Skip to main content

Advertisement

Log in

Is sampling transitional zone in patients who had prior negative prostate biopsy necessary?

  • Urology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Objective

To assess the necessity of transitional zone sampling of the prostate during repeat prostate biopsy procedures.

Methods

Patients treated for lower urinary tract symptoms with transurethral resection of the prostate (TURP) from April 2004 to July 2009 whom had at least 1 negative prostate biopsy prior to this treatment were chosen as the study group. A histopathological analysis of surgical specimens was employed to determine cancer detection rates.

Results

A total of 72 patients with the mean age of 66.1, mean prostate-specific antigen (PSA) of 10.4 ng/mL and mean prostate volume of 63.2 cc were included. Of the patients, 50 had 1 biopsy set, 17 had 2 sets, 4 had 3 sets and 1 patient had 4 sets of consecutive biopsies. All biopsy results were negative for prostate cancer. After the analysis of surgical specimens obtained during TURP, cancer was detected in 3 patients (4.2%). Transitional zone sampling during prostate biopsies did not significantly improve the cancer detection rate. Transitional zone sampling was performed in 29 biopsies taken from 20 patients, one of whom (5%) had prostate cancer. The remaining 71 biopsies were taken from 52 patients without transitional zone sampling, and cancer was detected in 2 (3.8%) of them.

Conclusions

Since no significant difference was observed between patient groups (those with and those without transitional zone biopsies) in the detection of prostate cancer in the transitional zone, strategies for increasing the number of cores taken from transitional zone during repeat biopsies should be reconsidered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References:

  1. Lin CC, Huang WJ, Wu LJ, Chang YH, Lin AT, Chen KK (2008) Diagnosis of prostate cancer: repeated transrectal prostate biopsy or transurethral resection. J Chin Med Assoc 71(9):448–454

    Article  PubMed  Google Scholar 

  2. Al Otaibi M, Ross P, Fahmy N, Jeyaganth S, Trottier H, Sircar K et al (2008) Role of repeated biopsy of the prostate in predicting disease progression in patients with prostate cancer on active surveillance. Cancer 113(2):286–292

    Article  PubMed  Google Scholar 

  3. Seidman H, Mushinski MH, Gelb SK, Silverberg E (1985) Probabilities of eventually developing or dying of cancer–United States, 1985. CA Cancer J Clin 35(1):36–56

    Article  PubMed  CAS  Google Scholar 

  4. Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E et al (2004) Cancer statistics, 2004. CA Cancer J Clin 54(1):8–29

    Article  PubMed  Google Scholar 

  5. 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 discussion 4-5

    PubMed  CAS  Google Scholar 

  6. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V et al (2010) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol

  7. Deliveliotis C, Varkarakis J, Albanis S, Argyropoulos V, Skolarikos A (2002) Biopsies of the transitional zone of the prostate. Should it be done on a routine basis, when and why? Urol Int 68(2):113–117

    Article  PubMed  CAS  Google Scholar 

  8. 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(2):471–475; discussion 475–476

    Google Scholar 

  9. Babaian RJ, Toi A, Kamoi K, Troncoso P, Sweet J, Evans R et al (2000) A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 163(1):152–157

    Article  PubMed  CAS  Google Scholar 

  10. Ravery V, Dominique S, Panhard X, Toublanc M, Boccon-Gibod L (2008) The 20-core prostate biopsy protocol–a new gold standard? J Urol 179(2):504–507

    Article  PubMed  CAS  Google Scholar 

  11. Serefoglu EC, Ozdemir AT, Balbay MD (2008) Re: The 20-core prostate biopsy protocol–a new gold standard?: V. Ravery, S. Dominique, X. Panhard, M. Toublanc, L. Boccon-Gibod and L. Boccon-Gibod. J Urol 2008; 179: 504–507. J Urol 180(5):2256–2257

  12. Eskicorapci SY, Guliyev F, Akdogan B, Dogan HS, Ergen A, Ozen H (2005) Individualization of the biopsy protocol according to the prostate gland volume for prostate cancer detection. J Urol 173(5):1536–1540

    Article  PubMed  Google Scholar 

  13. Eskicorapci SY, Baydar DE, Akbal C, Sofikerim M, Gunay M, Ekici S et al (2004) An extended 10-core transrectal ultrasonography guided prostate biopsy protocol improves the detection of prostate cancer. Eur Urol 45(4):444–448; discussion 448–449

    Google Scholar 

  14. Chun FK, Epstein JI, Ficarra V, Freedland SJ, Montironi R, Montorsi F et al (2010) Optimizing performance and interpretation of prostate biopsy: a critical analysis of the literature. Eur Urol 58(6):851–864

    Article  PubMed  Google Scholar 

  15. Keetch DW, Catalona WJ, Smith DS (1994) Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. J Urol 151(6):1571–1574

