Ultrasound for Prostate Biopsy

  • Christopher R. PorterEmail author
Part of the Current Clinical Urology book series (CCU)


The evaluation of prostatic conditions prior to the advent of sonographic techniques relied on palpation of the gland and “blind” sampling techniques via needle aspiration and biopsy. With the development of B-mode ultrasound in the 1950s, and probes capable of providing images to the clinician in real-time gray-scale ultrasound became the standard method of prostate imaging for most prostate conditions. The position of the prostate in the pelvis, tucked as it were beneath the pubis and anterior to the rectum, lends itself to the application of a transrectal approach. The transrectal approach to imaging the gland has become the standard of care for diagnostic evaluation of prostatic conditions, prostate biopsy, and therapeutic approaches to prostate cancer.


Prostate Cancer Benign Prostatic Hyperplasia Infective Endocarditis Prostate Biopsy Cancer Detection Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ferguson R. Prostatic neoplasms; their diagnosis by needle puncture and aspiration. Am J Surg. 1930;9:507.Google Scholar
  2. 2.
    Astraldi A. Diagnosis of cancer of the prostate; biopsy by rectal route. Urol Cutaneous Rev. 1937;41:421.Google Scholar
  3. 3.
    Wild J, Reid J. Fourth annual conference in ultrasound therapy. Philadelphia, 1955.Google Scholar
  4. 4.
    Wantanabe H, Kato H, Kato T. Diagnostic application of ultrasonotomography to the prostate. Nippon Hinyokika Gakkai Zasshi. 1968;59:273.Google Scholar
  5. 5.
    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.PubMedGoogle Scholar
  6. 6.
    Crawford ED, Haynes Jr AL, Story MW, et al. Prevention of urinary tract infection and sepsis following transrectal prostatic biopsy. J Urol. 1982;127:449.PubMedGoogle Scholar
  7. 7.
    Berger AP, Gozzi C, Steiner H, et al. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol. 2004;171:1478.PubMedGoogle Scholar
  8. 8.
    Cannon Jr GM, Smaldone MC, Paterson DL. Extended-spectrum beta-lactamase gram-negative sepsis following prostate biopsy: implications for use of fluoroquinolone prophylaxis. Can J Urol. 2007;14:3653.PubMedGoogle Scholar
  9. 9.
    Ozden E, Bostanci Y, Yakupoglu KY, et al. Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology. 2009;74(1):119–23.PubMedGoogle Scholar
  10. 10.
    Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis: recommendations by the American Heart Association. Clin Infect Dis. 1997;25:1448.PubMedGoogle Scholar
  11. 11.
    Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:887.PubMedGoogle Scholar
  12. 12.
    Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38:1706.PubMedGoogle Scholar
  13. 13.
    Lindert KA, Kabalin JN, Terris MK. Bacteremia and bacteriuria after transrectal ultrasound guided prostate biopsy. J Urol. 2000;164:76.PubMedGoogle Scholar
  14. 14.
    De Sio M, D’Armiento M, Di Lorenzo G, et al. The need to reduce patient discomfort during transrectal ultrasonography-guided prostate biopsy: what do we know? BJU Int. 2005;96:977.PubMedGoogle Scholar
  15. 15.
    Soloway MS. Do unto others–why I would want anesthesia for my prostate biopsy. Urology. 2003;62:973.PubMedGoogle Scholar
  16. 16.
    Nijs HG, Essink-Bot ML, DeKoning HJ, et al. Why do men refuse or attend population-based screening for prostate cancer? J Public Health Med. 2000;22:312.PubMedGoogle Scholar
  17. 17.
    Nash PA, Bruce JE, Indudhara R, et al. Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol. 1996;155:607.PubMedGoogle Scholar
  18. 18.
    Schostak M, Christoph F, Muller M, et al. Optimizing local anesthesia during 10-core biopsy of the prostate. Urology. 2002;60:253.PubMedGoogle Scholar
  19. 19.
    Trucchi A, De Nunzio C, Mariani S, et al. Local anesthesia reduces pain associated with transrectal prostatic biopsy. A prospective randomized study. Urol Int. 2005;74:209.PubMedGoogle Scholar
  20. 20.
    Hergan L, Kashefi C, Parsons JK. Local anesthetic reduces pain associated with transrectal ultrasound-guided prostate biopsy: a meta-analysis. Urology. 2007;69:520.PubMedGoogle Scholar
  21. 21.
    Bozlu M, Atici S, Ulusoy E, et al. Periprostatic lidocaine infiltration and/or synthetic opioid (meperidine or tramadol) administration have no analgesic benefit during prostate biopsy. A prospective randomized double-blind placebo-controlled study comparing different methods. Urol Int. 2004;72:308.PubMedGoogle Scholar
  22. 22.
