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Diagnostic performance of initial transperineal 14-core prostate biopsy to detect significant cancer

  • Urology - Original Paper
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Abstract

Purpose

To investigate cancers missed by extended transperineal (TP) 14-core biopsy (TP14PBx) and examined its diagnostic performance.

Methods

We evaluated 744 men with prostate-specific antigen (PSA) levels in the range 2.5–20 ng/mL or abnormal digital rectal examination underwent three-dimensional 26-core prostate biopsy (3D26PBx), a combination of TP14PBx and transrectal 12-core biopsy (TR12PBx), at initial biopsy. Of 269 patients diagnosed with cancer, 127 subsequently underwent radical prostatectomy (RP). Cancers were grouped into TP-positive cancers (detected through TP14PBx) and TP-negative cancers (those not detected through TP14PBx but detected through TR12PBx). Clinicopathological characteristics and cancer locations of TP-negative cancers were evaluated. For cancer location analysis, the prostate was divided into apex, midprostate, and base regions.

Results

Thirty-seven (14 %) TP-negative cancers were found in 269 biopsy-positive cancers. Median number of positive cores in TP-negative cancers was significantly lower than that in TP-positive cancers (1 vs. 5, p < 0.001). TP-negative cancers had biopsy Gleason score (GS) of 7 or less in 87 % of cases and had significantly lower biopsy GS than those of TP-positive cancers (p = 0.028). Of 20 TP-negative cancers treated with RP, 70 % (14/20) were insignificant cancers (GS <4+3, volume <0.5 cc, and organ-confined disease). Of all significant cancers treated with RP, 6 % (6/99) were missed by TP14PBx. TP-negative cancers treated with RP were located more frequently in the apex than in the base (85 vs. 20 %, p < 0.001).

Conclusions

Initial TP14PBx provides sufficient detectability of significant cancers despite a small risk of missing cancers located in the prostate apex.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Hideki Takeshita, Noboru Numao, Toshiki Kijima, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Fumitaka Koga, Kazutaka Saito, Hitoshi Masuda, Satoru Kawakami, Yasuhisa Fujii & Kazunori Kihara

  2. Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Shinya Yamamoto & Junji Yonese

Authors
  1. Hideki Takeshita
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  2. Noboru Numao
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  3. Toshiki Kijima
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  4. Minato Yokoyama
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  7. Fumitaka Koga
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  8. Kazutaka Saito
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  9. Hitoshi Masuda
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  10. Satoru Kawakami
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  11. Shinya Yamamoto
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  12. Junji Yonese
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  13. Yasuhisa Fujii
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  14. Kazunori Kihara
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Corresponding author

Correspondence to Noboru Numao.

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Takeshita, H., Numao, N., Kijima, T. et al. Diagnostic performance of initial transperineal 14-core prostate biopsy to detect significant cancer. Int Urol Nephrol 45, 645–652 (2013). https://doi.org/10.1007/s11255-013-0416-0

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  • DOI: https://doi.org/10.1007/s11255-013-0416-0

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