    PubMed  CAS  Google Scholar 

  16. Roehrborn CG, Pickens GJ, Sanders JS (1996) Diagnostic yield of repeated transrectal ultrasound-guided biopsies stratified by specific histopathologic diagnoses and prostate specific antigen levels. Urology 47(3):347–352

    Article  PubMed  CAS  Google Scholar 

  17. Fleshner NE, O’Sullivan M, Fair WR (1997) Prevalence and predictors of a positive repeat transrectal ultrasound guided needle biopsy of the prostate. J Urol 158(2):505–508; discussion 508–509

    Google Scholar 

  18. Rietbergen JB, Kruger AE, Hoedemaeker RF, Bangma CH, Kirkels WJ, Schroder FH (1998) Repeat screening for prostate cancer after 1-year followup in 984 biopsied men: clinical and pathological features of detected cancer. J Urol 160(6 Pt 1):2121–2125

    PubMed  CAS  Google Scholar 

  19. Letran JL, Blase AB, Loberiza FR, Meyer GE, Ransom SD, Brawer MK (1998) Repeat ultrasound guided prostate needle biopsy: use of free-to-total prostate specific antigen ratio in predicting prostatic carcinoma. J Urol 160(2):426–429

    Article  PubMed  CAS  Google Scholar 

  20. Djavan B, Zlotta A, Remzi M, Ghawidel K, Basharkhah A, Schulman CC et al (2000) Optimal predictors of prostate cancer on repeat prostate biopsy: a prospective study of 1,051 men. J Urol 163(4):1144–1148; discussion 1148–1149

    Google Scholar 

  21. Terris MK (2009) Strategies for repeat prostate biopsies. Curr Urol Rep. 10(3):172–178

    Article  PubMed  Google Scholar 

  22. Hwang SI, Lee HJ, Cho JY, Kim SH, Lee SE, Byun SS et al (2009) Should transition zone biopsies be added to 12-core systematic biopsies of the prostate? J Clin Ultrasound 37(5):281–284

    Article  PubMed  Google Scholar 

  23. Pelzer AE, Bektic J, Berger AP, Halpern EJ, Koppelstatter F, Klauser A et al (2005) Are transition zone biopsies still necessary to improve prostate cancer detection? Results from the tyrol screening project. Eur Urol 48(6):916–921; discussion 21

    Google Scholar 

  24. Eskicorapci SY, Guliyev F, Islamoglu E, Ergen A, Ozen H (2007) The effect of prior biopsy scheme on prostate cancer detection for repeat biopsy population: results of the 14-core prostate biopsy technique. Int Urol Nephrol 39(1):189–195

    Article  PubMed  Google Scholar 

  25. Miyake H, Kurahashi T, Muramaki M, Yamanak K, Hara I (2005) Significance of routine transition zone biopsies in Japanese men undergoing transrectal ultrasound-guided prostate biopsies. Int J Urol 12(11):964–968

    Article  PubMed  Google Scholar 

  26. Campos-Fernandes JL, Bastien L, Nicolaiew N, Robert G, Terry S, Vacherot F et al (2009) Prostate cancer detection rate in patients with repeated extended 21-sample needle biopsy. Eur Urol 55(3):600–606

    Article  PubMed  Google Scholar 

  27. Pepe P, Candiano G, Fraggetta F, Galia A, Grasso G, Aragona F (2010) Is transition zone sampling at repeated saturation prostate biopsy still useful? Urol Int 85(3):324–327

    Article  PubMed  Google Scholar 

  28. Puppo P, Introini C, Calvi P, Naselli A (2006) Role of transurethral resection of the prostate and biopsy of the peripheral zone in the same session after repeated negative biopsies in the diagnosis of prostate cancer. Eur Urol 49(5):873–878

    Article  PubMed  Google Scholar 

  29. Zigeuner R, Schips L, Lipsky K, Auprich M, Salfellner M, Rehak P et al (2003) Detection of prostate cancer by TURP or open surgery in patients with previously negative transrectal prostate biopsies. Urology 62(5):883–887

    Article  PubMed  Google Scholar 

  30. Pepe P, Fraggetta F, Galia A, Grasso G, Aragona F (2010) Prostate cancer detection by TURP after repeated negative saturation biopsy in patients with persistent suspicion of cancer: a case-control study on 75 consecutive patients. Prostate Cancer Prostatic Dis 13(1):83–86

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ege Can Serefoglu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dogan, B., Serefoglu, E.C., Atmaca, A.F. et al. Is sampling transitional zone in patients who had prior negative prostate biopsy necessary?. Int Urol Nephrol 44, 1071–1075 (2012). https://doi.org/10.1007/s11255-012-0139-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-012-0139-7

Keywords

Navigation