    Vanni AP, Schaal CH, Costa RP, et al. Is the periprostatic anesthetic blockade advantageous in ultrasound-guided prostate biopsy? Int Braz J Urol. 2004;30:114.PubMedGoogle Scholar
  23. 23.
    Walsh K, O’Brien T, Salemmi A, et al. A randomised trial of periprostatic local anaesthetic for transrectal biopsy. Prostate Cancer Prostatic Dis. 2003;6:242.PubMedGoogle Scholar
  24. 24.
    Adamakis I, Mitropoulos D, Haritopoulos K, et al. Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with the intrarectal instillation of lidocaine-prilocaine cream. World J Urol. 2004;22:281.PubMedGoogle Scholar
  25. 25.
    Obek C, Ozkan B, Tunc B, et al. Comparison of 3 different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial. J Urol. 2004;172:502.PubMedGoogle Scholar
  26. 26.
    Rabets JC, Jones JS, Patel AR, et al. Bupivacaine provides rapid, effective periprostatic anesthesia for transrectal prostate biopsy. BJU Int. 2004;93:1216.PubMedGoogle Scholar
  27. 27.
    Nambirajan T, Woolsey S, Mahendra V, et al. Efficacy and safety peri-prostatic local anesthetic injection in trans-rectal biopsy of the prostrate: a prospective randomized study. Surgeon. 2004;2:221.PubMedGoogle Scholar
  28. 28.
    Terris MK, Stamey TA. Determination of prostate volume by transrectal ultrasound. J Urol. 1991;145:984.PubMedGoogle Scholar
  29. 29.
    Djavan B, Zlotta A, Remzi M, et al. Optimal predictors of prostate cancer on repeat prostate biopsy: a prospective study of 1,051 men. J Urol. 2000;163:1144.PubMedGoogle Scholar
  30. 30.
    Zagoria RJ. Genitourinary Radiology. In: Thrall JH, editor. The Requisites. 2nd ed. Philadelphia, PA: Mosby; 2004. p. 335–8.Google Scholar
  31. 31.
    Gregg DC, Sty JR. Sonographic diagnosis of enlarged prostatic utricle. J Ultrasound Med. 1989;8:51.PubMedGoogle Scholar
  32. 32.
    McDermott V, Orr JD, Wild SR. Duplicated Mullerian duct remnants associated with unilateral renal agenesis. Abdom Imaging. 1993;18:193.PubMedGoogle Scholar
  33. 33.
    King BF, Hattery RR, Lieber MM, et al. Congenital cystic disease of the seminal vesicle. Radiology. 1991;178:207.PubMedGoogle Scholar
  34. 34.
    Frauscher F, Klauser A, Volgger H, et al. Comparison of contrast enhanced color Doppler targeted biopsy with conventional systematic biopsy: impact on prostate cancer detection. J Urol. 2002;167:1648.PubMedGoogle Scholar
  35. 35.
    Shinohara K, Scardino PT, Carter SS, et al. Pathologic basis of the sonographic appearance of the normal and malignant prostate. Urol Clin North Am. 1989;16:675.PubMedGoogle Scholar
  36. 36.
    Terris MK, Macy M, Freiha FS. Transrectal ultrasound appearance of prostatic granulomas secondary to bacillus Calmette-Guerin instillation. J Urol. 1997;158:126.PubMedGoogle Scholar
  37. 37.
    Purohit RS, Shinohara K, Meng MV, et al. Imaging clinically localized prostate cancer. Urol Clin North Am. 2003;30:279.PubMedGoogle Scholar
  38. 38.
    Varghese SL, Grossfeld GD. The prostatic gland: malignancies other than adenocarcinomas. Radiol Clin North Am. 2000;38:179.PubMedGoogle Scholar
  39. 39.
    Ramey JR, Halpern EJ, Gomella LG. Ultrasonography and biopsy of the prostate. In: Wein AJ, editor. Campbell-Walsh urology, vol. 3. 9th ed. Philadelphia, PA: Saunders; 2007. p. 2883–95.Google Scholar
  40. 40.
    Bigler SA, Deering RE, Brawer MK. Comparison of microscopic vascularity in benign and malignant prostate tissue. Hum Pathol. 1993;24:220.PubMedGoogle Scholar
  41. 41.
    Cornud F, Hamida K, Flam T, et al. Endorectal color Doppler sonography and endorectal MR imaging features of nonpalpable prostate cancer: correlation with radical prostatectomy findings. AJR Am J Roentgenol. 2000;175:1161.PubMedGoogle Scholar
  42. 42.
