title: A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy.
abstract: OBJECTIVE
  The 3 tumor locations unsampled by conventional sextant biopsies that have been identified on composite 3-dimensional reconstruction of 180 radical prostatectomy specimens are the anterior transition zone, midline peripheral zone and inferior portions of the anterior horn in the peripheral zone. We evaluated an 11-core multisite directed biopsy scheme incorporating these alternate areas and conventional sextant biopsies in 362 patients from 2 institutions.
  
  
  METHODS
  Patients without a prior diagnosis of cancer underwent ultrasound guided 11-core biopsies which included conventional sextant and 3 alternate sites. All specimens were separated for specific location identification. Biopsy was performed in 183 patients at MD Anderson Cancer Center (group 1) and in 179 at Toronto General Hospital (group 2). All group 2 and 54% of group 1 patients (98 of 183) had a prior biopsy negative for cancer.
  
  
  RESULTS
  Median prostate specific antigen was higher in group 2 than in group 1 patients (11.5 versus 9.5 ng./ml., p = 0.016). Overall a 33% increase (36 of 110 patients) in cancer detection was observed when biopsy technique included the alternate areas (p = 0.0021). The anterior horn was the most frequently positive biopsy site followed by the transition zone and midline sites. The 11-core technique had significantly better cancer detection rates when digital rectal examination and transrectal ultrasound were normal, and in men with serum prostate specific antigen between 4.1 and 10 ng./ml.
  
  
  CONCLUSIONS
  Biopsies of the alternate sites suggested by our simulation studies are feasible and reproducible. This new strategy significantly enhanced (p = 0.0075) prostate cancer detection compared to conventional sextant biopsies in men undergoing a repeat procedure.
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston 77030-4095, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Babaian
authors.forename: A
authors.initials: A
authors.lastname: Toi
authors.forename: K
authors.initials: K
authors.lastname: Kamoi
authors.forename: P
authors.initials: P
authors.lastname: Troncoso
authors.forename: J
authors.initials: J
authors.lastname: Sweet
authors.forename: R
authors.initials: R
authors.lastname: Evans
authors.forename: D
authors.initials: D
authors.lastname: Johnston
authors.forename: M
authors.initials: M
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography