Ambulatory and Office UrologyComparison of 12-Core Versus 8-Core Prostate Biopsy: Multivariate Analysis of Large Series of US Veterans
Section snippets
Material and Methods
This study was approved by institutional research board at Emory University and Atlanta VA Medical Center. The study population included 1546 consecutive patients who underwent initial prostate biopsy procedures at the Atlanta VA Medical Center over a period of 6 years and 5 months (January 2001 to May 2007). All patients were screened with digital rectal examination (DRE) and prostate-specific antigen (PSA) by their primary care providers before referral. No age cutoff was used. Indications
Results
A total of 1546 consecutive prostate biopsy procedures were included in the data analysis. The overall proportion of positive biopsies was 49.9% (772/1546). Median age at time of biopsy was 62 years (range 41-87 years). Almost 50% of the study participants (712/1546, or 46.1%) were African Americans (AA). There was a wide range of PSA values (0.1-5000 ng/mL); however, most patients (1251, or 81%) had a PSA of <10 ng/mL, and 1037 (67.1%) had a PSA of 2-10 ng/mL.
There were no statistically
Comment
Autopsy studies have documented high prevalence of prostate cancer. Incidental prostate cancer was found in 29%, 32%, 55%, and 64% in adult males in their 30s, 40s, 50s, and 60s, respectively, who died in motor vehicle accidents.15 This suggests that prostate cancer often presents as a small-volume, clinically insignificant disease. Therefore, excessive tissue sampling of the prostate would likely identify a certain proportion of clinically insignificant cancers. By contrast, limiting the
Conclusions
In this large series of prostate biopsy procedures, where the PZ was well targeted, there was no evidence that a 12-core biopsy improved the likelihood of prostate cancer diagnosis compared with an 8-core biopsy. As such, the results of this study of a VA population suggest that targeting the PZ is more important than the absolute number of biopsy cores. However, these results are applicable only to the 8-core versus 12-core comparison. In addition, in certain subgroups of patients with
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Cited by (23)
Comparison of cancer detection between 18- and 12-core prostate biopsy in Asian patients with prostate-specific antigen levels of 4–20 ng/mL
2018, Journal of the Chinese Medical AssociationCitation Excerpt :A randomized study reported by Francisco et al.15 also supported that extending the sampling protocol from 12 to 18 cores at initial prostate biopsy improved the CDRs (Table 5). On the other hand, Vincenzo et al.9 in 2008 conducted a study similar to ours (comparing 12 and 18 prostate biopsy cores) but arrived at the opposite conclusion (Table 5).9,30–32 This discrepancy in results could be related to sampling at the same position in other studies rather than extending the biopsy core to different sites, as we did in our study.
Randomised prostatic biopsy: Does the number of core specimens and PSA value influence the detection rate of prostate cancer?
2016, Revista Argentina de RadiologiaAndrogen receptors in hormone-dependent and castration-resistant prostate cancer
2013, Pharmacology and TherapeuticsCitation Excerpt :Early PCa can be detected by rising serum PSA levels or by digital rectal exam, but difficulties with using these two assessments as large-population screening tools led to the contentious repeal by the United States Preventive Services Task Force (USPSTF) of its previous recommendation for their use in PCa screening (Moyer & Preventive Services Task Force, 2012). The diagnosis of localized PCa is confirmed by biopsy via a trans-rectal approach with ultrasound guidance, which carries a 20–50% positive biopsy rate (Abd et al., 2011). Due to inter-individual variability in prostate size, PCa heterogeneity, and the possibility of multi-focality among other factors, multiple biopsy cores are collected.
Formalin disinfection of biopsy needle minimizes the risk of sepsis following prostate biopsy
2013, Journal of UrologyCitation Excerpt :Biopsies were positive for cancer in 53.1% (872), negative in 33.5% (550) and showed high grade prostatic intraepithelial neoplasia in 13.4% (220) of patients. The high proportion of positive biopsies is likely a result of the large percentage of African-American patients (57.4%) and the exposure to carcinogens (Agent Orange) unique to U.S. veterans.12 Post-biopsy sepsis with positive urine and blood cultures (quinolone resistant E. coli) developed in 2 patients (0.122%).