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  • Title: Indications for extended 14-core transrectal ultrasound-guided prostate biopsy.
    Author: Uno H, Nakano M, Ehara H, Deguchi T.
    Journal: Urology; 2008 Jan; 71(1):23-7. PubMed ID: 18242358.
    Abstract:
    OBJECTIVES: We compared the cancer detection rate of extended 14-core biopsy with that of sextant biopsy to assess whether additional biopsy cores are useful for detection of prostate cancer and to clarify the indications for obtaining additional cores. METHODS: Study subjects were 313 patients who underwent transrectal ultrasound-guided 14-core biopsy because of a prostate-specific antigen (PSA) level greater than 4.0 ng/mL and/or abnormalities found on digital rectal examination (DRE). In addition to the standard 6 biopsy cores, 6 lateral cores were obtained as well as 2 transition zone cores. PSA density (PSAD) was determined as the total PSA level divided by the prostate volume as estimated by transrectal ultrasound. RESULTS: Prostate cancer was diagnosed in 127 patients (40.6%). In 28 (22%) patients, the cancer would not have been detected by the sextant method alone. Among 211 patients with normal DRE findings, the cancer detection rate with 14-core biopsy was statistically higher than that with 6-core biopsy in the 141 patients with a PSA level of 4.01 ng/mL to 10.0 ng/mL, and 14 (38.9%) of 36 cancers were diagnosed in additional cores only, not in the standard sextant biopsy cores. Among the 141 patients with a gray-zone PSA level, the cancer detection rate with extended biopsy was statistically higher in those with PSAD greater than 0.13 ng/mL. CONCLUSIONS: Lateral biopsy should be used in conjunction with sextant biopsy in patients with a PSA level of 4.01 ng/mL to 10.0 ng/mL with normal DRE findings, especially in those with PSAD greater than 0.13 ng/mL.
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