    Halpern EJ, Strup SE. Using gray-scale and color and power Doppler sonography to detect prostatic cancer. AJR Am J Roentgenol. 2000;174:623.PubMedGoogle Scholar
  43. 43.
    Arger PH, Malkowicz SB, VanArsdalen KN, et al. Color and power Doppler sonography in the diagnosis of prostate cancer: comparison between vascular density and total vascularity. J Ultrasound Med. 2004;23:623.PubMedGoogle Scholar
  44. 44.
    Okihara K, Kojima M, Nakanouchi T, et al. Transrectal power Doppler imaging in the detection of prostate cancer. BJU Int. 2000;85:1053.PubMedGoogle Scholar
  45. 45.
    Kelly IM, Lees WR, Rickards D. Prostate cancer and the role of color Doppler US. Radiology. 1993;189:153.PubMedGoogle Scholar
  46. 46.
    Halpern EJ, Frauscher F, Strup SE, et al. Prostate: high-frequency Doppler US imaging for cancer detection. Radiology. 2002;225:71.PubMedGoogle Scholar
  47. 47.
    Levine MA, Ittman M, Melamed J, et al. Two consecutive sets of transrectal ultrasound guided sextant biopsies of the prostate for the detection of prostate cancer. J Urol. 1998;159:471.PubMedGoogle Scholar
  48. 48.
    Eskew LA, Bare RL, McCullough DL. Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol. 1997;157:199.PubMedGoogle Scholar
  49. 49.
    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.PubMedGoogle Scholar
  50. 50.
    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.PubMedGoogle Scholar
  51. 51.
    Presti Jr 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.PubMedGoogle Scholar
  52. 52.
    Terris MK, Pham TQ, Issa MM, et al. Routine transition zone and seminal vesicle biopsies in all patients undergoing transrectal ultrasound guided prostate biopsies are not indicated. J Urol. 1997;157:204.PubMedGoogle Scholar
  53. 53.
    Epstein JI, Walsh PC, Sauvageot J, et al. Use of repeat sextant and transition zone biopsies for assessing extent of prostate cancer. J Urol. 1997;158:1886.PubMedGoogle Scholar
  54. 54.
    Mazal PR, Haitel A, Windischberger C, et al. Spatial distribution of prostate cancers undetected on initial needle biopsies. Eur Urol. 2001;39:662.PubMedGoogle Scholar
  55. 55.
    Chang JJ, Shinohara K, Hovey RM, et al. Prospective evaluation of systematic sextant transition zone biopsies in large prostates for cancer detection. Urology. 1998;52:89.PubMedGoogle Scholar
  56. 56.
    Katsuto Shinohara VM, Chi T, Carroll P. Prostate Needle Biopsy Techniques and Interpretation. In: Voegelzang S, Shipley D, Linehan, editors. Genitourinary Oncology. 3rd ed. Philadelphia, PA: Lippincott; 2006. p. 111–9.Google Scholar
  57. 57.
    Djavan B, Remzi M, Marberger M. When to biopsy and when to stop biopsying. Urol Clin North Am. 2003;30:253.PubMedGoogle Scholar
  58. 58.
    Keetch DW, Catalona WJ, Smith DS. Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. J Urol. 1994;151:1571.PubMedGoogle Scholar
  59. 59.
    Djavan B, Ravery V, Zlotta A, et al. Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol. 2001;166:1679.PubMedGoogle Scholar
  60. 60.
    Catalona WJ, Partin AW, Slawin KM, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998;279:1542.PubMedGoogle Scholar
  61. 61.
    Wang R, Chinnaiyan AM, Dunn RL, et al. Rational approach to implementation of prostate cancer antigen 3 into clinical care. Cancer. 2009;115(17):3879–86.PubMedGoogle Scholar
  62. 62.
    Haese A, de la Taille A, van Poppel H, et al. Clinical utility of the PCA3 urine assay in European men scheduled for repeat biopsy. Eur Urol. 2008;54:1081.PubMedGoogle Scholar
  63. 63.
    Bott SR, Henderson A, McLarty E, et al. A brachytherapy template approach to standardize saturation prostatic biopsy. BJU Int. 2004;93:629.PubMedGoogle Scholar
  64. 64.
    Lane BR, Zippe CD, Abouassaly R, et al. Saturation technique does not decrease cancer detection during follow up after initial prostate biopsy. J Urol. 2008;179:1746.PubMedGoogle Scholar
  65. 65.
    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.PubMedGoogle Scholar
  66. 66.
