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Prostate biopsy strategies

Nature Clinical Practice Urology volume 4, pages 505–511 (2007)Cite this article

Abstract

Early detection is critical to good management of prostate cancer patients. Markers for detection, such as prostate specific antigen (PSA), and prostate biopsy are paramount for establishing an efficient diagnosis. Patients having an initial biopsy should undergo an extended biopsy scheme incorporating at least 10–12 cores, while in those undergoing a repeat biopsy particular attention should be addressed to the anterior apex. Saturation biopsies should be considered for patients with several prior negative biopsies. The chance of finding cancer on repeat biopsies has diminished in patients harboring high-grade prostatic intraepithelial neoplasia but not in those with atypical small acinar proliferation. This article reviews the history of prostate biopsy strategies with particular attention paid towards the development of extended biopsy schemes. Furthermore, a strategy is recommended for initial and repeat biopsy patients.

Key Points

  • Extended biopsy schemes incorporating 10–12 cores improve cancer detection rates over sextant biopsy schemes

  • Repeat biopsy schemes should include additional cores from the anterior apex as this region is undersampled in most contemporary extended biopsy schemes

  • Saturation biopsies should be considered in patients with multiple negative extended biopsies and a high degree of clinical suspicion

  • Extended biopsy schemes have reduced the cancer detection rates in patients demonstrating high-grade prostatic intraepithelial neoplasia on initial biopsy but not in patients with atypical small acinar proliferation

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Figure 1: Needle cores of traditional sextant biopsy (dashed arrows) are placed halfway between the midline and lateral boundary of the prostate
Figure 2: A 5-region biopsy scheme, including a total of 13 cores from the standard sextant (regions 2 and 4), the lateral aspect of the gland (regions 1 and 5) and the midline (region 3)
Figure 3: A 10-core biopsy scheme consisting of standard sextant and laterally directed cores at mid and base
Figure 4: An 11-core biopsy scheme
Figure 5: A 12-core biopsy scheme
Figure 6: Prostate cancer detection rates in a multipractice initial biopsy study using a 12-core extended biopsy scheme
Figure 7: Prostate cancer detection rates from repeat biopsies where the initial biopsy was either a standard sextant biopsy template or an extended template

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Author notes

  1. Room 2217, Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, CA 94305-5826, USA jpresti@stanford.edu

Authors and Affiliations

  1. JC Presti Jr is Professor of Urology and Director of the Urologic Oncology Program, Stanford University School of Medicine, Stanford, CA, USA.,

    Joseph C Presti Jr

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  1. Joseph C Presti Jr
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Presti, J. Prostate biopsy strategies. Nat Rev Urol 4, 505–511 (2007). https://doi.org/10.1038/ncpuro0887

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