World Journal of Urology

, Volume 25, Issue 1, pp 11–17 | Cite as

Biopsy standards for detection of prostate cancer

Topic Paper


The widespread use of measurement of prostate-specific antigen for prostate cancer screening has led to a dramatic increase in the number of transrectal biopsies. Although transrectal ultrasound-guided prostate biopsy is the gold standard in the diagnosis of prostate cancer, the strategies for initial and repeat biopsies remain controversial. Over the past decade numerous biopsy protocols have been developed. Several protocols have been established that increase the number of cores by combining sextant and lateral biopsies to increase the cancer detection rate. We review the current methods of prostate biopsies, the indication to perform an initial and repeat biopsy, the impact of prostate volume on the number of cores taken, and the morbidity of the procedure.


Prostate biopsy Prostate cancer PSA Prostatic intraepithelial neoplasia TRUS 


  1. 1.
    Djavan B, Susani M, Bursa B, Basharkhah A, Simak R, Marberger M (1999) Predictability and significance of multifocal prostate cancer in the radical prostatectomy specimen. Tech Urol 5(3):139–142PubMedGoogle Scholar
  2. 2.
    Stamey TA (1995) Making the most out of six systematic sextant biopsies. Urology 45(1):2–12PubMedCrossRefGoogle Scholar
  3. 3.
    Norberg M, Egevad L, Holmberg L, Sparen P, Norlen BJ, Busch C (1997) The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology 50:562–566PubMedCrossRefGoogle Scholar
  4. 4.
    Presti JC Jr, Chang JJ, Bhargava V, Shinohara K (2000) The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol 163(1):163–166PubMedCrossRefGoogle Scholar
  5. 5.
    Karakiewicz PI, Aprikian AG, Meshref AW, Bazinet M (1996) Computer-assisted comparative analysis of four-sector and six section biopsies of the prostate. Urology 48:747–750PubMedCrossRefGoogle Scholar
  6. 6.
    Karakiewicz PI, Hanley JA, Bazinet M (1998) Three-dimensional computer-assisted analysis of sector biopsy of the prostate. Urology 52:208–212PubMedCrossRefGoogle Scholar
  7. 7.
    Ravery V, Billeband T, Toublanc M, Boccon-Gibod L, Hermien JF, Moulinver F, Blanc E, Delmas V (1999) Diagnostic value of the systematic TRUS-guided prostate biopsies. Eur Urol 35:298–303PubMedCrossRefGoogle Scholar
  8. 8.
    Eskew AL, Bare RL, McCullongh DL (1997) Systematic 5-region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol 157:199–202PubMedCrossRefGoogle Scholar
  9. 9.
    Bauer JJ, Zeng J, Weir J, Zhang W, Sesterhern IA, Connely RR, Mun SK, Mone JW (1999) Three-dimensional computer-simulated prostate models: lateral prostate biopsies increase the detection rate of prostate cancer. Urology 53:961–967PubMedCrossRefGoogle Scholar
  10. 10.
    Chang JJ, Shinohara K, Bhargava V, Presti JC Jr (1998) Prospective evaluation of lateral biopsies of the peripheral zone for prostate cancer detection. J Urol 160:2111–2114PubMedCrossRefGoogle Scholar
  11. 11.
    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 175:1605–1612PubMedCrossRefGoogle Scholar
  12. 12.
    Djavan B, Zlotta AR, Ekane S, Remzi M, Kramer G, Roumeguère T, Etemad M, Ghawidel K, Schulman CC, Marberger M (2000) Is on set of sextant biopsies enough to rule out prostate cancer? Influence of transition and total prostate volumes on prostate cancer yield. Eur Urol 38(2):218–224PubMedCrossRefGoogle Scholar
  13. 13.
    Uzzo RG, Wei JT, Waldbaum RS, Perlmutter AP, Byrne JC, Vaughan ED (1995) The influence of prostatic size on cancer detection. Urology 46:831–836PubMedCrossRefGoogle Scholar
  14. 14.
    Chen ME, Troncoso P, Johnston DA, Tang K, Babaian RJ (1997) Optimization of prostate biopsy strategy using computer based analysis. J Urol 158:2168–2175PubMedCrossRefGoogle Scholar