    Stewart CS, Leibovich BC, Weaver AL, et al. Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol. 2001;166:86.PubMedGoogle Scholar
  67. 67.
    Fleshner N, Klotz L. Role of “saturation biopsy” in the detection of prostate cancer among difficult diagnostic cases. Urology. 2002;60:93.PubMedGoogle Scholar
  68. 68.
    Moran, et al. Re-biopsy of the Prostate With Stereotactic Transperineal Technique. J Urol. 2006;176:1376–81.PubMedGoogle Scholar
  69. 69.
    Egawa S, Wheeler TM, Scardino PT. The sonographic appearance of irradiated prostate cancer. Br J Urol. 1991;68:172.PubMedGoogle Scholar
  70. 70.
    Whittington R, Broderick GA, Arger P, et al. The effect of androgen deprivation on the early changes in prostate volume following transperineal ultrasound guided interstitial therapy for localized carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1999;44:1107.PubMedGoogle Scholar
  71. 71.
    Kapoor DA, Wasserman NF, Zhang G, et al. Value of transrectal ultrasound in identifying local disease after radical prostatectomy. Urology. 1993;41:594.PubMedGoogle Scholar
  72. 72.
    Goldenberg SL, Carter M, Dashefsky S, et al. Sonographic characteristics of the urethrovesical anastomosis in the early post-radical prostatectomy patient. J Urol. 1992;147:1307.PubMedGoogle Scholar
  73. 73.
    Rodriguez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol. 1998;160:2115.PubMedGoogle Scholar
  74. 74.
    Maatman TJ, Bigham D, Stirling B. Simplified management of post-prostate biopsy rectal bleeding. Urology. 2002;60:508.PubMedGoogle Scholar
  75. 75.
    Brullet E, Guevara MC, Campo R, et al. Massive rectal bleeding following transrectal ultrasound-guided prostate biopsy. Endoscopy. 2000;32:792.PubMedGoogle Scholar
  76. 76.
    Raaijmakers R, Kirkels WJ, Roobol MJ, et al. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology. 2002;60:826.PubMedGoogle Scholar
  77. 77.
    Thompson PM, Pryor JP, Williams JP, et al. The problem of infection after prostatic biopsy: the case for the transperineal approach. Br J Urol. 1982;54:736.PubMedGoogle Scholar
  78. 78.
    Desmond PM, Clark J, Thompson IM, et al. Morbidity with contemporary prostate biopsy. J Urol. 1993;150:1425.PubMedGoogle Scholar
  79. 79.
    Moul JW, Bauer JJ, Srivastava S, et al. Perineal seeding of prostate cancer as the only evidence of clinical recurrence 14 years after needle biopsy and radical prostatectomy: molecular correlation. Urology. 1998;51:158.PubMedGoogle Scholar
  80. 80.
    Moul JW, Miles BJ, Skoog SJ, et al. Risk factors for perineal seeding of prostate cancer after needle biopsy. J Urol. 1989;142:86.PubMedGoogle Scholar
  81. 81.
    Bastacky SS, Walsh PC, Epstein JI. Needle biopsy associated tumor tracking of adenocarcinoma of the prostate. J Urol. 1991;145:1003.PubMedGoogle Scholar
  82. 82.
    Koppie TM, Grady BP, Shinohara K. Rectal wall recurrence of prostatic adenocarcinoma. J Urol. 2002;168:2120.PubMedGoogle Scholar
  83. 83.
    Hara N, Kasahara T, Kawasaki T, et al. Frequency of PSA-mRNA-bearing cells in the peripheral blood of patients after prostate biopsy. Br J Cancer. 2001;85:557.PubMedGoogle Scholar
  84. 84.
    Meng MV, Shinohara K, Grossfeld GD. Significance of high-grade prostatic intraepithelial neoplasia on prostate biopsy. Urol Oncol. 2003;21:145.PubMedGoogle Scholar
  85. 85.
    Oyasu R, Bahnson RR, Nowels K, et al. Cytological atypia in the prostate gland: frequency, distribution and possible relevance to carcinoma. J Urol. 1986;135:959.PubMedGoogle Scholar
  86. 86.
    Prange W, Erbersdobler A, Hammerer P, et al. Significance of high-grade prostatic intraepithelial neoplasia in needle biopsy specimens. Urology. 2001;57:486.PubMedGoogle Scholar
  87. 87.
    Davidson D, Bostwick DG, Qian J, et al. Prostatic intraepithelial neoplasia is a risk factor for adenocarcinoma: predictive accuracy in needle biopsies. J Urol. 1995;154:1295.PubMedGoogle Scholar
  88. 88.
    Lefkowitz GK, Sidhu GS, Torre P, et al. Is repeat prostate biopsy for high-grade prostatic intraepithelial neoplasia necessary after routine 12-core sampling? Urology. 2001;58:999.PubMedGoogle Scholar
  89. 89.
    Helpap BG, Bostwick DG, Montironi R. The significance of atypical adenomatous hyperplasia and prostatic intraepithelial neoplasia for the development of prostate carcinoma. An update. Virchows Arch. 1995;426:425.PubMedGoogle Scholar
  90. 90.
    Helpap B, Bonkhoff H, Cockett A, et al. Relationship between atypical adenomatous hyperplasia (AAH), prostatic intraepithelial neoplasia (PIN) and prostatic adenocarcinoma. Pathologica. 1997;89:288.PubMedGoogle Scholar
  91. 91.
    Iczkowski KA, Chen HM, Yang XJ, et al. Prostate cancer diagnosed after initial biopsy with atypical small acinar proliferation suspicious for malignancy is similar to cancer found on initial biopsy. Urology. 2002;60:851.PubMedGoogle Scholar
  92. 92.
    Iczkowski KA, MacLennan GT, Bostwick DG. Atypical small acinar proliferation suspicious for malignancy in prostate needle biopsies: clinical significance in 33 cases. Am J Surg Pathol. 1997;21:1489.PubMedGoogle Scholar
  93. 93.
    Alsikafi NF, Brendler CB, Gerber GS, et al. High-grade prostatic intraepithelial neoplasia with adjacent atypia is associated with a higher incidence of cancer on subsequent needle biopsy than high-grade prostatic intraepithelial neoplasia alone. Urology. 2001;57:296.PubMedGoogle Scholar
  94. 94.
    Park S, Shinohara K, Grossfeld GD, et al. Prostate cancer detection in men with prior high grade prostatic intraepithelial neoplasia or atypical prostate biopsy. J Urol. 2001;165:1409.PubMedGoogle Scholar
  95. 95.
    Javidan J, Wood DP. Clinical interpretation of the prostate biopsy. Urol Oncol. 2003;21:141.PubMedGoogle Scholar
  96. 96.
    Makhlouf AA, Krupski TL, Kunkle D, et al. The effect of sampling more cores on the predictive accuracy of pathological grade and tumour distribution in the prostate biopsy. BJU Int. 2004;93:271.PubMedGoogle Scholar
  97. 97.
    Wills ML, Sauvageot J, Partin AW, et al. Ability of sextant biopsies to predict radical prostatectomy stage. Urology. 1998;51:759.PubMedGoogle Scholar
  98. 98.
    Ravery V, Boccon-Gibod LA, Dauge-Geffroy MC, et al. Systematic biopsies accurately predict extracapsular extension of prostate cancer and persistent/recurrent detectable PSA after radical prostatectomy. Urology. 1994;44:371.PubMedGoogle Scholar
  99. 99.
    Badalament RA, Miller MC, Peller PA, et al. An algorithm for predicting nonorgan confined prostate cancer using the results obtained from sextant core biopsies with prostate specific antigen level. J Urol. 1996;156:1375.PubMedGoogle Scholar
  100. 100.
    D’Amico AV, Whittington R, Malkowicz SB, et al. Clinical utility of percent-positive prostate biopsies in predicting biochemical outcome after radical prostatectomy or external-beam radiation therapy for patients with clinically localized prostate cancer. Mol Urol. 2000;4:171.PubMedGoogle Scholar
  101. 101.
    Naya Y, Slaton JW, Troncoso P, et al. Tumor length and location of cancer on biopsy predict for side specific extraprostatic cancer extension. J Urol. 2004;171:1093.PubMedGoogle Scholar
  102. 102.
    Freedland SJ, Aronson WJ, Terris MK, et al. Percent of prostate needle biopsy cores with cancer is significant independent predictor of prostate specific antigen recurrence following radical prostatectomy: results from SEARCH database. J Urol. 2003;169:2136.PubMedGoogle Scholar
  103. 103.
    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.PubMedGoogle Scholar
  104. 104.
    Freedland SJ, Csathy GS, Dorey F, et al. Clinical utility of percent prostate needle biopsy tissue with cancer cutpoints to risk stratify patients before radical prostatectomy. Urology. 2002;60:84.PubMedGoogle Scholar
  105. 105.
    Elliott SP, Shinohara K, Logan SL, et al. Sextant prostate biopsies predict side and sextant site of extracapsular extension of prostate cancer. J Urol. 2002;168:105.PubMedGoogle Scholar

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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of SurgeryVirginia Mason Medical CenterSeattleUSA

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