsy in patient with previous benign sextant biopsies. J Urol 163:158–162
de la Taille A, Antiphon P, Salomon L et al (2003) Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate. Urology 61:1181–1186
Rabets JC, Jones JS, Patel A et al (2004) Prostate cancer detection with office based saturation biopsy in a repeat biopsy population. J Urol 172:94–97
Walz J, Graefen M, Chun FK et al (2006) High incidence of prostate cancer detected by saturation biopsy after previous negative biopsy series. Eur Urol 50:498–505
Bott L, Langley S, Hindley L, Montgomery B (2009) Intensifying the saturation biopsy technique for detecting prostate cancer after previous negative biopsies: a step in the wrong direction. BJU Int 103(5):701
Pepe P, Galia A, Fraggetta F et al (2005) Prediction by quantitative histology on pathological stage in prostate cancer. Eur J Surg Oncol 31:309–313
Sajadi KP, Kim T, Terris MK, Brown JA, Lewis RW (2007) High yield of saturation prostate biopsy for patients with previous negative biopsies and small prostates. Urology 70(4):691–695
Lee MC, Moussa AS, Yu C, Kattan MW, Magi-Galluzzi C, Jones JS (2010) Multifocal high grade prostatic intraepithelial neoplasia is a risk factor for subsequent prostate cancer. J Urol 184(5):1958–1962
Satoh T, Matsumoto K, Fujita T, Tabata K, Okusa H, Tsuboi T, Arakawa T, Irie A, Egawa S, Baba S (2005) Cancer core distribution in patients diagnosed by extended transperineal prostate biopsy. Urology 66(1):114–118
Moran BJ, Braccioforte MH, Conterato DJ (2006) Re-biopsy of the prostate using a stereotactic transperineal technique. J Urol 176(4 Pt 1):1376–1381 (discussion 1381)
Pryor MB, Schellhammer PF (2002) The pursuit of prostate cancer in patients with a rising prostate-specific antigen and multiple negative transrectal ultrasound-guided prostate biopsies. Clin Prostate Cancer 1(3):172–176
Fleshner NE, Cookson MS, Soloway SM, Fair WR (1998) Repeat transrectal ultrasound-guided prostate biopsy: a strategy to improve the reliability of needle biopsy grading in patients with well-differentiated prostate cancer. Urology 52(4):659–662
Merrick GS, Gutman S, Andreini H, Taubenslag W, Lindert DL, Curtis R, Adamovich E, Anderson R, Allen Z, Butler W, Wallner K (2007) Prostate cancer distribution in patients diagnosed by transperineal template-guided saturation biopsy. Eur Urol 52(3):715–723
Novara G, Boscolo-Berto R, Lamon C, Fracalanza S, Gardiman M, Artibani W, Ficarra V (2010) Detection rate and factors predictive the presence of prostate cancer in patients undergoing ultrasonography-guided transperineal saturation biopsies of the prostate. BJU Int 105(9):1242–1246
Pinkstaff DM, Igel TC, Petrou SP, Broderick GA, Wehle MJ, Young PR (2005) Systematic transperineal ultrasound-guided template biopsy of the prostate: three-year experience. Urology 65(4):735–739
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Scattoni, V., Maccagnano, C., Capitanio, U. et al. Random biopsy: when, how many and where to take the cores?. World J Urol 32, 859–869 (2014). https://doi.org/10.1007/s00345-014-1335-0
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DOI: https://doi.org/10.1007/s00345-014-1335-0