  15. 15.
    Djavan B, Zlotta AR, Remzi M, Bursa B, Hruby S, Wolfram R, Schulman CC, Marberger M (1999) Total and transition zone prostate volume and age: how do they affect the utility of PSA based diagnostic parameters for early prostate cancer detection? Urology 54(5):846–852PubMedCrossRefGoogle Scholar
  16. 16.
    Djavan B, Zlotta AR, Byttebier G, Shariat S, Omar M, Schulman CC, Marberger M (1998) Prostate specific antigen density of the TZ for early detection of prostate cancer. J Urol 160(2):411–418PubMedCrossRefGoogle Scholar
  17. 17.
    Zlotta AR, Djavan B, Marberger M, Schulmann CC (1997) Prostate specific antigen density of the transition zone: a new effective parameter for prostate cancer prediction. J Urol 157:1315–1321PubMedCrossRefGoogle Scholar
  18. 18.
    Levine MA, Ittman M, Melamed J, Lepor H (1998) Two consecutive sets of transrectal ultrasound guided sextant biopsies of the prostate for the detection of prostate cancer. J Urol 159:471–476PubMedCrossRefGoogle Scholar
  19. 19.
    Letran JL, Meyer GE, Loberiza FR, Brawer MK (1998) The effect of prostate volume on the yield of needle biopsy. J Urol 160(5):1718–1721PubMedCrossRefGoogle Scholar
  20. 20.
    Vashi AR, Wojno KJ, Gillespie B, Oesterling JE (1998) A model for the number of cores per prostate biopsy based on patient age and prostate gland volume. J Urol 159:920–924PubMedCrossRefGoogle Scholar
  21. 21.
    Hodge KK, McNeal JE, Terris MK, et al (1989) Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 142:71–74PubMedGoogle Scholar
  22. 22.
    Presti JC Jr, Chang JJ, Bhargava V, Shinohara K (2000) The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol 163:163–167PubMedCrossRefGoogle Scholar
  23. 23.
    Philip J, Hanchanale V, Foster CS, Javle P (2006) Importance of peripheral biopsies in maximising the detection of early prostate cancer in repeat 12-core biopsy protocols. BJU Int 98:559–562PubMedCrossRefGoogle Scholar
  24. 24.
    Bazinet M, Karakiewicz PI, Aprikian AG, et al (1996) Value of systematic TZ biopsies in the early detection of prostate cancer. J Urol 155:605–606PubMedCrossRefGoogle Scholar
  25. 25.
    Terris MK, Pham TQ, Issa MM, Kabalin JN (1997) Routine TZ and seminal vesicle biopsies in all patients undergoing transrectal ultrasound giuded prostate biopsies are not indicated. J Urol 157:204–206PubMedCrossRefGoogle Scholar
  26. 26.
    Epstein JI, Walsh PC, Sauvageot J, Carter HB (1997) Use of repeat sextant and transistion zone biopsies for assessing extent of prostate cancer. J Urol 158:1886–1890PubMedCrossRefGoogle Scholar
  27. 27.
    Brossner C, Winterholer A, Roehlich M, Dlouhy-Schütz E, Serra V, Sonnleithner M, Grubmüller KH, Pummer K, Schuster E (2003) Distribution of prostate carcinoma foci within the peripheral zone: analysis of 8,062 prostate biopsy cores. World J Urol 21(3):163–166PubMedCrossRefGoogle Scholar
  28. 28.
    Orozco R, O’Dowd GJ, Kunnel B, et al (1998) Observations on pathology trends in 62,537 protstate biopsies obtained from urology private practices in the United States. Urology 51:186–195PubMedCrossRefGoogle Scholar
  29. 29.
    Bostwick DG, Qian J, Frankel K (1995) The incidence of high grade prostatic intraepithelial neoplasia in needle biopsies. J Urol 154:1791–1794PubMedCrossRefGoogle Scholar
  30. 30.
    Green J, Feneley MR, Young M, Peeling B, Kirby R, Parkinson C (1996) The prevalence of prostatic intraepithelial neoplasia (PIN) in biopsies from hospital practice and pilot screening: clinical implications. J Urol 155(Suppl):A1260Google Scholar
  31. 31.
    Raviv G, Janssen TH, Zlotta AR, Descamps F, Verhest A, Schulman CC (1996) Prostatic intraepithelial neoplasia: influence of clinical and pathological data on the detection of invasive prostate cancer, in patients initially diagnosed on previous needle biopsy. J Urol 156:1050–1055PubMedCrossRefGoogle Scholar
  32. 32.
    Raviv G, Zlotta AR, Janssen TH, Descamps F, Verhest A, Schulman CC (1996) Does prostate-specific antigen and prostate-specific antigen density enhance the detection of prostate cancer in patients initially diagnosed to have prostatic intraepithelial neoplasia? Cancer 77:2103–2108PubMedCrossRefGoogle Scholar
  33. 33.
    Zlotta AR, Raviv G, Schulman CC (1996) Clinical prognostic criteria for later diagnosis of prostate carcinoma in patients with initial isolated prostatic intraepithelial neoplasia. Eur Urol 30:249–255PubMedGoogle Scholar
  34. 34.
    Meyer F, Tetu B, Bairati I, Lacombe L, Fradet Y (2006) Prostatic intraepithelial neoplasia in TURP specimens and subsequent prostate cancer. Can J Urol 13:3255–3260PubMedGoogle Scholar
  35. 35.
    Djavan B, Zlotta AR, Remzi M, Ghawidel K, Basharkhah A, Schulman CC, Marberger M (2000) Optimal predictors of prostate cancer in repeat prostate biopsy: a prospective study in 1,051 men. J Urol 163(4):1144–1148PubMedCrossRefGoogle Scholar
  36. 36.
    Irani J, Fournier F, Bon D, et al (1997) Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol 79(4):608–610PubMedGoogle Scholar
  37. 37.
    Clements R, Aideyan OU, Griffiths GJ, et al (1993) Side effects and patient acceptability of transrectal biopsy of the prostate. Clin Radiol 47:125–126PubMedCrossRefGoogle Scholar
  38. 38.
    Adamakis I, Mitropoulos D, Haritopoulos K, Alamanis C, Stravodimos K, Giannopoulos A (2004) Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with the intrarectal instillation of lidocaine-prilocain cream. World J Urol 22(4):281–284PubMedCrossRefGoogle Scholar
  39. 39.
    Rodriguez LV, Terris MK (1998) Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol 160:2115–2120PubMedCrossRefGoogle Scholar
  40. 40.
    Cooner WH, Mosley BR, Rutherford CL, et al (1990) Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol 143:1146–1152PubMedGoogle Scholar
  41. 41.
    Crawford ED, Haynes AL Jr, Story MW, et al (1982) Prevention of urinary tract infection and sepsis following transrectal prostatic biopsy. J Urol 127:449–451PubMedGoogle Scholar
  42. 42.
    Davison P, Malament M (1971) Urinary contamination as a result of transrectal biopsy of the prostate. J Urol 105:545–546PubMedGoogle Scholar
  43. 43.
    Fawcett DP, Eykyn S, Bultidue MI (1975) Urinary tract infection following transrectal biopsy of the prostate. Br J Urol 47:679–681PubMedCrossRefGoogle Scholar
  44. 44.
    Ashby EC, Rees M, Dowding CH (1978) Prophylaxis against systemic infection after transrectal biopsy for suspected prostatic carcinoma. Br Med J 2:1263–1264PubMedGoogle Scholar
  45. 45.
    Thompson PM, Talbot RW, Packham DA, et al (1980) Transrectal biopsy of the prostate and bacteremia. Br J Surg 67:127–128PubMedCrossRefGoogle Scholar
  46. 46.
    Thompson PM, Prior JP, Williams JP, et al (1982) The problem of infection after prostatic biopsy: the case for the transperineal approach. Br J Urol 54:736PubMedGoogle Scholar
  47. 47.
    Shigemura K, Tanaka K, Yasuda M, Ishihara S, Muratani T, Deguchi T, Matsumoto T, Kamidono S, Nakano Y, Arakawa S, Fujisawa M (2005) Efficacy of 1-day prophylaxis medication with fluoroquinolone for prostate biopsy. World J Urol 23:356–360PubMedCrossRefGoogle Scholar
  48. 48.
    Sieber PR, Rommel FM, Agusta VE, et al (1997) Antibiotic prophylaxis in ultrasound guided transrectal prostate biopsy. J Urol 157:2199–2200PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of UrologyMedical University of ViennaViennaAustria

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